Dr. Sekula on weight loss, fitness and nutrition

On March 10, 2010, the Medical Wellness Association sponsored a Medical Wellness and Nutrition forum as part of the IHRSA convention in San Diego. As an aside, Sunny San Diego? Are you kidding me? It was sunny, but, man, was it cold! The wind was blowing. Hard. Felt it to my bones. Probably not cold to someone from Minnesota, but to a Texas boy it was. And can you do something about the homeless people? The only place I’ve been where it was worse was downtown Baltimore.

So back to the forum. There were four speakers (including me), each presenting on a topic related to nutrition and wellness. I think the forum was well-received. I listened to all presentations and only one other excited me. Amy Blansit works with obese people in Missouri and she gets it. Her presentation was excellent and she’s doing a bang-up job. The other talks seemed rather fluffy.

In order to gain more attention, I badly titled my talk: “How to increase revenue with weight loss programs.” IHRSA is not the most scientifically rigorous organization. A more appropriate, but boring, title would have been: “Misapplication of the energy balance equation.” That was the focus of my talk, but no one would have attended. I spent nearly half of the two hours building this up and why weight loss programs fail (or, the misapplication idea).

For more on this, check out Dr. Eades’ blog, Protein Power, more specifically, this recent post. You can also read this post by Robert McLeod on energy balance, it’s at the bottom of the post.

The gist of the talk centered on the pervasive notion of eat less, exercise more. For overweight and obese, hyperinsulinemia equals metabolic domination, efficiency at fat storage and feeble efforts in fat mobilization. Simply eating less does not fix this and leads to failure.

Oh, and before you chime in with ASP, leptin and all the others, don’t bother. ASP is a toothpick to the bat of insulin. While the research on leptin and leptin resistance is fascinating, I have yet to work with someone where it was a problem. I know it’s there, somewhere, and I know it exists. Just haven’t run across it in my day-to-day business.

You can also view the presentation at slideshare.net.  Don’t know why, but the embed code has jacked up the first slide. It’s normal at slideshare. Below the presentation are links to a reference list and white paper.

Click here to download the references.

Click here to download the white paper. Note: I can’t find my white paper. It’s somewhere on my laptop. I’ll hunt it down and post the link in the next day or so. 

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Jeff Garlin, co-star and executive producer of Curb Your Enthusiasm, has written a memoir about his lifelong struggles with weight. In an interview for ABC news, Garlin talks about his addiction to food and his new diet. You can read the interview and watch a video here.

This is sad. Really sad. He said he’d eat and eat and eat and never feel full. Stand-bys included gourmet sandwiches, pop-tarts and Cap-n-Crunch cereal. In the video, he talks about donuts and milkshakes. Also, knowing that a single donut or any sugar-filled food would send him over the top, meant these foods were forbidden and that moderation was not possible.

He alluded to his lifelong struggle with weight. Although not prominent, I’m sure there were never-ending attempts to lose weight. Well-wishers like Larry David, his wife and others, I’m sure, encouraged him to lose weight. I’ve never met a person that was overweight who didn’t want to lose weight. Really, I’ve never known an overweight person that hasn’t tried every diet under the sun.

At age 37, he suffered a stroke. At his heaviest, he weighed 320 pounds. Through various changes he’s down to the upper 260’s. I’ll talk about those changes in a second. 

So what’s going on? What’s the problem? Why can’t Jeff Garlin, et al just buckle down and lose weight? The answer lies in the ubiquitous message of energy balance. Accordingly, you can eat what you want, just eat less and the weight will disappear. Not in Jeff Garlin’s case.

Despite the fact he’d eat a half-dozen donuts and a milkshake, he was never full. He talks about stopping at In-N-Out Burger on the way home from work to get two double cheeseburgers because dinner at home would not be enough. He also mentions the ability to eat an entire pizza and wash it down with five boxes of instant pudding, topped off with graham cracker crust. I wouldn’t be surprised if that didn’t fill him up, either. 

