Dr Dea Roberts MD:

This is my first attempt at re-blogging. This is an important post and worthy of more than just a comment or posting to my facebook page. Lots of other good content on this site. Re-posted from Eathropology, by Adele Hite, MPH RD

Originally posted on Eathropology:

Nostalgia for a misremembered past is no basis for governing a diverse and advancing nation.

David Frum

The truth is that I get most of my political insight from Mad Magazine; they offer the most balanced commentary by far. However, I’ve been very interested in the fallout from the recent election, much more so than I was in the election itself; it’s like watching a Britney Spears meltdown, only with power ties. I kept hearing the phrase “epistemic closure” and finally had to look it up. Now, whether or not the Republican party suffers from it, I don’t care (and won’t bother arguing about), but it undeniably describes the current state of nutrition. “Epistemic closure” refers to a type of close-mindedness that precludes any questioning of the prevailing dogma to the extent that the experts, leaders, and pundits of a particular paradigm:

“become worryingly untethered from reality”

“develop a distorted…

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2 Child-Size Concepts About Treats

Two Simple Guiding Concepts to Consider

When my son was heading into adolescence, and so starting to have more food out of the home and more opportunities to buy food (and food-like substances), I realised there could be real health trouble ahead.  I suggested to him a couple of concepts to use for guidance.  It was a very brief conversation, and was only referred to again a couple of times over the years, but I know he found these concepts useful as he has incorporated them matter-of-factly into how he lives now as an adult.

Two child-size concepts about treats:

  • treat foods are fine to enjoy occasionally, but not when you are hungry.  If you are hungry, eat real food.
  • treat drinks, such as pop (soda), are alright to enjoy occasionally, but not when you are thirsty.  If you are thirsty, drink water.

For example, you deal with your hunger by eating dinner.  If dessert is served, this is eaten and enjoyed after people have had as much dinner as they want to serve themselves.

Of course, the key to this is also providing a general experience for the child that communicates what is meant by “occasionally”.  For example, my son was never exposed to the concept that pop is something you simply buy as part of your normal groceries.  It is for special events or special outings, never a routine part of daily life.  Also, something is not special if it happens every week.

I think the word “enjoy” also is key to how this worked out for him.  If it is a special occasion or special outing and you are having a treat, that is something fun – it is to be enjoyed, and then you go back to your normal life.

There was no policing or stringent application.

There is far more to healthy eating than is covered by this, but I think these two concepts are something that even small children can understand and might be useful.

Short Link for this post http://wp.me/p2jTRh-9Q

Talking with kids about sugar?

One resource you might find helpful when trying to communicate with kids about the problems with high intakes of sugars and starchy foods is the movie Fat Head, by Tom Naughton. Click to go to his web site and read more about this movie.

In an interview, Tom describes that he hears comments from parents that their kids have really been able to relate to the movie. The interview is also interesting as Tom relates his own experiences with low-carb living and how this has evolved over time for him.  The comments about kids and the Fat Head movie are in the last few minutes (24 min interview). Tom’s next project is a book for kids, with accompanying DVD. The interview is at NEquals1Health.com Link

Low-Carb Grew Up re-posted

I have expanded on my page “Low-Carb Grew Up”, listed under the “Key Keys” button above.  Here it is in full:

I won’t go into the full history of low-carb nutrition.  That has been written about elsewhere.

The current era of low-carb nutrition I would describe roughly (and tongue-in-cheek) as Low Carb 1.0, 2.0, 3.0 and Next:

Low-Carb 1.0 – the 60′s, 70′s, 80′s and 90′s  – Low-carb weight loss diets presented in popular books.  Careful instructions are given, gleaned from dedicated and detailed clinical work. Dr. Robert Atkins creates a contribution he will long be respected and appreciated for.  In his work, he understands and writes about the broad medical  benefits of low-carb eating and the great value of choosing low carb eating as a long-term lifestyle, but the message picked up by the public is overwhelmingly low-carb as a weight loss diet.

People often do, though, find it difficult fo follow.  The scientific knowledge base is still fairly skimpy. People are more on their own with any difficulties they had, due to an absence of knowledgable clinicians and also their being much less likely to be in contact with others sharing their experiences.

