Insight into Childhood Obesity and Food Cravings

This presentation gives some real on-the-ground insight into what kids who are struggling with their weight actually feel about their food and their eating.

No proposed intervention should fail to take into consideration the problems reported by these kids.

Much thanks to the kids who shared their information and first-hand experience.

Asking kids what they need — who would have thunk it.

This presentation was by pediatrician and obesity expert Dr. Robert A. Pretlow, from his blog Childhood Obesity News

It was presented at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Addiction to Highly Pleasurable Food as a Cause of the Childhood Obesity Epidemic

Sounds like the biggest resource these kids need is help with cravings and knowledge of how to put in place abstinence from their food triggers. Sounds like, for many of the kids he included in his survey, their lives could be changed by knowledge that abstinence from their food triggers can be done in a safe, viable, enjoyable and fulfilling way.

Too Fabulous – Just Pour It Out video

  Dad!  Quit sucking back on that soda all day!!

Hunger Therapy – Or?

How to Make Low Calorie Apple Breakfast Cut th...

How to Make Low Calorie Apple Breakfast Cut the Apple (Photo credit: admiller)

What is Hunger Therapy?

You know if it is Hunger Therapy by asking yourself this question:

“If I have eaten my meal (and waited some minutes), or am waiting for my next meal time, or have eaten all my “allowed” food for the day, and I’m still hungry – what am I “supposed” to do?”

If the answer is – – “go hungry”  then what you are doing is a form of Hunger Therapy.

I first published this April 9, 2012. I’m posting it now because it is still topical and because this was originally published as a page “Which Way to Weight Loss?”. As a page it is often not noticed by people in the way a post would be. I’ve made some minor editing to provide context and improve readability.

– – – – – – – – – – – – – – – – – – – – –

What is the most promising strategy to try first for most people seeking to reduce high total or belly body fat:

  • calories are controlled by intent – capped at a prescribed level in spite of hunger

OR

  • calorie are controlled by the appetite/satiety control system – the task is to help the appetite/satiety control system function appropriately so that weight can trend towards normal without sustained hunger?

CONTEXT

No-one has a lock on what the best way forward is. I am bringing up some concerns that I feel warrant some consideration.

Many people have spent their long efforts doing their best to support the health and well-being of people who would like to improve their health by loosing weight. Much effort has gone in to pursuing many different approaches to treatment. Given the striking and unexpected absence of substantial long term benefit other than for small numbers of people, a full re-evaluation is warranted. I am with those many who feel that one vitally important aspect of this is to assess and consider the potential harmful effects of not only the occurrence for individuals of sustained hunger as a side-effect of the recommended restricted-calorie eating, but also the potential harms from the very existence of professional advice that it is advisable and desirable and “good behaviour” to engage in sustained hunger for medical benefit.

– – – – – – – – – – – – – – – – – – – – – –

There is a fundamental choice at the core of any eating plan designed for loss of body fat:

  • (1) set a limit on the total daily intake of food energy (calories)
  • (2) do not set a limit on the total daily intake of food energy (calories)

These two options are mutually exclusive.  You can’t have both those choices at the same time.  Either there is a limit set or there is not.  If the limit is “sort-of-set”, there is not actually a limit – as in, “the total calories for the day is to be no more than (for example) 1400 calories  — well, unless you are really, really hungry, then have more to eat if you want”.

This choice could be expressed another way:

  • Option 1: stay below a set limit of total calories for the day, whether you become hungry or not. Calories are capped, and this is the path to success, with hunger being a nuisance side-effect to be ignored or managed.  Weight/fat mass is tracked over time and the calorie cap is adjusted up or down until a calorie level is found that permits weight loss at the desired pace.

or,

  • Option 2: calorie balance is monitored indirectly by following any changes in body weight/fat mass over time. Sustained or excess hunger is regarded as a threat to long-term success and is to be avoided. The path to success is through taking steps to achieve the absence of excess hunger (adequate level of satiety) while eating an amount of calories that permits slow weight loss.

In the first situation, excess hunger is regarded as not of direct importance to the outcome.  In the second situation, excess hunger is considered to directly interfere with long-term successful outcome.