The problem with the energy balance equation is that it assumes we can simply restrict calories and lose weight. Completely ignoring the real issue, insulin, of which Mr. Garlin could not be a more perfect example

As Gary Taubes eloquently pointed out in Good Calories, Bad Calories, hyperinsulinemia  drives fat storage and dictates cellular starvation, regardless of food intake. This is spelled out specifically in Chapter 22, The Carbohydrate Hypothesis. More specifically, on page 399 (paperback), he discusses the role of lipoprotein lipase (LPL) and fat storage. As insulin levels rise, triglycerides are preferentially stored in adipose tissue.

During caloric restriction (as I’m sure Mr. Garlin tried, you know, eat less, exercise more?), weight loss becomes more difficult and even problematic. Fewer calories lead to decreased muscle mass and smaller organs (brain and kidneys, for example), in the face of hyperinsulinemia. It’s a feedback loop, driven by insulin, that works to maintain body fat levels, even in the face of decreased organ systems.

So Jeff Garlin likely went on a typical diet of eat less, without changing the types of food he ate. Since his insulin levels were still high, it only made him hungry. Probably hungry as hell. And he could only hold on for so long.

One thing those foods will do is elevate insulin. All that glucose has to go somewhere. I’m sure he Jeff wasn’t exercising. Even if he was, there’s no way in Hades he was depleting his glycogen stores, so that glucose went somewhere. It got converted to fat and stored.

All of this brings me back to his new approach. I wish him well, but I have my reservations. Here’s what he’s doing. He meditates daily, 5:30am. He cut out sugar, fast-food and binge-eating. He doesn’t eat salt, chicken, turkey, red meat or ham, although he does still eat fish. He eats fruit, vegetables and whole grains. “It’s all very boring,” he says. Giving up sugar was, “really, really hard.”

He’s done pretty well. Lost about 50 pounds. Gave up sugar, salt and most forms of protein and he meditates. I think he’s been successful so far because of sugar elimination. I have no idea how much sugar he was eating, but with milkshakes, pizza, cereal and donuts, it had to be a boatload. I’m guessing 400-500 grams, minimum.

The problem I see, however, is the whole grains and fruit. His insulin is down, which helps the cravings. For the long run, however, it’s not down enough. He’ll find caloric balance soon and will get stuck, probably several pounds away from his goal weight. Then what? Probably try to eat less, again.

What will be the culprit then?

*Photo courtesy of abcnews.com.

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I recently had a meeting at a local coffee shop (Starbucks, is there anything else?). I was on time. My counterpart was stuck in traffic. After getting my drink of choice (Venti, half-caff), I picked up the Starbucks menu.

As I scanned the menu, I noticed a large number of items I would never consider… Let’s take a look. 

First of all, the menu is overwhelming. I’ve been countless times but never picked up or even unfolded it. Printed on a sheet of 10×18 in. paper, with four columns of choices, it’s loaded with drink choices. As far as I can tell, there are 218 items. With a choices of “Things to add or leave out” section, the choices are practically infinite.

So what did I find? A whopping 156 out of 218 drinks contain at least 25 grams of carbohydrate. That’s 72%. You will be happy to know that my Venti half-caff checked in with zero.

The worst offenders? Where should I start…at 72%, it ran the gamut. As far as hot drinks go, the worst offenders were White Chocolate Mocha, Espresso Truffle, Hot Chocolate, Signature Hot Chocolate, Caramel Apple Spice and Tazo Green Tea. Carb counts ranged from 25 to 94 grams per drink. All of these without whipped cream. Add that and you can figure up to 3 grams of sugar, depending on the size of your drink.

The Venti Caramel Apple Spice is the culprit checking in with 94 grams. That’s 22 teaspoons of sugar. As an aside, could you sit down and eat 22 teaspoons of sugar? Overall, 68% of the hot beverages checked in as FAILS. Your best bets, any plain Coffee, short, tall and grande Classic Espressos, any Caffe Americano, any Cappuccino, and any size plain Tazo tea. All check in at under 25 grams (still too much for me, but hey, you gotta draw the line somewhere). There are a couple of others here and there, but you get the idea.

