Here in the United States we are confronted with a lot of choices on what to eat, and making the right choice can be difficult to say the least. Sometimes it seems that there are "forces" fighting against us, and those roadblocks give rise to a lot of conspiracy theories and provide fodder for us to react out of fear instead of using good judgement. I definitely saw some fodder for fear in this blog post that popped up in my facebook feed.
The author does start out with some grim statistics about our health, and does actually provide a link to the article. One of the things I found interesting, however, is that while the author of the blog post focuses solely on diet, the authors of the linked article point to a multitude of factors that influence our health, including smoking, not wearing seat belts, limited access to health care, etc. Sure, diet plays a role, but to use those set of statistics and then only point to diet is not evidence based at all. On a related note, she also talks about how the main problem in Holmes County, MO is a lack of nutrition education. There might be a contributing factor, although we don't know for sure without some more information. I will throw my own anecdote in here and say that if lack of education was the only problem, then all of my patients would be slim with no health problems at all (pardon the sarcsam). Sure, people do need to know what to look for on labels, but they also need the desire to want to change their habits, the funds to purchase the food, the cooking skills to prepare healthy food, access to healthier choices, etc. I wish we could point to purely one thing (aka diet) as the solution to all our health/longevity issues, but it's more complicated than that. I also wish that education was the only thing needed to get all of us healthier, but there needs to be more support involved.
There is also an implication that the "Big Food" companies are all trying to kill us. Since we supposedly are in a free-market economy, the companies are trying to make money, and they will use whatever techniques they can to do so. Because of this, I can see the case for claiming "apathy" about the health of Americans, but are they out to get us? Maybe not. I don't agree with a lot of techniques personally, but I don't know why they are a surprised to anyone or why there was some sort of expectation that these big companies were suppossed to "lead" the discussion on healthy foods? I think there is definitely value in "voting with our dollars" to change what they make and sell (opinion), but we also going to have to make it a money issue for change to happen. I also don't think that "it was banned in other countries" is an evidence based argument, particularly when there are drugs (like Tylenol with Codeine) that are available elsewhere but not in the United States. It should give us pause, but it's not an evidence based argument.
As far as the ingredients that are used here vs. overseas, I find it interesting that she is pointing the finger at these mysterious ingredients as the cause of all of our ills, but then chooses to compare our products to ones that are found in the UK. A quick internet search indicates that obesity and type 2 diabetes rates in the UK are actually comparable to the rates in the United States (Link), so we can't point to those ingredients as the main cause just by using those comparison's there. Of the other comments that are made, the only one that she actually has any good evidence for is that hydrogenated oils/trans fats have been implicated in cardiovascular disease and insulin resistance. There just isn't any good evidence for GMO's, MSG, etc causing problems (1, 2). Even when she talked about the Mayo Clinic claiming that certain food dyes "caused" hyperactivity in children, if you follow the link, their answer is really close to a "we don't really know." In my very limited experience with pediatric nutrition, usually when parents "cut out" all the artificial colors and flavors and claim that they did experience a change in their children's behavior what they were doing was switching from a low nutrition diet (aka inadequate protein/vitamins/minerals) to a much more nutritionally adequate plan. Was it really just the artificial coloring that was doing it, or was it just eating like we are all suppossed to be eating that caused a change? Or was it parents learning to parent differently since their child received a diagnosis? Or was it all of the above? More evidence needed please.
Are any of the convenience/fast foods that were chosen actually healthier without the "red" ingredients, as in, would we want to eat those foods on a regular basis anyway? Probably not, as the foods mentioned didn't really have anything that we need (with the exception of the little bit of fiber in the oatmeal). Everything mentioned was pretty much devoid of nutritional value and a source of un-needed calories and refined carbohydrates. That right there should be enough evidence that we need to limit or avoid those foods, we shouldn't have to start using scare tactics using information that may or may not be true. And if you are like me, you don't want to spend the money on diet sodas, etc that are giving you little to no bang for your buck anyway.
Take home message--Most convenience foods and fast foods are empty calories--foods devoid of nutrition that really provide nothing but a more "convenient" way to get more calories. That should be enough of a reason to limit/avoid them.
Thursday, February 14, 2013
Tuesday, February 12, 2013
A Healthier Cocktail?
If there is one thing we human beings are good at, it's rationalizing our choices, or a process known as cognitive dissonance--we know we shouldn't be doing something but we will do it anyway, and then try to come up with all kinds reasons why our choice was justifiable. And that's what I thought of when I read this article about some restaurants are now creating and marketing "healthier cocktails."
