Fat and Always Hungry? No, cutting the carbs won't cure your weight struggle.

It’s 10 AM Sunday and quite frankly, I’d much prefer to be leisurely finishing my coffee after my blueberry pancakes-topped with a dollop of vanilla yogurt and heated real maple syrup. But Ludwig and Friedman’s Always Hungry? Here’s Why piece in the NY Times  today compelled me away from my plate.

To start, let’s get a title change, please, let’s say Here’s What We Think based on virtually no research at all. This is an opinion piece stating two doctors’ theories about why we get fat and what we should do about it. Period. But with the sensational image and title you, like most people, will be drawn into more myths about weight management.

Here’s where we agree—and disagree

Do you just eat bread for your meal?

Agree: There are factors outside of your control that may contribute to your size. Genetics and the presence of fat cells exert their influence. Once you have gained to a higher weight with an increase in fat cells, you will be fighting an uphill battle to lose that weight and keep it off—without disordered behaviors.  And it’s not your fault. For more on this see Professor Lowe’s work on weight suppression and bulimia. 

Agree: Metabolic rate slows down with food restriction—that’s indisputable from the research. Obese individuals who have undergone extreme low calorie diets will have a lower metabolic rate as a result of the decrease in muscle mass that results, compared to same weight controls who had not dieted. Less aggressive approaches to dietary activity change tend to spare the muscle loss and help maintain metabolic rate.

Before dieting...

But the authors state that metabolic rate also decreases with weight increase:  “…factors in the environment have triggered fat cells in our bodies to take in and store excessive amounts of glucose and other calorie-rich compounds. Since fewer calories are available to fuel metabolism, the brain tells the body to increase calorie intake (we feel hungry) and save energy (our metabolism slows down).” Yet there appears to be few examples of this cited in the scientific literature, with the exception of a possible rare genetic mutation, not likely the cause of obesity in the greater population.

And the temporary slowed metabolic rate seen with weight loss has been demonstrated to be reversed with weight restoration in the obese (albeit a small sample size studied) and more dramatically in those who are underweight with anorexia, summarized well by Carrie Arnold in ED Bites.  In practice we see dramatic increases in metabolic rate—calories burned and required each day—with weight gain in anorexic individuals at least until they have restored to their healthy state.

Agree: Insulin increases nutrient uptake and in excess causes weight gain. And carbohydrate results in an increase in insulin secretion.

Disagree: Ludwig and Friedman’s leap that foods that increase insulin secretion should therefore be reduced or avoided for weight management is faulty reasoning—unless there is a documented underlying metabolic abnormality. A relatively small percentage of the total population has PCOS or hyperinsulinemia—a faulty regulation of insulin. For these individuals, addressing carbohydrate amount or glycemic load (impact of a food on raising blood sugar) has a positive impact. But there’s no evidence that a low carbohydrate diet is any better at long-term weight management than any other dietary intervention. 

In addition, while individual foods and their glycemic index—the amount they raise blood sugar (and therefore subsequent insulin levels) may seem valuable, practically speaking they have less impact.  You see, we generally don’t eat single nutrients like carbohydrate. Rather, we eat mixed meals, containing protein, fat and carbohydrate. And in this combination, the impact on insulin levels that even the white potato might have if eaten solo is minimized with that piece of chicken and the added olive oil or nuts in the salad.

This banana chocolate pastry has plenty of fat to lower its glycemic load!
(From Tartine Bakery, San Francisco)

And did you know that many of the villainized desserts have a minimal impact on insulin levels? Peanut M&Ms aren’t much different than lentils (see glycemic load—the best measure of blood sugar impact which considers portion) and cheesecake made in it’s full fat recipe will no doubt come in quite low as well.

I don’t share this to promote a diet full of low nutrient, processed foods. Rather, to make a point. Viewing foods as good and bad will do nothing to help you manage your weight—nor your mental health. In fact, there’s plenty of evidence that feeling deprived by denying yourself foods you enjoy leads to rebound overeating.