Good luck with the cold drinks, where 81% have more carbohydrate than you can shake a stick at. Frappuccino’s were the worst. The winner? How about a Tazo Green Tea Blended Creme Frappuccino (without whipped cream, of course)…it only has 111 grams. Double Chocolate Chip and Vanilla Bean came a close 2nd and 3rd, with 104 and 100 grams, respectively. The Pancreatic Hammer Trio is what they really need to be called. 

Looks like Starbucks created their menu using the food guide pyramid. The drinks follow the blueprint: low in fat, high in carbohydrate. I’m just waiting for the barista to offer me a bagel or low-fat muffin with my coffee…oh wait, never mind.  I guess paying better attention is in order.

Why hasn’t the guy from CSPI (scroll down to the guy from CSPI) gone after Starbucks? He’s gone after Coke, McDonalds and everything in between. Why not Starbucks? As far as I can tell, Coca-Cola and Starbucks are pandering the same things.

Oh wait…I think I know. People at Starbucks are smart enough to know the difference. They don’t need someone like Jacobsen forcing calorie counts on the wall, like those who frequent McDonalds. 

So there you have it, you are smarter, at least now, for going to Starbucks. Just stick with plain coffee (fully caffeinated or not). Your pancreas will thank you.

Any Starbucks drink stories you care to add?

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In the last post, I detailed the 10 books I read last year. Here’s a list of books I intend to read this year. As stated, the goal is 11 books. The list contains nine, leaving two spots open. There are two reasons for this. One, it’s early and something is bound to come out I’ll want to read. Two, now that the Mitch Rapp series is complete, they will be hard to ignore.  

The Power of Less by Leo Babauta. In a world full of clutter, how is less more? Already skimmed through. Suits my style perfectly. To the point. Practical and a quick read.

4HWW-Expanded and Updated by Tim Ferris. This one is next. Can’t wait to get started. Should be in it before January is over.

Lone Survivor by Marcus Luttrell. Reading it now. After all I’ve heard, very excited to get this book. The sole Navy SEAL survivor of a mission gone bad in Afghanistan. In case you didn’t know, SEALS are badasses.

The Covenant of the Wild by Stephen Budiansky. From the back cover, Animal-rights extremists argue that eating meat is murder and that pets are slaves. … shows domestication of animals is not an act of exploitation but a brilliantly successful evolutionary strategy. Sounds like my kind of book.

The Blind Side by Michael Lewis. Because I’m in love with Sandra Bullock and I’d rather read the book than watch the movie. Plus I love me some football.

Memorial Day and Consent to Kill by Vince Flynn. No explanation needed. 

Living Life in the Zone by Kyle Rote and Joe Pettigrew. A book for men on being a better Christian.

The Vegetarian Myth by Lierre Keith. After all I’ve heard and read about this book, I feel like I’ve read it. Sadly, that is not the case. But it won’t be for long.

So there you have it. The books I read last year and what I’m going to read this year. When the open slots get filled, I’ll let you know. What are you going to read this year?

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I”m not one for New Year’s Resolutions. Don’t know why. Never have been. But most people want to lose weight or start exercising more at this time of year. Those great and I help people do this all day, but I also like to read. Books, magazines, newspapers, journals, anything, really. Not much for the pop culture type stuff, something that will keep me involved (Mitch Rapp series) or teach me something (Eades, Ferris, Taubes) is my preference.

In the spirit of New Year’s Resolutions, I decided to post a list of books I read last year, with a brief review. My resolution this year is to read at least one more book than last. In the next post, I’ll put a list of books I intend to read this year.

Books that I read last year…

Good Calories, Bad Calories, Gary Taubes. It was my 3rd time through. Each time feels like the first. I’ll read it again this year. 