What's wrong with cocktails when drinking alcohol in moderation doesn't seem to be a problem? Well, first of all, not everybody practices moderation, period. Second of all, cocktails by their very nature tend to be empty/un-needed calories that mostly serve to thwart your weight loss efforts instead of helping. Third, if you've got diabetes or one of those insulin-resistant conditions that I am so fond of talking about, you are probably getting way more carbohydrate in those drinks than you might initially suspect, and if you already have wildly swinging blood glucose levels any alcohol might make that worse. Fourth, since people have to do a little more digging to figure out the carb/calorie content of those drinks, it's easier to allow that information to go by the way side when you're concentrating on the nice restaurant that you are at. So, those of us that have done even a little bit of research into why that cocktail may not be so good for us, but still like to have them, might start to do a little rejoicing when you see "healthier cocktail."
Until I come along and ruin it for you. You asked for it by reading my blog.
If you are hoping to save on some calories by consuming some of these cocktails, I don't think your in luck. If I did my calculations correctly, the recipe for the cocktail recipe they gave in the article is still going to run about 150-163 calories, about the same as a can of soda. Granted, that's less than margarita which could run 400 calories plus, but if you have more than one ("It's a healthy cocktail!") it starts to add up. I also noticed that a lot of the cocktails mentioned seemed to have fruit juice, and even if it's "fresh pressed" you are still running the risk of allowing some extra carbohydrate in there. And those cocktails that promise to "boost your immunity?" I've already talked about how that doesn't mean what you think it means. Now you might actually get some antioxidants and other good things by having that beet juice, but you could also just eat the beets, or whatever other vegetable they are putting in there and not get the extra calories.
My suggestion is to first learn to say, "I am drinking a cocktail because I damn well want to." (The choice of "colorful metaphors" is up to you). My other suggestion, if you really are concerned about the calories and carbohydrate is to spend a little time on the internet ahead of time and research which ones have the least amount of carbohydrate and calories, or better yet, just make your own at home so you can control what goes in it. (Boyfriend of SkepticRD makes a damn good whiskey sour with Splenda). And of course, plan ahead of time how much you are going to drink, and maybe even ask a buddy to help you keep it in "moderation."
Take home message--Quit rationalizing and do a little homework before you drink. And enjoy it in a way that you don't regret it later.
What's wrong with cocktails when drinking alcohol in moderation doesn't seem to be a problem? Well, first of all, not everybody practices moderation, period. Second of all, cocktails by their very nature tend to be empty/un-needed calories that mostly serve to thwart your weight loss efforts instead of helping. Third, if you've got diabetes or one of those insulin-resistant conditions that I am so fond of talking about, you are probably getting way more carbohydrate in those drinks than you might initially suspect, and if you already have wildly swinging blood glucose levels any alcohol might make that worse. Fourth, since people have to do a little more digging to figure out the carb/calorie content of those drinks, it's easier to allow that information to go by the way side when you're concentrating on the nice restaurant that you are at. So, those of us that have done even a little bit of research into why that cocktail may not be so good for us, but still like to have them, might start to do a little rejoicing when you see "healthier cocktail."
Until I come along and ruin it for you. You asked for it by reading my blog.
If you are hoping to save on some calories by consuming some of these cocktails, I don't think your in luck. If I did my calculations correctly, the recipe for the cocktail recipe they gave in the article is still going to run about 150-163 calories, about the same as a can of soda. Granted, that's less than margarita which could run 400 calories plus, but if you have more than one ("It's a healthy cocktail!") it starts to add up. I also noticed that a lot of the cocktails mentioned seemed to have fruit juice, and even if it's "fresh pressed" you are still running the risk of allowing some extra carbohydrate in there. And those cocktails that promise to "boost your immunity?" I've already talked about how that doesn't mean what you think it means. Now you might actually get some antioxidants and other good things by having that beet juice, but you could also just eat the beets, or whatever other vegetable they are putting in there and not get the extra calories.
My suggestion is to first learn to say, "I am drinking a cocktail because I damn well want to." (The choice of "colorful metaphors" is up to you). My other suggestion, if you really are concerned about the calories and carbohydrate is to spend a little time on the internet ahead of time and research which ones have the least amount of carbohydrate and calories, or better yet, just make your own at home so you can control what goes in it. (Boyfriend of SkepticRD makes a damn good whiskey sour with Splenda). And of course, plan ahead of time how much you are going to drink, and maybe even ask a buddy to help you keep it in "moderation."