The authors also state “what if it’s not overeating that causes us to get fat but the process of getting fatter that causes us to overeat? Unfortunately, I think they have oversimplified their hypothesis.

Sure, having more fat cells may contribute to our struggle if attempting to lose weight. But it’s not simply a macronutrient issue. Being larger presents more challenges for being active; larger individuals report being subjected to fat shaming while exercising—presenting its own challenges.

Rebound binge eating following starvation—think dieting—has been well documented as well. All or nothing thinking—what I call the “what the heck effect” results in overeating when you believe you’ve already blown it.

After...

Our over-scheduled lives with multiple competing needs don’t help us either. Multitasking while eating makes us less aware of what we are consuming and contributes to overeating. And the larger the containers or plates we are eating from, the more we will over-consume (see Prof.Wansink's extensive work on this).

Time and money constraints add flames to the fire—we take little time to plan, shop and eat mindfully. In fact, our cognitive ability is compromised by these stressors and worsened when we diet. Perceiving that we won’t have enough food to meet our wants or needs, referred to as scarcity creates a range of secondary effects. Poor decision making, impaired ability to organize and follow through and hyper-focusing on the immediate benefits without considering the long term consequences of food choices are well researched and described in the fascinating new book, Scarcity.

Unrealistic goals set by national organizations  and by ourselves adds to the problem. If 150 minutes per week plus 2 days of muscle strengthening/wk is unattainable, why bother?

Further, the food industry isn’t all bad. (And no, I am not a paid consultant to any food company!) They are the ones who bring us the convenience of precut and cleaned vegetables and canned, high fiber, low glycemic legumes. They allow us the convenience of reheating frozen brown rice and quick cook barley. And they have given us a range of milks in every fat percentage we could ask for, and yogurts of every style—Greek and higher protein, sweetened, full fat, real sugar, artificial sugar and no added sugar. But many of the choices remain ours.

So what’s the solution to our climbing weights beyond a healthy range?

• Move away from dieting and that sense of scarcity.
• Set realistic goals for change—be it frequency of a home-cooked meal or a visit to the gym.
• Begin to work on behaviors; separate eating from distractions, and delay seconds (see older posts on this blog for help)
• Include a range of foods and nutrients. Include high fiber, whole grains and legumes, fruits and vegetables, nuts and healthy oils; protein-rich foods such as poultry and fish, and less frequently red meat; low fat milk and yogurt and modest amounts of cheese.
• As part of a balanced meal, by all means enjoy your rice, breads and pasta, too. And you know my stand on baked goods! All or nothing approaches to dietary change will get you nowhere.

Thanks for reading and for passing this on via FB, Pinterest, Twitter...

From the Land of Oz: Hillary's Hyman and Detox Diets

Wouldn't you just love to find a cure for your struggles?

Hyman's suggestion that my diet is the reason for my

MS is beyond insulting.

Let’s give a round of applause ladies and gentleman to Dr. Mark Hyman for finding the answer to all of our weight loss troubles! Dr. Mark Hyman’s Book, The Blood Sugar Solution 10-Day Detox Diet: Activate Your Body's Natural Ability to Burn Fat and Lose Weight Fast, is a New York Times bestseller. His book is a guided weight loss and detox program that claims to be the solution in preventing disease, losing weight and reducing insulin levels in just 10 days. His book provides meal plans, recipes, shopping lists, recommended medications, supplements, and more. Written by an MD, there must be truth to his detox diet claims, right?

About that M.D. credential

A Medical Doctor, meaning “teacher of medicine” is an honorable profession that rightfully holds esteem in society. Often times, when you are diagnosed with a condition, such as Type 2 Diabetes, you see a team of clinicians with varying credentials. Understanding what an MD, RD, NP, RN, PA or PhD are and their scope of practice is important to know and understand when it comes to your treatment plan.