Also, there is a great lack of support in society and in the health professions for people doing low-carb eating.  Although many people have a great deal of initial success, and are very pleased and enthusiastic, and there is great potential for life-changing benefit, most people do not stay with a low-carb lifestyle.  Some do and continue to receive benefit.

The tremendous promise of low-carb eating is obvious to those who benefit from it.  There is a feeling that we are just so close to making it work long-term.  This prompts numerous authors to come out with books promoting various tweaks to the low-carb diet.  We still feel that a (world-changing) more workable version is just so close, but tantalizingly just beyond our fingers.

The missing concept (a broader adoption of a positive attitude to higher fat intake when not targeting weight loss) is yet to come.

Low-Carb 2.0 - the 2000s and continuing  – Ground-breaking research is published.  Practicing physicians gain more and more experience with the daily application of low-carb living.  More researchers and more clinicians and more patients means putting heads together.  There is greater and greater insight into trouble-shooting and individualized application.  More is understood about adaptation to ketosis, about gluconeogenesis and about low-carb in the context of high exertion and athletic performance, among other topics.  The physicians, researchers and others at the core of this carry forward and expand the understanding of low-carb eating having great potential for widespread health and medical benefit far beyond solely as a weight loss tool.

The single most important understanding is the evidence supporting the safety of high fat intake when, (specifically when) paired with a low intake of carbohydrates.  Without mentally and emotionally accepting a high fat intake, long-term success on a low-carb eating plan is not possible.

This    changes    everything. 

This is what really breaks open the doors to more wide-spread long-term use of low-carb as a sustainable health strategy and continuing lifestyle.  This also is required to increase the recognition and understanding of low carb eating and nutritional ketosis as viable long-term tools with medical applications independent of whether the person is overweight or not, independent of whether they have metabolic syndrome or not.

It’s time for the broader public and wider medical/research community, beyond the more knowledgable core researchers, clinicians and happy low-carb lifestylers to take another look at low carb.  Along comes growing use of the internet (special recognition to Jimmy Moore).  The emergence of another popular author, Gary Taubes, who receives wide-spread and sustained media attention, plays a major role in resurgence of interest in the low carb option.

One other thing, the research clearly shows that eating a low carbohydrate diet is associated with a general broad shift in metabolism that goes well beyond just whether one is burning predominantly carbohydrates or predominantly fats/ketones for fuel.  This means that medical research conducted on people who are eating higher amounts of carbohydrates cannot be just assumed to apply to people who are adapted to low carbohydrate nutrition.  Research findings cannot be properly reported and interpreted without consideration of this.

Low-Carb 3.0 - the current time  – Low-carb meets up with other dietary practices and principles, for example:

- whole foods, Paleo, Primal, Ancestral, Nourishing Traditions

- addiction or “addiction-like” responses to food  – food addiction, sugar addiction, carb addiction, brain sensitization

- health issues with gluten, including celiac disease (studies have repeatedly shown about 1% of the population to have celiac disease and it can onset at any age) and gluten sensitivity (estimated to affect another 7% of the population)

- sports and physical fitness nutrition science

- diabetes care and greatly minimizing glycation damage (damage to body tissues from high blood glucose levels).  Opening up of the concept of low carb as a lifelong strategy takes this beyond the already tremendously valuable use of low carb as a weight loss technique, with its benefits in improving, resolving, and preventing type 2 diabetes.  More awareness comes to the decades of work by Dr. Richard K. Bernstein in using low carb nutrition to achieve fine control of blood sugar in both type 1 and type 2 diabetes, with dramatic impact on avoidance of the many severe complications that would usually develop in these conditions over time.  Research is published showing that harm to health correlates in the general population to blood sugar levels well down into what is considered the normal range.

- ketosis as a medical intervention to help various symptoms and medical problems and as a strategy in high-performance athletics, in addition to its previously understood role in reducing appetite

- an expanded concept of the many health impacts of metabolic syndrome and insulin resistance.

