Hacking blindly at a problem

"'It's the best therapy for diabetes that we have today, and it's very low risk,' said the study's lead author, Dr. John Dixon of Monash University Medical School in Melbourne, Australia."

Sounds fantastic! Is Dr. Dixon speaking of restricting carbohydrates in the diet, so as to not flood the bloodstream with the glucose that a diabetic person's metabolism is ill-equipped to handle? So that person doesn't need to rely on insulin injections to normalize blood sugar, with side effects like obesity from the insulin moving the excess into fat cell storage?

Alas, no.

According to the lead author of a study published in JAMA Vol. 299 No. 3, January 23, 2008, as quoted in an AP release, the "best therapy for diabetes that we have today" is not cutting sugar and starch from the diet. It's bariatric surgery. Cutting down the size of the tummy. That's correct. There are doctors who believe that surgery -- gastric bypass, lap band surgery and the like -- with its risk of complication and morbidity, is a low-risk endeavor. Where's the risk in cutting sugar, wheat, potatoes, rice and other starches from the diet first? The foods that were absent from the diets of some of the healthiest groups of humans known to history, even into the twentieth century? (And perhaps also today, if groups like the Masai are still living their traditional lifestyle.)

Ironically, these are among the foodstuffs that are prohibited during the recovery period after these surgeries. In the AP/Yahoo article, Dr. David Cummings of the University of Washington in Seattle says that patients' diabetes often goes into remission shortly after the surgery, sometimes within only days. I wonder what would be the results in a control group of patients who adopted the post-surgery recovery diet, but who didn't actually have the surgery?

That is, is the miraculous remission from diabetes from the surgery? Or from the elimination of glucose from the bloodstream?

In the article, the assumption among the doctors seems to be that the positive effects in the diabetic condition result from the weight lost. Impossible. No significant amount of weight can be lost within several days. So what's the diabetes miracle? The fact that weight will be lost, now that the stomach is smaller? That would be a farfetched hypothesis.

A simpler one would be: something in the post-operative period itself relieves diabetes. The objective scientific mind would inquire as to what that is.

The quote that opens this post is appeared on Yahoo! News, dated Jan 24, 2008, here:
Obesity surgery seen as diabetes cure

Many more articles on this topic can be found through an Internet search for a set of terms like "diabetes obesity surgery JAMA."

Gastrointestinal Surgery as a Treatment for Diabetes
David E. Cummings and David R. Flum
JAMA. 2008;299(3):341-343.

Here's a link to JAMA's extract of the full article:
http://jama.ama-assn.org/cgi/content/short/299/3/316

Full text is available to site members only. A trial site registration is offered at the link above.

"Carb Comeback" puff in Arizona Republic

The following appears on the Web site of the Arizona Republic.

I would love to know what is behind an article like this. A commenter on the AR site insinuates it's compiled largely from industry booster brochures. Note that Fernau cites nothing at all in support of her central assertion that that "we" (Arizonians? Americans? Humans?) are eating more carbs, and feeling better about that emotionally. Nor does she quote any of the "former low-carb disciples" that she refers to.

(Via "John" commenting on Dr. Mike Eades's Protein Power blog, on the 'Low-carbs and lipids" post.)

http://www.azcentral.com/arizonarepublic/food/articles/0109Carbs0109.html
Carb comeback
After years of diets badmouthing pasta, potatoes and rice, they're happily back in style

By Karen Fernau
The Arizona Republic
Jan. 9, 2008 12:00 AM
With low-carb eating back in its rightful spot alongside cabbage soup and grapefruit diets, we again are celebrating foods that give comfort and energy.

We are cooking and ordering three of our favorites - potatoes, pasta and rice - without feeling the guilt of committing a dietary no-no. Alas, we're carbo-loading again and proud of it.

"So many of the messages in the last decade have been negative: 'Don't eat carbs. Don't eat this or that.' People are ready to enjoy food that tastes good and is good for you - like carbs," said Cynthia Harriman, spokeswoman for the Whole Grain Council in Boston. "The carb mania finally has subsided."


Carbohydrates, an important part of any healthy diet, are the body's No. 1 choice of fuel. Before the Atkins and South Beach diets vilified and blamed carbs for super-sizing our bellies, they were accepted as the building blocks of a sensible eating plan.

Today, carbs have regained the respect they deserve, with the realization by former low-carb disciples that, when eaten regularly, carbs do not lead to weight gain unless they are gobbled to excess.