In a nutshell, a doctor (MD), assesses the condition, forms a plan and treats the condition. An MD has extensive education in anatomy, biology, physiology, and chemistry and is an expert on injuries, diseases and drug therapy. That being said, a doctor (as well as an NP, RN and PA) has very little education in nutrition and is far from qualified as an expert in nutrition. Unless a doctor is an RD (Registered Dietitian) or has an advanced degree in nutritional science (think PhD), they should not proclaim themselves nutrition experts. Similarly, an RD, an expert in nutrition and dietetics should not prescribe medicine or formulate a plan for surgery as this is outside their scope of practice.

The Tell Tale Signs

So, how do you know if these self-proclaimed “wholistic” MD’s (as Dr. Hyman calls himself) have gone too far? Well, Dr. Mark Hyman produced a perfect example for us to explore.

There are no shortcuts to getting healthy and fit.

The first sign of quackery is the guaranteed “quick fix” that we all secretly want. We hate to be the bearer of bad news, but anytime a doctor (yes, that includes Dr. Oz), or medical professional for that matter, guarantees over 7 lbs of weight loss in 2 weeks without vigorous physical activity, then you may want to assess whether their techniques are safe and can be maintained for the long-term. For reference, the Academy of Nutrition and Dietetics, considers healthy weight loss of ½ -2 lbs. per week with a balanced/portioned diet and regular vigorous physical activity. Even this guidance is quite controversial, as the long term data gives little support that that lost weight is maintainable. Dieting leads to deprivation and long term struggles with rebound over eating and weight gain.

In one of the first pages of Dr. Hyman’s book, he catches eager readers by telling a story of Janet, a 48 year old woman who lost 11 pounds in 10 days by eliminating fish, gluten, dairy, sugar, all grains, beans and legumes, all processed foods, all refined vegetable oils, alcohol and caffeine. Is it not obvious? Of course she lost a ton of weight in a short amount of time, virtually every food group was eliminated! But successful weight management needs to address thoughts and behaviors, so that dietary changes can be maintained. Rigid rules will only lead to failure.  Haven’t we all seen this?

You, on a diet.

The second sign of “wait, this book or treatment plan is a crock” is the all mighty powerful “DETOX”.  According to Dr. Hyman, virtually all foods lead to weight gain and illness, so a 10 day detox is warranted to get rid of decades of food toxins and promote weight loss. Makes sense, right? Well, no. The problem with this, is that our body naturally detoxifies itself. The liver, kidneys and colon filter out toxins and bacteria in the body. Therefore, eliminating essential foods and nutrients for a body cleanse/detox does not make sense at all. The last thing we need is to narrow our selection of foods for no good reason!

What happened to 'an apple a day keeps the doctor away?'

Eliminating whole categories of foods from your diet for weight loss is just absurd. It is not realistic to think you can survive a diet that is limited in variety and nutrients without serious consequences—low energy, increased thoughts and preoccupation, nutritional deficiencies, to name a few. It is also not realistic to think that you will continue to have an abundance of weight loss post “detox” as behavior and dietary changes do not magically occur in 10 days. Further, rebound overeating results from deprivation. This, combined with slowed metabolic rate from your body perceiving starvation will only result in weight regain. 

What Is The Magic Pill?

You're really gonna give these up? Until you lose weight? 

Then what?

We challenge you to realize that there is no cookie-cutter way to treat chronic conditions such as obesity, diabetes and inflammatory conditions as Dr. Hyman suggests. Standards of practice and research-proven methods exist to guide people toward health. And there is individual variation in our calorie and nutrient needs and healthy weight ranges. Self-help/”wholistic”/detox “treatment plans” are damaging—they don’t take into consideration these individual needs nor consider the impact on a person’s medical status as a whole. They offer false hope that if you just follow (this most un-followable plan) you will cure your ills and be happy. 

We challenge you to do your research, recognize what the credentials mean and be cautious of the quackery rules of advice. And by you, we include very intelligent readers who might've been pulled into believing this misinformation--like Bill and Hillary Clinton, who endorse Hyman's sensational promises.

Avoid triggering and false messages from shows like Dr. Oz and books like Dr. Hyman’s. And if it sounds too good to be true, it probably is!