- low carb for metabolic health, yielding also improvement in weight control; nutritional ketosis for reduction in appetite; together generally leading to substantial weight reduction – but not always enough to reach and maintain a normal body weight

- total body fat content is not what is lethal, the consequences of metabolic syndrome/insulin resistance/diabetes and inflammation are and these can be greatly improved with low carb nutrition

Thus, an ever expanding community brings different experiences, concepts and understandings to the shared table.

Now we can better understand people’s different responses to low-carb eating and what can happen as they consume carb foods after eliminating them for awhile.  Without considering these other dietary issues, the response to small intakes of carbs can be very difficult to understand.  Figuring out why low-carb eating can be so life-changing might also be confusing.

If someone has brain sensitization to sugar or to starch (turns into sugar in the digestive tract), even a small intake that would not be expected to have much impact on ketosis or insulin levels might actually be very disruptive and precipitate an abrupt onset of craving and result in abandonment of low-carb eating (even after months of happy, productive and contented success).  People who have such sugar or carb addiction-like responses have reported that long-term triumph requires not just abstinence from the more obvious food triggers, but carefully noting all addictions and addictive-like responses and maintaining abstinence from all triggers.  Further, in this context the sweet taste of artificial sweeteners and sugar alcohols (in many ‘diet’ and commercially-made ‘low-carb’ products) might be disruptive in a confusing way.

A person with celiac disease (an auto-immune response triggered by gluten) or with gluten sensitivity (a different type of immune reaction to gluten) is very likely to be unaware of it.  Most people who have these problems with gluten are blind to their situation.  Thus, when they start a low carb eating plan, they might eliminate gluten and not truly understand that as being part of why they feel so much better.  However, low-carb eating itself, even at a ketogenic level, does not actually require elimination of gluten grains (wheat, rye, barley), it just often is done that way in practice.  Very small intakes of wheat, etc., (like scraping almost every bit of sauce off a meat served at a dinner, for example) then, might cause wild swings in symptoms that are confusing and discouraging.  There would likely be accompanying large swings in weight as fluid retention accompanied the inflammatory response (or the opposite if diarrhea resulted).

What is Next?  As I see it, what is next is a more complete recognition of the central importance of the special role low-carb nutrition plays as a satiety-focused intervention.  Actually, that it is a set of satiety-focused interventions woven together. For example, lowering elevated insulin, more stable blood sugar, respite for those addicted to sugar/starches, gluten elimination and nutritional ketosis all can help separately and together with having less hunger/craving and more easily feeling satisfied with a meal.

Dr. Atkins has received recognition and admiration for many things, but I think that his stance of practicing low-carb specifically with a satiety focus, rather than a calorie-limiting focus, is his second biggest contribution.  While recognized as the father of modern-day carb-controlled nutrition, to me he is also the father of satiety-focused weight health.  We might take it for granted that he chose this route, but I would imagine that he came under considerable pressure to add a calorie-restriction to his recommendations. (A calorie restriction can be obviously stated, or less obvious such as set serving sizes and amounts.)

If you read my pages under “Satiety-Focused Weight Health” you will see my argument that there are only two dietary paths to consider when targeting weight health – either imposed calorie-restriction OR targeting optimal appetite/satiety system function.  The two are mutually exclusive.  The act of imposing calorie restriction intrinsically interferes with attaining optimal functioning of the appetite/satiety system.

The world of calorie-restricted dieting is imploding.  The doctors and the agencies and the public are all discouraged.  Rather than giving up, which is now being openly discussed seriously as a viable option within the medical system, wouldn’t it now be time to give satiety-focused weight health a proper chance?

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A full teaching regarding low-carb eating is far beyond the scope or intent of this blog.  Many good resources are available.

Dr. Eric Westman, Duke University

Dr. Alessio Fasano, Director of the University of Maryland Center for Celiac Research, defines gluten and describes the spectrum of gluten intolerance. Dr. Fasano describes the symptoms and treatment of celiac disease.

Short Link http://wp.me/p2jTRh-6u

Telling People They Don’t Exist

One of my pet peeves is when people are, in effect, told that they don’t exist.