Take home message--Quit rationalizing and do a little homework before you drink. And enjoy it in a way that you don't regret it later.
Monday, February 11, 2013
Pre or Probiotics?
You've probably heard that we have more "bacterial" cells than we have human cells, or some variation of this statement (Link), and this seems to have a decent amount of evidence to back that up. What we are still learning about, however, is how disruptions in what is termed the "microbiome" can impact our health and health indicators like weight. In my news feed I came across one particular article that indicated that pre-biotics could help in the "battle" against obesity. But what are prebiotics?
Those of you who have been following this blog for a while probably remember an earlier post on probiotics, and the basic message was that taking probiotics does not change your gut microbiome for the better because your body sees them as foreign objects and tries to get rid of them as fast as possible (the exception being that it does seem to help anti-biotic related diarrhea if probiotics are started at the same time as the anti-biotics). Pre-biotics, on the other hand, actually help the growth of beneficial bacteria that is already there. Think of the beneficial bacteria in your gut as potted plants and pre-biotics as a type of "plant food" such as Miracle Grow. We don't know yet if changing your gut flora will actually help you lose weight (i.e. change the way you absorb nutrition/calories from food), but it certainly doesn't seem to hurt to keep growing the good stuff.
Now, one of the problems that I have whenever prebiotics are mentioned is that someone is usually trying to sell me a supplement of some kind, similar to the way people try to sell me other vitamin supplements. There are foods that have prebiotics in them, and they are usually plant based. (I liked this quote from, oddly enough, Wikipedia, which states "Referring to a food as "a prebiotic" is no more accurate than calling a food 'a vitamin'.") Usually if you try to eat a variety of vegetables (aim for as many different kinds of vegetables as you can) you will increase your pre-biotic intake, and these particular vegetables (jerusalem artichokes, asparagus, jicama, red and white onions, leeks, garlic, spinach, dandelion greens and tomatoes) have a somewhat higher content.
For people who tolerate grains and legumes you can also get pre-biotics from these foods as well, but I would really rather people concentrated on vegetables first. In my experience/in the population I work with (anecdote alert!), people do not check carefully enough to make sure that the bread, etc really is whole grain and they get essentially empty calories and no fermentable fiber. The other problem that I have (and remember, my specialty is diabetes) is that people wind up way overdoing their carbohydrate intake through the use of bread, pasta, cereal, etc even if they were careful to get the whole grain. Same thing with legumes--if you have diabetes or any other insulin-resistant conditions you will carefully have to watch the amount to keep your blood glucose/insulin levels in check. Remember, more at one time is not usually better even if you are eating the "double fiber" bread.
There's one other consideration when it comes to pre-biotics, particularly if you are taking a pre-biotic supplement or eating an pre-biotic supplemented food (Inulin is usually the pre-biotic of choice for supplementation). Pre-biotics are also called "fermentable fibers" and guess what fermentation produces? That's right, it produces flatulence, more commonly called "gas." The internet does have some fairly entertaining stories about the so-called "Jerusalem Fartichokes", but if you don't have pets to blame it on you could be in deep trouble. Even if you can stand the smell (and the noise), if you have IBS, like yours truly, you might find the "gas pains" rather hard to cope with. So, if you are choosing to use a supplement, a high inulin food, or a pre-biotic supplement food, start with very small amounts to see how you tolerate it and/or cook the food well.
Take home message--eating more vegetables and fermentable fiber foods could help change your gut microbiome. Probiotics are of limited use only.
Those of you who have been following this blog for a while probably remember an earlier post on probiotics, and the basic message was that taking probiotics does not change your gut microbiome for the better because your body sees them as foreign objects and tries to get rid of them as fast as possible (the exception being that it does seem to help anti-biotic related diarrhea if probiotics are started at the same time as the anti-biotics). Pre-biotics, on the other hand, actually help the growth of beneficial bacteria that is already there. Think of the beneficial bacteria in your gut as potted plants and pre-biotics as a type of "plant food" such as Miracle Grow. We don't know yet if changing your gut flora will actually help you lose weight (i.e. change the way you absorb nutrition/calories from food), but it certainly doesn't seem to hurt to keep growing the good stuff.