This piece was written primarily by my awesome intern, Lakisha Dubar--with direction and editing by yours truly. Please share your thoughts with us! As always, thanks for reading, and sorry for the long wait--I had to travel to San Francisco for these photos!

Smoking good for your health? Making sense of the new fat and heart disease study.

It was like waking up in Sleeper, the Woody Allen movie, when the main character, asleep for umpteen years, wakes to find that cigarette smoking is good for your health. That’s how I felt some weeks ago after reading the half page article in the NY Times entitled “Study Questions Fat and Heart Disease Link”, based on the recent study by Dr. Chowdhury et al which reviewed more than 70 scientific studies and appears to turn our cholesterol lowering guidelines on its head.

No one is concluding you should be eating more of this.

You, my readers, may have little concern about your heart disease risk. Yet I urge you to keep reading—because unless this news splash is explained, you’ll be left feeling like health professionals just can’t get it right. I mean, one day they say saturated fats are bad, and next day they tell you they don’t impact your risk. Carbs are good, and then they’re bad. Hormone replacement therapy is recommended, and then it’s dangerous. Confronted with so much conflicting information, you, like me, might decide to trust none of it. And health professionals end up looking like a bunch of clowns.

After a deep breath, I poked through the research and sorted through the recommendations. And here’s how I’ve made sense of it so far:

• Saturated fat increases blood cholesterol levels, including LDL, the so-called ‘bad’ cholesterol. Yes, that’s still true.
• LDL does increase heart disease risk. Yup, still the case.
• But reducing saturated fat doesn’t appear to lower heart disease.

So why doesn’t reducing saturated (sat) fat appear to improve risk? There are a few explanations:

Cornbread from Food to Eat and Drop the Diet, 
fits in a balanced diet!

• Because most studies reducing sat fat reduced all fat. And when you reduce all fat something has to fill the void. Our food supply has three main building blocks—protein, carbohydrate and fats. Dramatically reduce one, something else fills the void, as a percentage of total calories. Generally, carbohydrate-rich foods replaced saturated fats in our diets. And the increased carbs tend to come from convenient, more processed, low fiber choices. Now let me clarify—those foods, themselves, as part of a balanced diet, don’t cause disease! But substituting saturated fat with a large intake of these items—rather than, let’s say foods rich in non-saturated fats (think nuts, avocado/guacamole, olive oil) raises another blood fat called triglycerides. And triglycerides increase heart disease risk. So in an effort to do something positive, namely reduce saturated fat to lower LDL/bad cholesterol, we’ve been increasing triglyceride levels. It’s like thinking that eating fat free Snackwell cookies instead of Oreos will make you healthier.

• Harvard professors Willett, Sacks and Stampfer highlight several problems with Chodhury’s study. It fails to point out that substituting polyunsaturated fat for sat fat was associated with lower risk of heart disease. And the monounsaturated fats we usually think about as the healthy ones-those from avocado, nuts and olive oil, for instance—were not the sources referred to when concluding no health benefit from monounsaturated fats. 
• When we combine lots of studies, the summary of the data may block out the small but critical findings. For instance, the authors conclude that  "Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats." And that is surely what the media jumped on. But the truth is that certain unsaturated fats did result in benefits. Specifically, the active components in fatty fish, the omega 3s EPA and DHA were clearly shown to be protective. It's well established that these fatty acids lower triglyceride levels, decrease clot formation, decrease inflammation and act as a blood thinner, among other functions. 

Don't let fatty fish scare you!
Check out our curry salmon recipe in Food to Eat.

• Supplementing with omega 3 fats had no benefit in Chodhury’s study. But here’s what I’d wonder: how consistent were supplementers with taking their supplements? Were doses at levels that really make a difference (most people mistake total omega 3s for the active EPA and DHA we’re looking to boost), and were those supplement takers already at higher risk—like maybe people who had already had heart attacks? Perhaps increasing food sources of omega 3 fatty acids (think salmon, tuna, bluefish, sardines, for instance), displaced saturated fat from other common protein sources, such as beef, pork and poultry, showing that food sources have more impact than simply supplements. Just a thought.