Beating Cancer with Nutrition, Patrick Quillin. Thorough book on dietary practices and cancer with a focus on food and supplements. If your approach is to do all you can,  Beating Cancer with Nutrition is the book you need. 

4HWW, Tim Ferriss. I read this book in 3, maybe 4 days. It was a fast, entertaining and educational read. Read it while in Mexico last year. Karma?

In Defense of Food, Michael Pollan. After two failed attempts, finally forced myself to read it. The message is good. The writing style, not so much. Too many words. Too many long sentences. I thought Pollan was a journalist? 

Outliers, Malcolm Gladwell. Bill Gates is just lucky, I guess. The 10,000 hour rule lives!

Training Camp, Jon Gordon. A book on the importance of hard work and the desire to succeed.

23 Minutes in Hell, Bill Weise. If you’re a Christian and have questions about Hell, read this book. It will change a lot (if not everything), that’s all I’m going to say. 

The 3rd Option, Separation of Power and Executive Power by Vince Flynn, from the Mitch Rapp series. If CIA secret spy stuff is your game, this series was written for you. Mitch Rapp is a terrorist and bad politician killing machine. Is bad politician redundant?

That’s the list of books, all 10 of them. I didn’t mention blog posts and journal articles. Like I said, my objective is to read 11 books this year, which will be detailed in the next post. The list already has 9 books. One little rule: it won’t count if I’ve already read it. 

What did you read last year and what is on your list for this year? Give me some ideas for the remaining spots.

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We interrupt our regularly scheduled programming (Top 10 non-generic and generic prescription drugs) to bring you this, what appears to be a concerted effort on the part of Big Pharma to keep their precious statins high on the list of prescribed drugs. (can you blame them? Between Lipitor and Simvistatin you’re looking at 109.2 million prescriptions and $7.4 billion in sales per year!).

In case you haven’t heard, statins and big pharma took it on the chin in a new study from the Journal of the American College of Cardiology. The results showed niacin was significantly more effective at reducing carotid artery plaque than statins alone. In fact, results showed plaque continuing to grow in the statins only group while regressing in the niacin group. I’m not going to detail the study and author’s conclusions, Dr. Eades has done a wonderful job of that.

I’m not even going to get into whether or not reducing LDL prevents heart attacks. I’m taking a different approach.

Now, a normal thinking individual might conclude niacin as a better alternative to statins in preventing cardiovascular disease. Such as Dr. William Davis over at the Heart Scan blog. He’s not really normal thinking, more like forward thinking (WAY forward compared to his colleagues) and he’s been banging on statins and tooting the niacin horn for a while.

What really has me perturbed is a concerted effort to keep precious statins at the top of the prescription list. For example, a Google news search today (11/20/09) showed 800+ stories on the search term: statin+niacin. Scrolling through the headlines of those on the first page, you see phrases like, “Vitamin B niacin offers no extra benefit to statin therapy,” “Niacin may not help arteries,” “No benefit for statin patients,” and on and on.

Another example is this, a press release published November 20, 2009, which relates study details showing an approximate 1/3 drop in “bad” cholesterol levels in the US from 1999 to 2006 (study abstract here). The last sentence in the first paragraph sums it up nicely,

“But a high percentage of adults still are not being screened or treated for high cholesterol levels.” 

I’m not sure what they mean by high. As you’ll see in my next post, about 1 in 2 adults in the US are taking a statin. You would think this one-third drop would be cause for celebration, and it is among the statins crowd. But while there is a significant drop in the number of cardiovascular-related deaths, incidence hasn’t decreased.

So the question isn’t whether or not statins work. They reduce LDL cholesterol but they don’t reduce the incidence of heart disease. So why take them? Why prescribe them? It’s like the statinators and policy makers can’t see the forest for the trees.

The unfortunate (for them) news on the effectiveness of niacin, the quick-to-the-table message parroted by the media, that the incidence of cardiovascular disease has not decreased and the $7.4 billion cash cow of statins is enough to make one skeptical, or disgusted.

Your thoughts?