Now, one of the problems that I have whenever prebiotics are mentioned is that someone is usually trying to sell me a supplement of some kind, similar to the way people try to sell me other vitamin supplements. There are foods that have prebiotics in them, and they are usually plant based. (I liked this quote from, oddly enough, Wikipedia, which states "Referring to a food as "a prebiotic" is no more accurate than calling a food 'a vitamin'.") Usually if you try to eat a variety of vegetables (aim for as many different kinds of vegetables as you can) you will increase your pre-biotic intake, and these particular vegetables (jerusalem artichokes, asparagus, jicama, red and white onions, leeks, garlic, spinach, dandelion greens and tomatoes) have a somewhat higher content.
For people who tolerate grains and legumes you can also get pre-biotics from these foods as well, but I would really rather people concentrated on vegetables first. In my experience/in the population I work with (anecdote alert!), people do not check carefully enough to make sure that the bread, etc really is whole grain and they get essentially empty calories and no fermentable fiber. The other problem that I have (and remember, my specialty is diabetes) is that people wind up way overdoing their carbohydrate intake through the use of bread, pasta, cereal, etc even if they were careful to get the whole grain. Same thing with legumes--if you have diabetes or any other insulin-resistant conditions you will carefully have to watch the amount to keep your blood glucose/insulin levels in check. Remember, more at one time is not usually better even if you are eating the "double fiber" bread.
There's one other consideration when it comes to pre-biotics, particularly if you are taking a pre-biotic supplement or eating an pre-biotic supplemented food (Inulin is usually the pre-biotic of choice for supplementation). Pre-biotics are also called "fermentable fibers" and guess what fermentation produces? That's right, it produces flatulence, more commonly called "gas." The internet does have some fairly entertaining stories about the so-called "Jerusalem Fartichokes", but if you don't have pets to blame it on you could be in deep trouble. Even if you can stand the smell (and the noise), if you have IBS, like yours truly, you might find the "gas pains" rather hard to cope with. So, if you are choosing to use a supplement, a high inulin food, or a pre-biotic supplement food, start with very small amounts to see how you tolerate it and/or cook the food well.
Take home message--eating more vegetables and fermentable fiber foods could help change your gut microbiome. Probiotics are of limited use only.
Friday, February 8, 2013
Gluten or Something Else
One question/comment that I get a lot, when I mention that I eat gluten free (and they know I'm a dietitian), is something a long the lines of "Oh, is that healthier?" (meaning that "you eat this way, so it must be better, right?")
As much as I would love to claim myself as the perfect shining example of health, I usually have to say "well, it's more complicated than that." (Most people who know me now realize they will not get a yes or no answer out of me, and some of them even appreciate it! They also realize I'm no more perfect than anyone else). I did come across this blog post in the NYT the other day, however, that does give a pretty good overview of what we do and do not know about gluten, and who is and who is not taking a scientific approach.
We do know that people with true celiac disease do need to avoid gluten if they ever hope to recover a functioning digestive system. People with conditions like dermatitis herpetiformis also must avoid all sources of gluten if they ever want that rash to go away. That's a definite "yes, it's healthier" for people with these conditions. But for some of us it gets a bit murkier. There are no good tests for gluten sensitivity like there are for celiac disease (and even then, people have to make sure they have been on their regular gluten-full diet for at least two weeks for those tests to be accurate). And sometimes people feel better and lose weight when they "gluten-free" simply because their diets got healthier overall. I remember one patient who came to me with dermatitis herpetiformis who did lose about 25-30 pounds after he cut out gluten (he was glad to lose the weight), but since he didn't want to pay for the more expensive gluten free pastas, etc he wound up eating grilled/baked meats, more vegetables, and the occaisional rice/corn tortillas to fill in the gaps. In other words--he had a significant calorie reduction and he started eating higher quality food and found it satisfying. Had he been willing to spend the money on gluten free bread, gluten free pasta, gluten free crackers, etc, I highly doubt he would have seen an improvement. So, if someone winds up cutting out gluten and loses weight, and oh-by-the way I cut way back on my carbohydrate intake and eat more nutrient dense vegetables, maybe it wasn't the gluten.
One of the double blind studies indicated that a gluten free diet seemed to help people with irritable bowel syndrome. (IBS) But, it may not have been the gluten that causes the problems, there are other things found in wheat, namely fructans, that some people have trouble digesting and may cause symptoms. And with the people who claim relief of arthritis when eliminating wheat; once again we only have anecdotal evidence. If someon with arthritis wants to eliminate wheat, and subsequently improves the quality of their diet in other ways, and has a relief of symptoms--if it isn't broken I won't try to fix it, but I can't claim proof at this point.