"It never made sense to me that people believed that if they stayed away from pasta for more red meat, they would be thinner and healthier. Those of us who know the power of pasta survived the attack by realizing that moderation eventually will prevail," said Wade Moises, chef at Sassi, a high-end Italian eatery in north Scottsdale.

"Carbs were never the enemy, and finally the low carb is exposed as the fad it was."

Nutritionists, in fact, recommend a carb-heavy diet. Calories should be divided this way: 40 to 50 percent from carbohydrates; 20 to 30 percent from protein; and 30 percent fat.

Pasta, potatoes and rice - the three missed sorely during the no-carb era - also provide essential nutrients and little harm.


• Pasta is fortified with folic acid, an essential B vitamin. A half-cup serving of cooked pasta contains a mere 99 calories, less than half a gram of fat and less than 5 milligrams of sodium.


• Potatoes are high in vitamin C, fiber and potassium. They contain no fat or cholesterol and minimal sodium. And a 6-ounce potato contains 3 grams of highly digestible protein, almost as much as half a glass of milk, making it a great foundation for a whole meal.


• White rice is a good source of insoluble fiber, low in fat, contains some protein and plenty of B vitamins.

Nutrients weren't enough, however, for rice, pasta and potatoes to make "good" carb lists with high-fiber, slow-burning types such as lentils and beans. Instead, they often found themselves on the "bad" carb lists with Twinkies and sugary cereals.

"The attack on the potato was unfair and misleading. We were on the wrong list as far as the low-carb movement was concerned," said Frank Muir, president of the Idaho Potato Commission, which fought back four years ago with an expensive advertising campaign celebrating the potato's virtues.

These three carbohydrate staples also provide culinary vessels for other favorite foods: macaroni tossed in a creamy cheese sauce, mashed potatoes spiked with wasabi, pasta topped with fresh chopped tomatoes and garlic or rice stir-fried with broccoli and peppers.

The key is eating these time-tested and economical favorites in moderation.

"A small bowl of pasta is wonderful," Moises said. "A tub is too much."


Post a Comment

Dustbag
Posted Jan-09
7:46 AM

It is disappointing that repeating food industry talking points is now passing for journalism at azcentral.com. Here's an idea - maybe Ms. Fernau could earn her salary and actually research her articles instead of reprinting brochures mailed to her by pasta and potatoe peddlers.

While the "low-carb fad" is having its death knell sounded by the grain and starchy food lobbies, the USDA is revising its guidelines to eliminate refined wheat products and focus on whole grains and leafy vegetables, the American Diabetes Association is recommending controlled carbohydrate nutrition to its members including eliminating starches in all forms. The nutrional science proves that controlling carbohydrates and getting sufficient PROTEIN in the diet is far and away the MOST HEALTHFUL DIET that the human body can consume. Its the diet your body was designed to eat.

Time article: "Can a High-Fat Diet Beat Cancer?"

Article in Time magazine about using a high-fat diet in the treatment of cancer patients:

Can a High-Fat Diet Beat Cancer?
Monday, Sep. 17, 2007 By RICHARD FRIEBE

An excerpt:

"Since early 2007, Dr. Melanie Schmidt and biologist Ulrike Kämmerer, both at the Würzburg hospital, have been enrolling cancer patients in a Phase I clinical study of a most unexpected medication: fat. Their trial puts patients on a so-called ketogenic diet, which eliminates almost all carbohydrates, including sugar, and provides energy only from high-quality plant oils, such as hempseed and linseed oil, and protein from soy and animal products."

Right, don't dare even mention animal fats.

An interesting article. You would think they were talking about restricting oxygen, the way they talk about the temerity with which people cut down their carb consumption. You would think they were talking about giving people heroin or some dangerous drug with loads of awful side effects, like statins, the way they discuss letting people eat fat. Oh, wait ... that's right, it's OK to pump folks with statins. Because ANYTHING is better than letting people eat fat!

Also interesting: The article doesn't say what the macronutrient ratios actually were; just that the diet is ketogenic. That is, carb-restricted.

Gary Taubes and exercise

New York magazine recently published an excerpted chapter from Good Calories, Bad Calories here:

http://nymag.com/news/sports/38001/

The article is titled "The Scientist and the Stairmaster."

Here's a point many people miss: Taubes is not promoting a theory. He is reporting on the results of scientific attempts to find a link between exercise and weight loss. So far, scientific studies have not found evidence of a strong causal relationship. Taubes is just the guy with the nerve to say that out loud.