This post is part of the Kathleen Show, Prevention not Rx.

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In last weeks post I detailed the Top 10 prescription drugs for the US in 2008. And since I was half-way through before realizing it was non-generic only, I decided to complete it and follow up with this one.

In a follow-up post I’m going to get into the metrics a little more, comparing generic and non-generic.

Let me preface the descriptive nature of this post by saying it’s amazing we prescribe drugs at this rate. I knew we took too many prescription drugs. I knew we were too dependent on them. But actually looking at this data and what it says sheds light on the extent of the problem, which is why I’m writing a follow-up. So on with this one…

Forty percent of non-generic drugs are related, one way or another, to hyperinsulinemia. For generic drugs, it’s 50% and for the same conditions – metabolic syndrome. Table 1 shows Top 10 Generic Drugs by number of prescriptions (millions). Additionally, the table also shows total sales (billions) and rank (in parentheses).

Table 1. Top 10 Generic Drugs in US for 2008.

Metabolic Syndrome Fab 5

The 50% of drugs related to metabolic syndrome (italicized in table) account for 258.1 million (or 44%) of prescriptions and $3.3 billion (or 40%) of retail sales. Chew on that for a moment…258.1 million prescriptions related to hyperinsulinemia, which is 25.1 (edit: 21.5 – operator error) million prescriptions and $270 million in retail sales per month.

Think anyone’s interested in keeping that kind of cash flowing? Do I have to ask?

Furthermore, these dollars are only a small part of the direct costs. No estimates for other direct or indirect costs are included.

Pretty disgusting, actually.

I mentioned last week that cognitive dissonance was to blame. I’m not so sure anymore. In my opinion, what we’re seeing here is nothing short of disgusting. There is plenty of research showing most of these problems can be fixed with simple changes in diet and exercise. Yet those recommendations aren’t coming. The ADA, for example, thinks type 2 diabetics need to eat 45-60 grams of carbs at each meal! It’s like telling someone with lung cancer that it’s okay to smoke one cigarette a day. Statinators are blind or on the dole. American Heart still spouts the low-fat dogma that has blinded all of them.

The more I think about it and the more I write about it, the more disgusted I get. What I need is a good laugh.

This post is part of the Kathleen Show, Prevention not Rx.

References (both are pdf documents)

1. 2008 Top 200 generic drugs by total prescriptions

2. 2008 Top 200 generic drugs by retail dollars

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Most people I work with are significantly overweight – average weight > 300 pounds. As you might expect, all have a cluster of metabolic disorders. Coincident with their condition,  they take a laundry list of prescription medications. In general the lists are nearly identical and include prescriptions for hypertension, diabetes, cholesterol and digestive disorders.

Given this, I assumed their laundry list was similar to that of the general public. So I went looking for the top 10 prescription drugs of 2008 to see if my thoughts would be confirmed.

Finding the Data.
I scoured the FDA website and could find nothing (for some reason, I thought the organization in charge of controlling this industry might track this stuff – go figure). I decided to contact them by phone and the person I spoke with (after about 3 minutes of menu clicks – seriously), directed me to drugtopics.com – here is their about page.

Table 1 shows information for 2008 (1), including the top 10 prescriptions, the number of prescriptions (millions) and retail sales (in billions) (2). Note: the list is for non-generic drugs only. Additionally, drugtopics.com separates their publications by top prescriptions and top selling. Table 1 is a combination of the two. The Sales column includes rank information.

 Table 1. Top 10 Prescribed Drugs in 2008.

Confirmation and Surprise.

So what was the confirmation? Cholesterol, hypertensive and digestive (GERD) disorder medications occupy spots #1, 2, 7 and 10 (italicized in table). They represent 110.2 million prescriptions and $15.3 billion in retail sales. It’s 40% of the top 10, 45% of all prescriptions and 49% of total retail sales. Lipitor by itself is 20% of all prescriptions and 19% of all retail sales for those in the top 10!