Now, for those of who do have gastro-intestinal problems like the ones mentioned in the IBS article, please tell your doc so that you can be tested for serious conditions like celiac. If you and your doc do think your GI problems are diet related, the best approach that we have is to follow the Low FODMOPS plan. This particular plan severely limits foods that contain compounds that are poorly absorbed by the body, draw more water into the bowel, and cause "gas" through increased fermntation. You get to follow this diet for 6-8 weeks (hopefully with the help of a qualified person like yours truly!) and see if your symptoms improve. At the end of the six weeks you start adding certain things back in (one at a time!) and see if your symptoms worsen.
One of the other complaints about gluten free diets (besides the expense of gluten free crackers, etc) is that some health care professionals are worried about nutrition deficiencies. I understand their concern--because some people who are eating a lot of processed food just keep eating their processed food, only now they don't even have a little vitamin fortification from whole wheat bread, etc. You have to not just go gluten-free, you actually have to make sure your are getting enough nutrient dense vegetables, protein, and good fat. I also know that some people think that since not all people have genetically adapted to have gluten in our diet that no one should eat it--this sounds like it's based on an assumption that we have stopped evolving/adapting over the past 10,000 years and that doesn't appear to be the case either as some people do seem to be able to eat dairy and grains without an issue.
As much as I would love to claim myself as the perfect shining example of health, I usually have to say "well, it's more complicated than that." (Most people who know me now realize they will not get a yes or no answer out of me, and some of them even appreciate it! They also realize I'm no more perfect than anyone else). I did come across this blog post in the NYT the other day, however, that does give a pretty good overview of what we do and do not know about gluten, and who is and who is not taking a scientific approach.
We do know that people with true celiac disease do need to avoid gluten if they ever hope to recover a functioning digestive system. People with conditions like dermatitis herpetiformis also must avoid all sources of gluten if they ever want that rash to go away. That's a definite "yes, it's healthier" for people with these conditions. But for some of us it gets a bit murkier. There are no good tests for gluten sensitivity like there are for celiac disease (and even then, people have to make sure they have been on their regular gluten-full diet for at least two weeks for those tests to be accurate). And sometimes people feel better and lose weight when they "gluten-free" simply because their diets got healthier overall. I remember one patient who came to me with dermatitis herpetiformis who did lose about 25-30 pounds after he cut out gluten (he was glad to lose the weight), but since he didn't want to pay for the more expensive gluten free pastas, etc he wound up eating grilled/baked meats, more vegetables, and the occaisional rice/corn tortillas to fill in the gaps. In other words--he had a significant calorie reduction and he started eating higher quality food and found it satisfying. Had he been willing to spend the money on gluten free bread, gluten free pasta, gluten free crackers, etc, I highly doubt he would have seen an improvement. So, if someone winds up cutting out gluten and loses weight, and oh-by-the way I cut way back on my carbohydrate intake and eat more nutrient dense vegetables, maybe it wasn't the gluten.
One of the double blind studies indicated that a gluten free diet seemed to help people with irritable bowel syndrome. (IBS) But, it may not have been the gluten that causes the problems, there are other things found in wheat, namely fructans, that some people have trouble digesting and may cause symptoms. And with the people who claim relief of arthritis when eliminating wheat; once again we only have anecdotal evidence. If someon with arthritis wants to eliminate wheat, and subsequently improves the quality of their diet in other ways, and has a relief of symptoms--if it isn't broken I won't try to fix it, but I can't claim proof at this point.
Now, for those of who do have gastro-intestinal problems like the ones mentioned in the IBS article, please tell your doc so that you can be tested for serious conditions like celiac. If you and your doc do think your GI problems are diet related, the best approach that we have is to follow the Low FODMOPS plan. This particular plan severely limits foods that contain compounds that are poorly absorbed by the body, draw more water into the bowel, and cause "gas" through increased fermntation. You get to follow this diet for 6-8 weeks (hopefully with the help of a qualified person like yours truly!) and see if your symptoms improve. At the end of the six weeks you start adding certain things back in (one at a time!) and see if your symptoms worsen.
