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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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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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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At least that’s the message from top researchers who wanted to set the record straight.

Let’s lay the groundwork. Three top researchers (as labeled by the press release) wanted to correct the inaccuracies and misunderstandings about high fructose corn syrup and it’s impact on the American diet.

At the Institute of Food Technologists annual meeting, a session entitled “High Fructose Corn Syrup: Sorting Myth from Reality” was held to set the record straight.

The first quote is telling.

Contrary to its name, high fructose corn syrup is essentially a corn sugar, stated sweetener expert John S. White, Ph.D., president of White Technical Research. "Recent marketing claims that sugar is healthier than high fructose corn syrup are misleading to consumers.

Yeah, sort of like saying stabbing myself with a big knife will hurt more than with a small knife. I can read the headlines already. “Leading researchers have discovered that stabbing yourself with a smaller knife causes less pain.” Somehow the whole wound thing gets completely ignored.

It’s convenient for them to gloss over the influence of HFCS (and sugar) in heart disease and a whole host of metabolic disorders, which happen to have coincided with an approximately 20% increase in fructose consumption from 1970 to 2007. Yikes, that’s a big knife!

After a few more mundane quotes aligning the similarities between sugar and HFCS, we get to the meat of the special session and press release.

This is a marketing issue, not a metabolic issue," stated David Klurfeld, Ph.D., national program leader for human nutrition in USDA’s Agricultural Research Service and editor of the June 2009 Journal of Nutrition supplement, "The State of the Science on Dietary Sweeteners Containing Fructose," in response to recent reformulations by manufacturers of products that once contained high fructose corn syrup. "The real issue is not high fructose corn syrup. It’s that we’ve forgotten what a real serving size is. We have to eat less of everything," he noted.

And there you have it…a marketing issue. It’s not about whether people are confused. In fact, these people are confused. They start with marketing and end with just eat less of everything. Can we apply that eating less mantra to HFCS?

It seems more like an act of desperation. Remember the Corn Refiners HFCS commercials? Here’s one and two.  And I don’t think people are confused. Here’s a list of HFCS spoofs on youtube. Accurate and funny.

To strengthen my hypothesis, I looked through the exhibitor list of the IFT annual meeting. I sorted by nutritive sweeteners and featured exhibitors. Here’s what I found (it’s an interactive database, so not sure results will come up properly – select featured exhibitors and nutritive sweeteners from the ingredient list). It’s pretty populated, showing a large number of nutritive sweetener exhibitors (somewhere between 40 and 50%). There’s also some overlap between featured exhibitors, sponsors and manufacturers of nutritive sweeteners. I’ll just say it’s pretty interesting…

What’s next, a special session on soy eggs? I produce plenty of estrogen, thank you very much.

Brian

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CSPI has released their 2009 Xtreme eating awards. The press release is here and their website announcement is here. 

Should I laugh? Should I cry? Or should I get pissed off? There hasn’t been much sleep this week, pissed off is leading down the stretch. 

CSPI does not have the public interest at heart (watch the first video).  They think you can’t make a decision on your own. You’re too dumb to decide, so they should decide for you.

This whole idea that I, you or anyone else will suddenly change our mind on what to order at the counter when presented with caloric content is silly. And to blame restaurants and fast food on obesity is further destruction of personal responsibility.

And I’m not so sure McDonald’s is responsible. Sure, there’s Spurlock and Supersize Me. But there are major issues with Spurlock, which I won’t completely detail here but he has refused to show his food logs – raising questions on the 5,000 daily caloric intake.

Next, he gained 10 pounds in one week. If the obesity argument is all about calories in versus calories out, how do you explain that? That’s an extra 35,000 calories in one week. That’s an extra 5,000 calories per day, with emphasis on extra! So if we take him at his word, that he was eating 5,000 calories per day, where does this extra fit in?

Which brings me back to CSPI and their Xtreme awards. If they really stood by their name – Center for Science in the Public Interest, they would promote what we’ve learned from science and not personal dogma. Science has taught us a significant reduction, if not complete elimination of bad carbohydrates from the body leads to a multitude of positive health benefits.

Now that I got that off my chest, it was a photo finish and feeling better won by a nose.

Brian

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So glad you asked!

There are many ways to effectively lose weight, some better than others. But for most of us, at least according to this study, your plan should have some accountability.

The study compared formal weight loss programs (diet and exercise only) to those that had a meeting/group component included, which they referred to as dietary counseling. Weekly meetings helped participants understand what their bodies were going through, how to deal with setbacks and learning to live a new lifestyle.

Those in the counseling group lost 10-15 pounds and kept it off for approximately 1 year, significantly greater weight loss and long-term success than diet and exercise alone. Now I know what you are thinking, only 10-15 pounds? I want/need to lose 25, 50 pounds or more. That’s not the point. The point is they lost weight and kept it off for a year.