What surprised me? For starters, no diabetes drug in the top 10. Actos was the highest rated and it was 18th, with 12.5 million prescriptions. The $2.4 billion in sales would have been good enough for 10th on the sales list. This piqued my curiosity and led to another visit to drugtopics.com.

Thankfully they track prescriptions and sales of generic drugs too. Guess what was in the top 10? I’ll give you a hint. It starts with “M” and ends with “M.” This list too is dominated similarly and I’m working on a follow-up post.

My thoughts…

Insulin resistance is big business in this country, playing a small or large role in nearly all of these on the list. And the Standard American Diet (SAD) is being pushed down our throats by so many factions, I don’t even know which way is up sometimes.

With all the healthcare debate going on, it’s amazing to me those in charge can’t see what’s right under their noses. I’m blaming cognitive dissonance and the powerful sugar, corn and wheat lobbies.

My advice, trash the food guide pyramid. Ignore nearly all advice from registered dieticians and your doctor – they’re part of the cognitive dissonance crowd. Eat quality protein and healthy fats (including naturally saturated ones) at every meal, along with vegetables and exercise vigorously 2-3 days per week. That and keeping your stress levels down will go a long way to keep you from being on this list.

This post is part of the Kathleen Show, Prevention not Rx.

References (both are pdf documents).

1. 2008 Top 200 branded drugs by total prescriptions.

2. 2008 Top 200 branded drugs by retail dollars.

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Can the insanity of listening to celebrities ever stop? Are they ever right about anything?

Why is it news when Paul McCartney and Yoko Ono (and a bunch of other, pasty looking pseudo-celebrities) attempt to create a free yourself from meat day? Jeez, if giving up meat (even for one day) would bring me closer to looking like them, I’d put beef jerky in my socks.

And why are they the experts on “climate change?” I’ll bet they were consulted on the name change too, huh? As a perfect display on her understanding of the situation, Yoko provided this brilliant piece of evidence…

Give up one day and then it will be two days maybe. It’s a very, very intelligent idea.”

Very intelligent, indeed.

Sounds about as intelligent as the lady in the video (not identified, although she sounds like a nutritionist).

Cutting your meat consumption in half would be better for the climate than cutting your car use in half.

She looks like a vegetarian – too many carbs! (if you know what I mean)

Hey, I have an idea. Why don’t I start walking or riding my bike everywhere and doubling my meat consumption? All that extra activity will require more protein, gotta rebuild that tissue – and as I said before, I’m not not putting soy in my body.

I’ll let Paul and all the other men eat soy. Then I’ll put them in contact with Kramer – they’re gonna need some of these.

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Some random links on cholesterol and diabetes. They arrived in my daily research update and I’ve found them interesting. Interesting in that most of the treatments focus on a big pharma approach when simply dietary changes will work just as well.

So without further adieu, here are the ones I found most interesting…

• Could it be they’re targeting the wrong LDL particles? After all, statin therapy doesn’t care and the lipophobes certainly don’t. But according to this study from JAMA, lowering your LDL-C doesn’t necessarily reduce your risk of MI. Go figure. They seem a bit confused and hell-bent on finding a prophylactic treatment. I’ll do a full post on this article next week.
• And yet they’re told fructose is okay in moderation. Could it be all the fructose in their diet leads to liver problems? Why not tell them to control their carbohydrate intake and eliminate fructose (HFCS, specifically – see this post)? Oh no, that wouldn’t be prudent. That doesn’t fit with our ability to prescribe medicine.
• More backpedaling on the ACCORD trial. The mess that is the ACCORD trial has been discussed by Dr. Eades. It amazes me that aggressive behavior entails more intense prophylactic treatment. Could it be the danger arose from the prophylactic cocktails? Why not? Intensive HbA1C control through diet works extremely well and there is no cocktail effect.
• Red wine is good for you? What? No Glevlivet or Anejo. I’ll take a glass or two after a long week!

So there you have it. A few research updates.

Next week I’ll do a full review of the JAMA article.

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