An example?  I get a migraine and flu-like symptoms if I eat even a tiny amount of gluten.  I don’t have celiac disease, I have gluten sensitivity. This has a major impact on the day-to-day living of my life and is something I can never afford to forget, ignore or down-play any time I am around food. Yet, to the vast majority of my own medical colleagues I don’t exist. They recognize the existence of a person occupying the space my body is in. However, what they see there is a person who isn’t me as I know myself to be. They see some deluded or self-deluded not very competent person who holds a questionable and likely false belief that places them in the ranks of the crackpots who think they are harmed by wheat, in the absence of laboratory proof. The recent recognition of gluten sensitivity as a medical condition (see this post) has not received wide-spread attention and is likely to be slow to be incorporated into routine medical practice.

People who have gained substantial health benefits from following a low-carb lifestyle are often treated in the same way. Many people report how frustrated they have felt when their doctors, their friends or work colleagues, or family members have discounted their stories and/or, even worse, discounted them as individuals for the decisions they have made and the “obviously false” conclusions they have come to.

But consider, does it ever happen the other way?

A few months ago I had an experience that has stayed in the back of my mind since.  On one of the blogs about low carb nutrition, I was reading an older post and the looong list of 50 or more comments under it. There was a lot of back-and-forth commenting among the contributors and with the author.  There was a good spirit of comradery evident. Everybody who raised a question, interesting idea or dilemma was responded to  — that is, everyone except one soul. One person posted a comment asking for insight or helpful comment on her situation – asking, that is, for help.  This soul was ignored as if she had leprosy. Her comment fell into a black pit.  The others resumed their conversations as if she didn’t exist.

Her social crime for which she received shunning – she dared to report that she was having little progress with weight loss despite a persistent and apparently well-applied very low carb/ketogenic diet. The post was old and the comments section had been closed, so I couldn’t respond to her myself.

It is easy to love the idea that going low-carb is a sure-fire ticket to weight loss heaven.  This idea makes people smile and feel confident and enthusiastic.

The up-side  — the enthusiasm helps the knowledge spread.

The down-side  — since there is and never will be a sure-fire ticket to weight loss heaven, some individuals can feel unrecognized and discounted. Also, people who are broadly knowledgable about weight control issues recognize this as a false concept and this contributes to lack of respect for the message that low-carb nutrition is a valuable medical intervention (thus limiting the spread of the knowledge).

Low-carb nutrition and nutritional ketosis are very powerful and broadly beneficial tools that can help with weight loss in many ways. There are people who need other tools in addition or instead. Also, the benefits of low-carb nutrition can be swamped or over-ridden by other factors  – for example, certain medications or high stress states.

Many people do spectacularly well when adopting low-carb nutrition as a means to weight loss. Many others do very well or at least do well.  Messaging that focuses on dramatic weight loss, though, can mean that people miss the knowledge of how low-carb nutrition may benefit their health even in the absence of substantial weight loss.  It can mean that people get discouraged and miss out on the many other potential benefits.

“The reasonable man adapts himself to the world.  The unreasonable man persists in trying to adapt the world to himself.  Therefore, all progress depends on the unreasonable man.”  – George Bernard Shaw

If you have benefited from low-carb nutrition, or someone you love has, you might owe a debt to someone somewhere in the past who was not able to achieve success with weight loss with the use of the knowledge and advice they then had access to. The knowledge and understanding of low-carb nutrition is only available to us today because of the determined efforts of one individual after another, acting in response to this lack of success.

If you have a story of fabulous, easy success to tell  – please share it, share it!  Be proud, strut, jump up and down.

I would like to encourage the practice of avoiding suggesting that because it was easy  – or even just that it was possible - for you, that this means it would be or should be the same for all others.

That “unreasonable person” whose response isn’t the same as others’ is a person we can all learn from.  Their situation may be just about to spur some new understanding that will benefit us all some day.

Addendum:  I realize that I might have left that sounding as if there was only one incident that concerned me. Unfortunately, I have more than once read posted comments that flat out stated that since that person had achieved a great outcome with controlled carb intake, that this meant all was solved for everyone else if they would only just get with the program – again meaning that anyone still visibly overweight could be judged on the spot as someone who just wasn’t trying hard enough. I guess being addicted to feeling superior is something that doesn’t show at the waist band.