One of the other complaints about gluten free diets (besides the expense of gluten free crackers, etc) is that some health care professionals are worried about nutrition deficiencies. I understand their concern--because some people who are eating a lot of processed food just keep eating their processed food, only now they don't even have a little vitamin fortification from whole wheat bread, etc. You have to not just go gluten-free, you actually have to make sure your are getting enough nutrient dense vegetables, protein, and good fat. I also know that some people think that since not all people have genetically adapted to have gluten in our diet that no one should eat it--this sounds like it's based on an assumption that we have stopped evolving/adapting over the past 10,000 years and that doesn't appear to be the case either as some people do seem to be able to eat dairy and grains without an issue.
Take home message--If you have GI complaints and/or a weird rash that won't go away, talk to your doctor about the possibility of getting tested for celiac disease (particularly if these are in your family history). If all other problems are ruled out and your doc labels you with IBS, you can try an elimination diet to see if your symptoms improve. If you know you are overeating on bread, pasta, etc and having trouble losing weight, you are going to benefit from limiting the processed food period.
Tuesday, February 5, 2013
Pickles and Garlic?
People have a lot of interesting ideas about what will raise or lower their blood glucose levels. The other day I was dealing with a particularly trying individual whose blood glucose levels were so high his glucometer (blood glucose measuring device) would only read "HI," meaning that his readings were over 600. This is the point where I as a medical professional plead with the person to go to the hospital as he is risking dehydration and death, but he was agreeable to increasing his insulin dose slowly day by day to get his readings under control.* He also said he was going to start "eating pickles and garlic to bring my sugar down, just like my daddy said."
*I'm sure there are some people who are going to read that line and start accusing me of just wanting to give people medicine instead of going the "natural route." First of all, in a situation like this one--having a person just change their diet to lower their blood glucose levels is the equivalent of standing over someone who is having a heart attack and saying "Dude, you really need to eat more vegetables" instead of dialing 911 and/or performing CPR. Second of all, people have to actually FOLLOW a reduced carb meal plan to lower their blood glucose and this guy was clear he knew all about it and wasn't going to do it anyway.
Anyway, I've heard the pickles and/or garlic myth before, and I think I have a pretty good handle on where that might have come from. As far as the pickles go--if you have someone who has been eating a lot of salty tasting snacks like potato chips or pretzels, and they substitutes pickles, they have just went from a high carbohydrate consumption to a lower carbohydrate consumption and the removal of the all of that carbohydrate probably is what helped. Nothing magic about the pickles. Now, interestingly enough, there is some limited evidence that regular consumption of vinegar (which is in pickles!) might result in lower post meal blood glucose levels (Link); but we certainly don't know if a steady dose of pickles after your dose of potato chips will continually control your blood glucose.
Garlic is a different story in that there seems to be no evidence that eating garlic or using it as a supplement will actually help lower your blood glucose. (Link) Now, once again, some people will just eat garlic as is, and other people are probably going to use it as a flavoring on their meats or vegetables. If using garlic as a flavoring helps you eat more vegetables and less carbohydrate, by all means add the garlic, but don't expect it to magically bring your blood sugar down.
Take home message--substituting pickles and garlic on vegetables for high carb snacks and high starch meals could help keep your blood sugar from going to high, but it won't bring it down if it's already high.
*I'm sure there are some people who are going to read that line and start accusing me of just wanting to give people medicine instead of going the "natural route." First of all, in a situation like this one--having a person just change their diet to lower their blood glucose levels is the equivalent of standing over someone who is having a heart attack and saying "Dude, you really need to eat more vegetables" instead of dialing 911 and/or performing CPR. Second of all, people have to actually FOLLOW a reduced carb meal plan to lower their blood glucose and this guy was clear he knew all about it and wasn't going to do it anyway.
Anyway, I've heard the pickles and/or garlic myth before, and I think I have a pretty good handle on where that might have come from. As far as the pickles go--if you have someone who has been eating a lot of salty tasting snacks like potato chips or pretzels, and they substitutes pickles, they have just went from a high carbohydrate consumption to a lower carbohydrate consumption and the removal of the all of that carbohydrate probably is what helped. Nothing magic about the pickles. Now, interestingly enough, there is some limited evidence that regular consumption of vinegar (which is in pickles!) might result in lower post meal blood glucose levels (Link); but we certainly don't know if a steady dose of pickles after your dose of potato chips will continually control your blood glucose.
