We haven't posted in a while because we really had nothing meaty. We've been busy at work, in cruise control, maintaining steady weight on LCHF. Been thinking of some post ideas for the site but nothing seemed compelling enough. Today, going through my email I found a link to the American Heart Association's Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association published April 22, 2021. There is so much food for thought here (pun intended). The article starts out by recapping that there is an obesity epidemic and that, "Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders." They describe abdominal obesity (visceral fat) and it's correlation with increased CV risk and recommend reduction as a prevention strategy. One strategy is exercise which does reduce visceral fat even without weight loss. The authors acknowledge the role of insulin resistance and inflammation in children and young adults with early atherosclerosis. Yet despite all this, there is no good evidence thus far that medical weight loss has demonstrated a clear reduction in CAD. Bariatric surgery, on the other hand does have some evidence. We'll get to why in short order. Physical activity also increases insulin sensitivity. The statement goes on to summarize the evidence for the role of obesity in Heart Failure (HF), sudden cardiac death (SCD) and atrial fibrillation (AF). In fact, obesity may account for up to 1/5 of AF. The more the BMI is up, the greater the risk. There are benefits to weight loss shown for HF and AF.
Ourlowcarb Take: This scientific article is over 16 pages, well written and researched. The role of lifestyle interventions and the Mediterranean Diet are mentioned for further investigation. Unfortunately, they stop short of fixing the root cause. What do hypertension, increased waist circumference, atherogenic dyslipidemia, and glucose intolerance all have in common? METABOLIC SYNDROME! Bariatric surgery works not only because of weight loss, but because it can normalize insulin resistance in a matter of days to weeks. What else has been shown to reduce insulin resistance to such as degree, and improve almost every metabolic marker of risk? Why, its our old friend and purpose of this site, the #LCHF #NSNG lifestyle. This article is a good start, but leaves us hungry for more interventions. It's good to see the AHA coming around and acknowledging the role of metabolic health, now let's see some more options given to patients other than expensive pharmaceuticals.
Endnote: Powell-Wiley TM, Poirier P, Burke LE, Després J-P, Gordon-Larsen P, Lavie CJ, Lear SA, Ndumele CE, Neeland IJ, Sanders P, St-Onge M-P; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143:e•••–e•••. doi: 10.1161/CIR.0000000000000973.
We highly recommend you read this thought provoking opinion piece by one of the leading researchers in the field, David S. Ludwig M.D., Harvard professor. Nicely outlines why conventional paradigms may not have worked.
We have been recommending Avocado Oil as one of our healthy fats for a while. Unfortunately we now have to give a "buyer beware" disclaimer on most retail avocado oils. This study by UC Davis outlines testing they conducted on store bought and online purchases of variouss brands of oils. They found that 82% were either cut or substituted with other oils, such as soybean (which we do not recommend) or were rancid before their expiration date. Only two of 22 brands tested met their standards for purity and freshness. Those were Chosen or Marianne's BTW. For the time being, either stick with those brands if you can find them, or avoid entirely.
You will hear us talk a lot about Intermittent Fasting or Time Restricted eating if you follow this site. One of the first vocal proponents of IF is Dr. Jason Fung. Recent studies have validated this concept beyond just weight loss as published last December in the New England Journal of Medicine. Benefits begin from 10 to 18 hours. How are we to know just what is optimal? Most of us agree that 14-16 hours is the minimum. This week on High Intensity Health's YouTube channel, a recently published study in Cell Metabolism looked at eating windows of 4 versus 6 hours (18 versus 20 hours). There really was no difference between the two groups, but surprisingly, the 4 hour window group lost less muscle. Note: This loss of muscle was insignificant and as long as you are getting adequate protein intake you should not be worried about losing muscle mass with IF. The benefits to metabolic health far outweigh this concern.
Last month, another study came out in JAMA that did not show expected benefits in a 16 hour daily fasting protocol. We'll have a separate post soon dissecting this one.