• Lumping saturated fats as a single category misses the differences of various types of saturated fats. Saturated fat from dairy fat, for instance, was not viewed as a bad fat; it was associated with lower cardiovascular risk (perhaps it’s time to skip the low fat cheese and enjoy the good stuff!). So if you combine a bunch of studies with different sources of saturated fats with varying benefits and risks for heart disease, it waters down the results. As this study concludes, saturated fats (AS A WHOLE GROUP) may not be the issue, but certain types remain a concern.

Where do we go from here?

Can't go wrong with my favorite wheatberry salad, made with 
whole grains,a bit of sweetness and heart healthy oil and nuts.

First, let's focus on foods, not just nutrients. To me what’s most practical is to learn from the diets of populations which have lower(ed their) risk of heart disease. This Circulation article demonstrates the benefits of a Mediterranean style diet on not just lowering cholesterol values, but significantly reducing heart disease risk—so much so, that the study had to be stopped early, given the 50-70% lower risk of recurrence. “These study subjects adopted a Mediterranean-type diet that contained more bread, more root vegetables and green vegetables, more fish, fruit at least once daily, less red meat (replaced with poultry), and margarine supplied by the study to replace butter and cream.”  Use of various oils were recommended, but not limited to olive oil, and moderate alcohol was also included.

And then there was the diet in Crete which is quite similar—full of fresh and dried fruits, grains and cereals, daily dairy, poultry and fish only weekly and red meat rarely. Oil was the predominant fat and oh, the Cretans ate desserts—and not just fruit, but pastry made with honey, too--a few times weekly!

Yes, balance.

Nope, the healthiest people were not eating low carb, nor gluten free. There was no almond milk nor fear of dairy. And fats and desserts still had a role in this most healthy way of life.

My conclusion? We should focus more on eating a balanced diet rich in a range of nutrients. Yes, back to the basics you may now fear—grains and cereals (whole grains are best), nuts and oils, fruits and vegetables and fish, including fatty types and lean meats and poultry to fill the void. Include dairy, not limited to the lowest fat ones you can stomach.

And remember there’s a place for wine and desserts, in moderation.

You? An eating disorder? Breaking the silence on binge eating disorder and OSFED.

I'm not posting this to brag nor, I'll add, to solicit more emails. 

We can't tell just looking at you who's living with an eating disorder.

And I certainly don't want those of you who are not in such a great place to feel worse about your apparent lack of recovery; I'm aware that's how some of you may think. Perhaps you, too, have come a long way on your journey toward recovery, in ways you rarely stop to acknowledge. (SHOUT OUT: identify what you have done well with today!)

Rather, I write because of what could have happened to Leah. And about what usually happens, to those with Binge Eating Disorder and other eating disorders. So please read on!

"I hope you are doing well and a Happy Belated Birthday!  I just read your latest blog post and it made me quite happy and blessed for our time together.I am happy and proud to say that I am doing great and haven't used food to deal with my emotions.  I am still in therapy and it is a big help but I have really come to the other side with my eating disorder.  I have my moments here and there but ultimately I consider my self in recovery.  I completely think a different way about food and to me that is huge.  I have an amazing relationship with food again and for that I thank you and all of your help.  It was just a year ago - March 18, 2013 that we had our first Skype session and I was in a pretty dark place and didn't know how I was going to get through it all....and then you came into my life.

To build on what Dana wrote....thank you thank you thank you for having the confidence in me when I didn't and for being there as a guide to help me get to this amazing place in my life that I can now say I am truly thankful and happy to live. Thank you!!"

I'm driven to post after an ICED (International Conference on Eating Disorders) session about the lack of treatment for eating disorders, particularly binge eating disorder and EDNOS—Eating Disorders Not Otherwise Specified (now renamed OSFED for Other Specific Feeding or Eating Disorder)—that catch all disorders not meeting the criteria for bulimia, anorexia, and binge eating disorder.