Garlic is a different story in that there seems to be no evidence that eating garlic or using it as a supplement will actually help lower your blood glucose. (Link) Now, once again, some people will just eat garlic as is, and other people are probably going to use it as a flavoring on their meats or vegetables. If using garlic as a flavoring helps you eat more vegetables and less carbohydrate, by all means add the garlic, but don't expect it to magically bring your blood sugar down.
Take home message--substituting pickles and garlic on vegetables for high carb snacks and high starch meals could help keep your blood sugar from going to high, but it won't bring it down if it's already high.
Monday, February 4, 2013
Obesity Mythology
I'm feeling a little bit happier about nutrition reporting today, and it's because I saw this article: Myths of Weight Loss are Plentiful and read this first paragraph:
"If schools reinstated physical education classes, a lot of fat children would lose weight. And they might never have gotten fat in the first place if their mothers had just breast fed them when they were babies. But be warned: obese people should definitely steer clear of crash diets. And they can lose more than 50 pounds in five years simply by walking a mile a day."
I was happy because it indicated someone else is trying to dispel myths and not trying to sell you his/her own mythology. And I was happy that there was a link to the actual article itself so that people could compare what was actually said versus what was reported on (Link), as sometimes they are not the same thing. And I also liked that one of the authors of the study admitted that everyone is vulnerable to logical fallacies, including confirmation bias, if we are not careful. It gave me hope that there are still people who are good at communicating their skepticality out there.
One potential pitfall that I did see in reading the orginal article, however, is that people would look at one of the points (e.g. the one on school physical education programs not preventing obesity) and conclude that these behaviors have no value at all. We have to remember that the authors of the study were looking at obesity, period, and that we can't say "school physical education programs have no value at all." In other words, just because a particular behavior or program can't help with one thing doesn't mean that it is not useful at all, it just needs to be studied from another angle or other outcomes need to be looked at.
I also wanted to highlight this statement in the conclusion as well: "While we work to generate additional useful knowledge, we may in some cases justifiably move forward with hypothesized, but not proved, strategies. However, as a scientific community, we must always be open and honest with the public about the state of our knowledge and should rigorously evaluate unproved strategies." In other words, sometimes we do have to move forward using what we know while acknowledging there is always someone out there working for a better designed study to improve our knowledge, because that's what we do in science. And we all have to continually stop and re-evaluate where our own biases might be.
"If schools reinstated physical education classes, a lot of fat children would lose weight. And they might never have gotten fat in the first place if their mothers had just breast fed them when they were babies. But be warned: obese people should definitely steer clear of crash diets. And they can lose more than 50 pounds in five years simply by walking a mile a day."
I was happy because it indicated someone else is trying to dispel myths and not trying to sell you his/her own mythology. And I was happy that there was a link to the actual article itself so that people could compare what was actually said versus what was reported on (Link), as sometimes they are not the same thing. And I also liked that one of the authors of the study admitted that everyone is vulnerable to logical fallacies, including confirmation bias, if we are not careful. It gave me hope that there are still people who are good at communicating their skepticality out there.
One potential pitfall that I did see in reading the orginal article, however, is that people would look at one of the points (e.g. the one on school physical education programs not preventing obesity) and conclude that these behaviors have no value at all. We have to remember that the authors of the study were looking at obesity, period, and that we can't say "school physical education programs have no value at all." In other words, just because a particular behavior or program can't help with one thing doesn't mean that it is not useful at all, it just needs to be studied from another angle or other outcomes need to be looked at.
I also wanted to highlight this statement in the conclusion as well: "While we work to generate additional useful knowledge, we may in some cases justifiably move forward with hypothesized, but not proved, strategies. However, as a scientific community, we must always be open and honest with the public about the state of our knowledge and should rigorously evaluate unproved strategies." In other words, sometimes we do have to move forward using what we know while acknowledging there is always someone out there working for a better designed study to improve our knowledge, because that's what we do in science. And we all have to continually stop and re-evaluate where our own biases might be.
Friday, February 1, 2013
Dude, where's my Pancreas?
I suppose on some level I should be grateful for celebrities, because without them I would have less blog material. Like the story this week on Ashton Kutcher's hospitalization and the subsequent commentary that went along with it. Let's look at what's wrong with this story, shall we?
First of all, we don't know by reading this article, or anywhere else, what he really had. The only indicators that he gives is the abdominal pain and his "pancreas levels were out of whack." I think that he might be referring to the levels of "pancreatic enzymes" perhaps? So, quite possibly, given his abdominal pain and elevated pancreatic enzymes it is quite possible he had pancreatitis, but we don't really know as we are not privy to the rest of his medical history. And even if we had all of that, you can't just diagnose because you read something on the internet.