This study published July 22 by Ludwig, et al, in the Journal of the American Heart Association randomized groups and supplied a years worth of beverages. One group received sugary drinks, another an artificially sweetened drink, and the remainder all unsweetened drinks. They then compared the groups metabolic responses. Not surprisingly, " Among individuals with central adiposity, replacing SSBs with either ASBs or USBs had a favorable effect on body weight and adiposity, consistent with prior findings." Those with the most trunk fat gained more in the sugar drinking group compared with the artificial and unsweetened. There was a difference in taste sensitivity to sweets in the unsweetened group, which those of us doing keto have experienced. Overall, if you still are suffering with some belly fat, probably from insulin resistance, artificially sweetened beverages may be an alternative if you can't stay with unsweetened drinks.
Many articles have come out recently that are earth shattering to the diet-heart hypothesis. One, Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions Published in the British Journal of Sports Medicine, this article reviews the pathogenesis of atherosclerotic plaques and the inflammatory conditions necessary to progress to rupture (heart attack). These are inflammation and insulin resistance. RCT's of dietary interventions show no relationship with saturated fat consumption. Simple ways to reduce insulin resistance and inflammation are discussed and referenced. in the coming weeks, we will present information on LCHF approaches in Alzheimer's research and cancer treatment, stay tuned!
I had a little extra time today and a few links came across my timelines. First is a short video by Dr Ted Naiman on Personal Fat Threshold This is a good, concise explanation about how we proliferate fat cells and some genetic differences that affect that process and a very brief introduction to his PE diet
When I got started with NSNG and LCHF one of the first things that came out was the recommendation to avoid all seed and vegetable oils and stick with healthier oils such as olive oil, avocado oil, and coconut oil. While I subscribe to the carbohydrate-insulin model of obesity, there are others who feel as strongly about the damage done by processed oils. Here is a good YouTube presentation by Dr Chris Knobbe, an ophthalmologist and founder of Cure AMD. He was recently featured also on Ivor Cummings Fat Emperor podcast
I had a chance today to purchase and view Extra Time Movie This was made by Donal O'Neill who made a film in 2013 called Cereal Killers which is available on Dietdoctor.com. Extra Time was sponsored by the Irish Heart Disease Association and chronicles Irish Footballers later in life. These formerly peak athletes were screened for CAD using coronary calcium scores (a 5 minute CT scan I have done as well) with some surprising results. Other than this Yank having a hard time with some thick Irish accents it is well worth the rental price. I also became a fan of Irish Football!
Two days ago on Medscape I came across this article from Circulation "Coconut Oil and Heart Health: Fact or Fiction?" Within the first couple of paragraphs I was cringing about some of the mis-characterizations. The author, Frank M Sacks M.D., reviewed a meta-analysis which concludes "that coconut oil significantly increased plasma LDL cholesterol and high-density lipoprotein (HDL) cholesterol, and had no effect on triglycerides, body weight, body fat, and markers of glycemia and inflammation in comparison with nontropical vegetable oils." The author proceeds to describe the composition and characteristics of coconut oil. He goes on to conclude, "In culinary practice, coconut oil should not be used as a regular cooking oil, although it can be used sparingly for flavor or texture." There are so many wrong things to unpack in this article in a short daily briefing that I can not go into it all. While technically, this may be true, it totally misrepresents the fact that association of high LDL with CVD does not mean causation. In addition, he ignores the fact that it also raises HDL, which is probably more of a protective factor. He is ignoring the three major trials of saturated fats vs. low-fat diets that failed to show any difference in outcomes such as the Sydney Diet Heart Study, and the Women's Health Initiative that we have already discussed in our daily briefing. Furthermore, in 2013, the AHA and the American College of Cardiology acknowledged that there was no scientific evidence for limiting dietary cholesterol. The final nail in this reviewer's opinion dovetails into the discussion of the next article in Medscape describing dietary saturated fat effects in the body.
This review on Metabolic Disease: Is It the Fat, Sugar, or Processed Food? from June 18th highlights three presentations including one from Sarah Hallberg D.O., Medical Director Virta Health, who presented a study showing that "that dietary and plasma saturated fat are not related." She presented further studies outlining that "a low-carbohydrate diet, despite being higher in saturated fat, decreases circulating saturated fatty acids, and that dietary carbohydrate restriction improved metabolic syndrome independent of weight loss." Dr Caroline Apovian, M.D. concluded, "Low-carb, high-fat diets are healthy for the cardiovascular system and do not increase diabetes risk. Patients should be able to enjoy saturated fat in the diet as long as simple carbohydrate is minimized, and this should maintain good serum lipid levels." The key point here is that this is in the setting of a low carbohydrate diet.