Anorexia and to a lesser extent, bulimia, are more likely to be treated—although admittedly so many more aren't in treatment and need to be. And truly, treatment is typically not long enough or intense enough or multi-faceted enough—my thoughts, not the presenter’s.

But I write about these other conditions, these seemingly lessor eating disorders because their impact is so great; of those with eating disorders, approximately 60% of women and 83% of men have BED/EDNOS combined. And while the need for hospitalization or risk of sudden death might be lower, the impact on quality of life, mood, self-esteem, body image, control over eating is tremendous. And let's not forget GI distress, heartburn, constipation, fatigue, high cholesterol, blood sugar management issues—I could go on.

You? Living with an eating disorder?

No, it's not about size!

Sufferers are rarely identified nor have their eating behaviors addressed, contributing to minimizing their own struggle. I mean, if your doctor doesn't ask the questions why would you volunteer about your struggle? More likely, attention is paid to your BMI or 'weight issue' instead. If your loved ones don't sense your struggle with food, but rather just see your weight as a concern, maybe you're the one with the distortion. If you look good and your weight is more or less fine, what's the big deal? They have no idea how you struggle. And if everyone around you is focused in how fat their thighs are or how much weight they're gaining, then you’re certainly not the one needing treatment, right?

Wrong.

Back to Leah. I received her note coincidently while at the ICED conference, and invited her to stop by, as we had never met in person. She would have surely agreed to meet for lunch—as she had come a long way from relying on froyo as lunch/dinner—but time was tight for me, so chai lattes would have to do. And our meeting got me thinking about her history. She long struggled with dieting and food rules, consuming way too much of her mental energy.  That was the norm in both her family and in her peer group.

But Leah knew that this was no way to live.

As she recalls it, it took a tweet of mine that she came across, which lead her to my blog, and then my website and then my book, food to eat, to move her from knowing to doing, to taking action on making her life around food better. We skyped, and I encouraged therapy as well. And as you can see by her note, she did it.

But what if she didn't stumble upon that tweet? Would she, or you, or your friends take the step and initiate change, to move from being ruled by food? Apparently not. The stigma and shame around binge eating and EDNOS is great,as described by Stephanie Bauer, PhD, a researcher in Heidelberg, Germany, making the barrier to change hard to get over. And I learned in a session by Federico Girosi, PhD, from the University of Western Sydney, Australia, that it's hard for those with eating disorders to consider the long term consequences of their disorder, when the short term risk of seeking treatment seems great.

I'm doing my small part. You can do yours too!

Let me tell you, you are not alone. More of you struggle with binge eating disorder and other eating disorders that don't meet the criteria for anorexia or bulimia but which need to be treated!!! You are no less deserving of being freed from the burden of your disease as the person living with cancer.

Please speak up. Halt the fat talk that you hear in your home and with your friends. Start living now, regardless of your size. Ask yourself if the cost of treatment--your fear of what you might hear and how you might feel--is really greater than the cost of not seeking treatment. Do you want to live your whole life concerned about food labels and the calories you consume? Do you want to spend time at meals preoccupied with food and it's nutritional value, rather than enjoying the company of your loved ones? And do you want to carry this sentiment to your children as well? For Leah, that might've been just the tipping point she need, as she was approaching age 30. It felt like enough was enough.

Yet there was no action until perhaps she felt like somebody got it, that she'd be understood, that the risk of shame and stigma might be lower seeking help from someone whose messages she was already comfortable with.

Or in a blog?

Please share this with your friends, whether they have an eating disorder or not. If they start a conversation about dieting or body image, turn it on it's head. share the messages you're reading here and challenge them to have a better life. Check out our new book drop the diet: guided recipes for overcoming your food rules, a modified version of food to eat, rewritten with chronic dieters and binge eaters in mind—coming VERY soon!

Work on giving yourself permission to eat, and enjoying food, all foods, regardless of their fat or carb content. And seek out the services of providers who specialize in eating disorders to help guide you along the way.

Really it's not too late.

Please share on FB, Twitter, Pinterest, email or in conversation with your community! Thanks for reading. More to come from the ICED conference soon!