American Diabetes Association's 18-degree turn on carb restriction

The 2008 recommendations by the American Diabetes Association have been released. In regards to carbohydrate restriction, they've done an astounding 18 degree turn -- which is to say, they've gone a tenth as far as they ought to.

ADA Issues New Clinical Practice Recommendations: New Advice for Doctors About Low-Fat, Low-Carb Restricted Diets For Short-Term Weight Loss

(Note that the press release is incorrectly titled. The body of the press release concerns the ADA's new advice about fat-and-total-calorie-restricted diets and carbohydrate-restricted diets .)

The ADA now says -- oh, so grudgingly, it seems -- that low-carb can have a place in the weight loss efforts of a person with diabetes. Specifically, they now admit that low-carb reducing diets, when used over a short term, have the potential to be at least as effective (for weight loss) as a low-fat, calorie-restricted diet.

Unfortunately, in this faint praise, they completely miss the larger benefit of carb restriction as it relates to diabetes: insulin control. Insulin! Insulin! How long will this organization, one ostensibly dedicated to helping the diabetic, continue to ignore the role of diet in the management of blood glucose and insulin?

Speaking of weight loss, here's a sentence that's completely off-base: "[T]here is now evidence that the most important determinant of weight loss is not the composition of the diet, but whether the person can stick with it, and that some individuals are more likely to adhere to a low carbohydrate diet while others may find a low fat calorie-restricted diet easier to follow."

Wrong. The evidence suggests that macronutrient composition is indeed the most important determinant of weight loss. It's more important than total amount of calories. Which, by the way, is the real other choice in the standard debate, not whether a person can stick to it. Framing the debate as one between composition and ease of adherence is what's known in informal logic as a "false dilemma."

At any rate, the evidence -- as well as common sense -- suggests that a low-fat, calorie restricted diet is more difficult to stick to than a diet that sticks to your ribs. Low-fat meals leave you hungry, especially if they're also low in protein. Low-carb meals might leave you a little dizzy, but only until you've broken the addiction. It takes a couple of days for the body to adjust once you stop shooting it up with the glucose from your starchy, sugary food.

Here's a good article by Jimmy Moore: New 2008 ADA Recommendations Partially Acknowledge Low-Carb Diets -- it gets better, more informative, and more thought provoking as it goes along, so be sure to keep going past the first few grafs. He has great info about and links to discussions of many diabetes-related benefits of carbohydrate restriction. Also good commentary on what the ADA spokesperson has said about the new recommendations.

Here's the Men's Health online article by Adam Campbell, "Apparently, Hell just froze over," which discusses the ADA's change in recommendation.

The Atlanta-Journal Constitution overstated with this headline: "Diabetes Group Back Low-Carb Diets."

Men's Health articles on saturated fat

Saturated Fat:What if Bad Fat is Actually Good for You?
For decades, Americans have been told that saturated fat clogs arteries and causes heart disease. But there's just one problem: No one's ever proved it
By: Nina Teicholz
Men's Health
Section: Health: Heart Health

Saturated Fat: Stop Blaming Saturated Fat
The research is clear: Carbohydrates, not fats, are the foe in America's battle against heart disease and obesity
By: Adam Campbell & Jeff Volek, Ph.D., R.D.
Men's Health
Section: Nutrition: Food for Fitness

Gary Taubes on Charlie Rose (2002?)

This show, posted by YouTube member "CharlieRose" -- an official action of the PBS show, or so one would hope -- is about an hour long.

Guest host subbing for Charlie Rose: Dr. Mehmet Oz.

Guests:
Gary Taubes, who had recently published his New York Times Magazine cover article discussed elsewhere on Lowcarbarama.com
Dr. Dean Ornish "who has led a crusade with the low-fat diet ... as a wellness diet."
Dr. Barbara Howard, chair of the American Heart Association's nutrition committee

Interestingly, Dr. Oz is here identified simply as being with the Columbia Presbyterian Medical Center. Five years later -- by October 2007 -- Dr. Oz had attained celebrity doc status, due to his "You On A Diet" series of books and his association with Oprah. Dr. Oz appeared with Gary Taubes on Larry King live, to provide a counterpoint to the conclusions in Taubes's book. It's remarkable to watch the later show in the context of this one, and observe his transformation into a polished, media-savvy figure who appears to have mastered smooth talk and the art of bantering with hosts. None of that is necessarily a bad thing. It's just fascinating to witness.