So there you have it. Two articles from the same well respected medical website within a few days with totally conflicting information, and more importantly, conclusions. So by all means enjoy your coconut oil, and your saturated fats. Just do so in the setting of low carbohydrate healthy fat nutrition!
My Twitter feed blew up last night from the #LCHF community. The uproar was about the proposed U.S. dietary guidelines, which completely ignore a myriad of studies supporting #LCHF. The day before was the last day to comment and I and many others signed letters urging the committee to acknowledge low carbohydrate approaches. Indeed, they in their infinite wisdom are still recommending limiting saturated fats despite all evidence to the contrary. Why is this happening? Follow the money, like everything else in Washington, D.C. When the committee is stacked with doctors and representatives for such companies such as Coca Cola, Nestle, and Monsanto who have an interest in selling us sugar and grains, this is the result. A sad commentary on the state of nutritional affairs. Check out Nina Teicholz's feed for great information on this travesty.
I have not had time to post many daily briefings in the past 10 days due to a new full time clinical position, but rest assured I am still getting my reading in, listening to podcasts, and scouring the internet for useful tidbits. I am currently reading the Fatburn Fix by Catherine Shanahan, M.D., so far so good, and I will publish a full review soon
Today i was doing some site update and I was adding to the definition section on the FAQ page. I was adding the definition of metabolic syndrome which comprises 5 criteria, three of which are needed to diagnose. Simply put, these are fasting glucose >100, waist circumference >40 in men, 35 in women; Systolic BP >130 and diastolic >85.; Triglycerides >150 mg/dl and low HDl <40 mg/dl in men or 50 mg/dl in women. I wanted to link some sites for the reader to find out more, but the first two I looked at from a respected medical news site and a heart organization both contained good definitions, but erroneous diet information to limit fats and saturated fats, and eating more fruits and whole grains. We recently did a post on fructose, and will do one soon on starches such as in grains. Both contribute to the development of insulin resistance and most of the parameters of metabolic syndrome. In addition, several major studies such as the Sydney Diet Heart Study and the Minnesota Diet Heart study have failed to prove a link between saturated fat consumption and CVD. In the latter, this data was buried for many years because the researchers were disappointed in the outcome. The very famous Women's Health Study buried similar findings in the fine print after over 600 pages. So I will refer the reader to this post on metabolic syndrome on Dietdoctor.com
I haven't done a daily brief in a few days due to finishing up my EM position on Memorial Day weekend, but I came across this little blurb today:
ROUND NUMBERS: Americans are devouring pizza in lockdown. In the eight weeks starting March 23, Domino's comparable-store sales jumped 16%. That trend accelerated the longer people were shut in. In the final three weeks of that period, sales spiked 22%, the company said Wednesday. It was the same story at Papa John's, where same-store sales rocketed 27% between March 30 and April 26, and 33.5% through the end of May.
Copyright 2020 The Associated Press. All rights reserved.
As many had predicted, and I have seen in many of my various low carb forums, due to the stress and anxiety provoked by the COVID-19, more of us are making unhealthy choices. I get it; pizza used to be one of my drugs. After a particularly hard block of stressful ER shifts, I could polish off most of a large pizza solo. Obviously for me and many others this leads to unhealthy consequences. So understand those cravings, and make healthy choices! #NSNG #LCHF
I have been working EM shifts this weekend and last night I had a little downtime and decided to continue watching Hunters on Amazon Prime. What does this have to do with LCHF nutrition? Read on (Spoiler Alerts) In Episode 8, set in circa 1977, the Nazi Hunters were torturing a Nazi Scientist about their plot to destroy America's lower class by putting a substance in foods and "everything." What was this substance? CORN SYRUP! After I got done laughing, it occurred to me that this wasn't as far-fetched as it sounds. Many of us consider High Fructose corn syrup as injurious to the metabolism. There is only one organ which can metabolize fructose; the liver. Some is converted to glucose, some stored as glycogen, and the rest converted to lactate, triglycerides or lipids. This is believed to be the major driver of NAFLD (non-alcoholic fatty liver disease) and visceral obesity. It is currently estimated that between 35-45% of Americans eating a SAD diet are metabolically unhealthy. The percentage may be as high as 88% in older adults. These are the folks getting the brunt of COVID-19 complications currently. Bottom line, although this episode was based on fiction, they were not wrong about the effects on the body. We'd urge you to ditch the corn syrup. Read food labels as you would not believe how many packaged foods contain added corn syrup. If it has it, keep moving along.