Second of all we have the logical fallacy of "post hoc ergo propter hoc" or "after this, therefore because of this." In other words, he went on a crazy diet, had problems, therefore it must be part of the diet. Once again, we don't know all of the information about Mr. Kutcher's medical history, what other food/beverages he might have been injesting (or not injesting) before/during his all-fruit diet, what (if any) medications he was taking, what (if any) herbal products he was using, what his lab work really was like, etc. So we can't assume that whatever he had was exactly a direct cause of the diet.
Third, let's pretend for a moment that he did really have acute pancreatitis. Could the "all fruit diet" actually cause pancreatitis? The quote from the dietitian referenced in the CNN article almost implied that it could, but that is highly unlikely (and she might have been misquoted anyway). Yes, your pancreas does produce insulin, and yes when you are eating a lot of carbohydrate your pancreas will make more insulin (the pancreas also does other things like produces enzymes to help us digest fat). But if hyperinsulinemia (aka. over production of insulin) caused pancreatitis, then everyone with pre-diabetes and early stage Type 2 would have acute pancreatitis. Pancreatitis is usually caused by gall-bladder problems or chronic alcohol use. Some people have had acute pancreatitis because of having triglycerides over 1000 mg/dL (although you are considered at risk if they are >500 mg/dL), and high triglycerides can result from elevated insulin levels (although usually at that level we also have some genetic disorder and/or medication reactions to thank for that)--so I suppose you could stretch it to say that he might have had elevated triglycerides. But once again--that's just a leap, we don't have all the information.
So, yes, a diet that consists only of fruit can cause other problems--mainly a lack of protein and essential fats. Was the diet the cause of the illness of the star of "Dude, Where's My Car?" Probably not, but once again, we don't have all the info. And if you take medical advice from a celebrity? You probably need more help than I can give you. And that "mucusless" diet that Steve Jobs was following? That is another post for another day.....
First of all, we don't know by reading this article, or anywhere else, what he really had. The only indicators that he gives is the abdominal pain and his "pancreas levels were out of whack." I think that he might be referring to the levels of "pancreatic enzymes" perhaps? So, quite possibly, given his abdominal pain and elevated pancreatic enzymes it is quite possible he had pancreatitis, but we don't really know as we are not privy to the rest of his medical history. And even if we had all of that, you can't just diagnose because you read something on the internet.
Second of all we have the logical fallacy of "post hoc ergo propter hoc" or "after this, therefore because of this." In other words, he went on a crazy diet, had problems, therefore it must be part of the diet. Once again, we don't know all of the information about Mr. Kutcher's medical history, what other food/beverages he might have been injesting (or not injesting) before/during his all-fruit diet, what (if any) medications he was taking, what (if any) herbal products he was using, what his lab work really was like, etc. So we can't assume that whatever he had was exactly a direct cause of the diet.
Third, let's pretend for a moment that he did really have acute pancreatitis. Could the "all fruit diet" actually cause pancreatitis? The quote from the dietitian referenced in the CNN article almost implied that it could, but that is highly unlikely (and she might have been misquoted anyway). Yes, your pancreas does produce insulin, and yes when you are eating a lot of carbohydrate your pancreas will make more insulin (the pancreas also does other things like produces enzymes to help us digest fat). But if hyperinsulinemia (aka. over production of insulin) caused pancreatitis, then everyone with pre-diabetes and early stage Type 2 would have acute pancreatitis. Pancreatitis is usually caused by gall-bladder problems or chronic alcohol use. Some people have had acute pancreatitis because of having triglycerides over 1000 mg/dL (although you are considered at risk if they are >500 mg/dL), and high triglycerides can result from elevated insulin levels (although usually at that level we also have some genetic disorder and/or medication reactions to thank for that)--so I suppose you could stretch it to say that he might have had elevated triglycerides. But once again--that's just a leap, we don't have all the information.
So, yes, a diet that consists only of fruit can cause other problems--mainly a lack of protein and essential fats. Was the diet the cause of the illness of the star of "Dude, Where's My Car?" Probably not, but once again, we don't have all the info. And if you take medical advice from a celebrity? You probably need more help than I can give you. And that "mucusless" diet that Steve Jobs was following? That is another post for another day.....
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