If you need to lose more and participate in a program that only helps you lose 15, is that failure? I think it’s a darn good success story and gives you all the confidence you need to keep going.

Again, the main point is that they lost weight!

But why?

It’s the social support aspect of the dietary counseling. When you have weekly meetings, you’re more likely to stick with the program. Encouragement from others within the group builds confidence. These meetings also have someone participate that’s “been there, done that.” Their experience alone is invaluable. Finally, should you ever miss a meeting, someone will be there to ask you why. If your excuse is lame, the guilt alone can be enough to get you over a hurdle.

Back to the title of the post. Is this the best way to lose weight? On an individual basis, maybe – maybe not. For most people, weekly meetings (counseling, inspiration, motivation – however you want to label them) work extremely well for long-term success.

Remember, losing weight and then gaining it back is not the ultimate. Keeping it off is.

Have you been in a program like this? What are your thoughts? Have you tried, tried and tried to lose weight, only to have a little success and then fall back to the old habits?

We can help. First, sign up for our fitness center newsletter BSFC Monthly. It’s absolutely free and comes with nice bonus gifts for signing up. Plus, each month it’s loaded with all sorts of good information on fitness, diet, health and exercise.

If you live in Houston or pass through the SW part of town on a regular basis, our Fit Heart Membership is just the ticket for you. The benefits, amenities and services associated with this membership are absolutely second to none!

Until next time, break a sweat today and eat some fruits and vegetables!

Dr. Brian

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Potential New Target For Type 2 Diabetes Found By Penn Researchers

“We hope that drug companies will look for new ways to modify fat metabolism in type 2 diabetics using these possible targets.”

Big Pharma dovetails quite nicely with the tertiary nature of our health care system. You don’t visit the doctor before you get sick. Type II diabetes and most chronic cardiovascular conditions are almost completely related to lifestyle. Eat a diet high in nutrient deficient, highly processed foods, do very little physical activity and it doesn’t take a rocket scientist to predict glucose metabolic problems in your future.

But the purpose of this post is to shed light on the dependence of federal research monies on Big Pharma. The quote above is taken directly from the article and shows that perfectly. It’s as if researchers using federal money are directing the research focus of Big Pharma.

Why do we need more or different drugs when a perfectly acceptable solution is available? Why can’t there be a quote like this directed at lifestyle change? It is a perfectly acceptable solution.

I closed a previous post by asking if I was being cynical, maybe I am.

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As a former academic (and fully aware of the importance of scientific publications), there are times when I scratch my head and wonder, “Federal dollars were spent on this!”

In nearly all cases, outcomes are predictable within an expected range. It’s called the scientific method. With no desire to get into a discussion of the scientific method, a recent study looked at the role of diet on recovery from colon cancer.

You can read the summary. Here is the first paragraph:
“Patients with stage III colon cancer who have undergone surgery and chemotherapy with the goal of cure may have a higher risk of relapsing and dying early if they follow a predominantly “Western” diet of red meat, fatty foods, refined grains, and desserts, according to research led by investigators at Dana-Farber Cancer Institute in Boston.”

As I read this summary, all I could think was, “What type of diet do you think got them there in the first place?” I’m sure this research was needed somewhere, after all, if a study doen’st prove it, how do you know it’s true.

But there is some good news…we know now the answer to the question and a “prudent” diet has made some headlines.

Am I just being cynical?

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“Scientists in Indiana are reporting progress toward development of low glycemic and slowly digestible starch, a form of starch that would be less apt to cause the spike in blood sugar – and perhaps sharp hunger pangs – that many individuals experience after eating bread, baked goods, and other high-carbohydrate foods.”

The rest of the summary can be read here.

My only question is why?

I can understand the need for people to consume healthier foods – particularly than those listed in the quote above. But what if we just ate less of that food and more fruits and vegetables, healthier meats and drank more water? What if we just ate grains as they grow in the field?

Look in your pantry. Foods in plastic bags and carboard boxes are loaded with things that used to be good, healthy foods. Take enriched white flour for example. Out in the field, its a perfectly healthy and natural food.

To end up as a cake, bread or other food, it gets processed. The problem with processing is that it removes the good stuff, mainly the fiber, vitamins and minerals. As the end-product food stuff, it’s a plain-old, bland, quickly digesting starch.

Now, based on the objectives of these scientists, a new, more slowly digesting starch is being manufactured. And they’re making progress. I don’t know if I should jump for joy or just ask the question: “What is wrong with this picture?”

If we have a perfectly healthy food, process it and turn it into something that is not good for our digestive system, why do we want to further alter it so that it is better for our digestive system? Before you answer, think about the steps being taken to make the food better.

Is this coming full circle or am I just missing something completely obvious here? Please enlighten me!

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