Update: In episode 10 they clarified the bad guys were putting a virus in the corn syrup. Corn syrup by itself will still do you in, it just takes longer
There has been a lot in the news lately about Vit D and COVID-19. Ivor Cummins has had a few recent episodes on the Fat Emperor Podcast about this subject highlighting that if you are Vit D deficient you are 10x more likely to die from the coronavirus. Today on Medscape there was another review on the subject. We're here to give you the TLDR! If you have normal Vitamin D levels, you are good, but one study in the UK showed a 12% decrease in respiratory infections with people supplementing with Vitamin D, which was 70% if you were Vitamin D deficient already. So, what should you do? Get 15-30 minutes of sun daily, preferably at times when you can cast a shadow meaning that the harmful UV rays are lessened, eat foods high in Vit D and consider a supplement with 1000-2000 IU of vitamin D. Stay healthy!
Today's post is in honor of the first question submitted to the website. They wanted to know how to encourage a significant other to get involved in reducing high carbohydrate diet as they thought this would make the other partner feel better. Well, this is a delicate topic and needs to be approached carefully. It is akin to approaching someone about other habits such as drinking. We would recommend it coming from a place of concern, and a little education to plant the seeds. Ultimately, the person needs to come to their own conclusions. I became involved in LCHF nutrition for weight loss goals, but over the course of my personal investigations I have learned there is much data to suggest many other benefits. It along with fasting can reverse long-standing type 2 Diabetes. It can prevent metabolic syndrome from blossoming into frank DM or worsening risks of CAD, stroke or hypertension. Ketogenic diets have been used for years to treat seizures successfully. There is improvement in mood and many cases of intractable depression have been markedly improved. Some authorities consider Alzheimer's as the "third" type of diabetes. Inflammation is markedly reduced in many people. Joint pain is markedly reduced in many people, including myself. So how does this person get involved? The first step would be to just markedly reduce processed foods, refined sugars and flours. Next step is to have a metabolic assessment done with a history taken and few basic labs and measurements to begin a customized plan. I have highlighted several reference sites, books, films and other resources on our Resources Tab.
Yesterday I reviewed an article from the Nutrition Network regarding risk of morbidity and mortality from COVID-19. Of the top risk factors what do they have in common? Poor metabolic health and insulin resistance. The article is well written by Dr. Mark Cuccuzella, a Hospitalist in WV who has done some very interesting work in the low carb field with hospitalized patients. I strongly urge you read the article.
Watching the news the last few days, I spotted an ad for GOLO. Intrigued because the commercial referenced insulin levels and insulin resistance as drivers of weight gain, and their plan addresses that. Unfortunately, when I went to their website to research the program, it really is just a supplement called Release that they are selling for 30-50 dollars a bottle. The only things I can recommend in it are berberine, Mg, and chromium, all of which you can pretty much find anywhere. You can do the low carb program for free with all of the free references available online. Our take? Save the money and spend it on good quality foods
Jane and I watched Fat Fiction, a new documentary now available on Amazon. This is a very well made film about the obesity epidemic and the dietary guidelines which have caused so much harm over the years. It methodically covers the history and (bad) science behind the low fat dietary recommendations and showcases the results of a low carbohydrate, high fat approach in treating obesity and type 2 DM. Well worth the watch.
On today's commute, I listened to Dr Bret Scher's Diet Doctor Podcast with Audra Wilford. This was a very inspiring interview about the Max Love Project started after her son was diagnosed with brain CA. The Project is focused on Nutrition, wellness, and family support. I would highly recommend this one.