The Theory – In the calorie restriction model, the idea is that as long as the individually-adjusted calorie cap is not exceeded, then loss of body fat will proceed. The idea is that hunger will not itself prevent this loss of body fat, it is just an unpleasant nuisance. It is agreed that hunger can indirectly prevent success, if the person responds to the hunger by eating more than the set limit of food. Hunger can also indirectly interfere with the effectiveness of this approach by leading the person to abandon the treatment plan and/or by discouraging future attempts to follow similar treatment plans. Note that this set of ideas must be based on an assumption that it is safe and smart to ignore and disrupt your body’s basic maintenance and survival signalling system.

Because excess hunger can lead to the person “breaking their diet”, a growing amount of medical attention and research is being paid to the science of hunger/appetite/satiety. It is also understood that the study of hunger/satiety will shed light on the factors that are promoting the current obesity crisis.

For the past many decades, overwhelmingly the common (OK, the standard of care) approach to body fat loss has been to advise or prescribe a set limit on total daily food energy (calorie) intake. This limit may be expressed as a calorie number (for example, 1500 calories per day) or as serving amounts of various foods, which is just a less obvious way of counting calories.

How do you recognize a calorie-restricted approach? Curiously, by the same criteria I have outlined at the top of this page regarding Hunger Therapy.

The mathematics of the approach is so convincing, and it all appears so logical, that it has pretty much been taken as a given that:

  • the benefits were plainly obvious
  • the risk of harm was plainly low
  • the balance of benefit to harm was plainly so great as to not require specific investigation

So, why this long article?  What is the point of this discussion?

There is a shaking, dust and confusion at the very foundation of what has been the standard approach to weight loss. Each of the above three points has come under serious doubt:

  • the long-term effectiveness of limited-calorie dieting seems to be amazingly less than anticipated
  • the long-term safety of limited-calorie dieting has increasingly come under doubt
  • the net benefit versus harm is in doubt and has not been proven scientifically

To be clear, these statements are not limited to limited-calorie dieting, but are true for weight loss diets in general. However, I would contend that the attitude favouring calorie restriction is so pervasive in the culture that any research on over-weight/obesity is going to be studying calorie-restricted eating unless a very concerted effort is expressly made to avoid the ingrained behaviours of calorie restriction in the study population. Therefore, are we actually totally sure what we have in the way of weight-loss/control studies (on obese people, otherwise they don’t count anyway) that are completely free from the contaminating effect of calorie-restricting behaviours. In other words, have pretty much all research studies in the past decades been, in actuality, studies that at least reflect, in some part, the effects of self-imposed and possibly even automatic calorie-restriction (even when that has not been intended or there has even been an attempt to avoid it)?

Under these circumstances, perhaps it would be useful to revisit the core decision as to whether to impose a calorie limit or not.  Or, more to the point, the choice whether to use a diet approach where excess hunger is a nuisance to be tolerated, or a diet approach where excess hunger is considered a threat to success and is to be avoided (and excess hunger is primarily considered as a symptom of something more needed to be understood or changed for that person).

One might term the first choice “Hunger Therapy”. As tempting as that is, that delicious term would be misleading as there is actually no intent to cause hunger, hunger just happens to be the standard outcome. On the other hand, I suspect it is a term that many people who have been through multiple cycles of limited-calorie diets would instantly relate to. There is some merit, though, to the use of a term like “Hunger-Inducing-Treatment”.  This would yield the acronym “HIT”.

This might seem like just having some fun with words. It might also seem like an attempt to be nasty or to pick a fight and throw names at people who have been doing their best to provide the best care they know to people who have a real medical need to reduce their body fat. Neither is true. No-one can lay claim to knowledge of a medical treatment for reduction of excess body fat that is scientifically proven in a large population of people to be both safe and effective in the long, long term – none exist.

For all these reasons, the conversation must be opened up. Things that have been taken for granted, assumptions that have been made, things that “every-one knows are true” all have to be brought out and looked at from the ground up. I think that naming hunger as an under-considered harm is one aspect of the broad re-considering that must be done.

Hunger? What of that?  Aren’t we supposed to ignore the hunger and “stick to the diet plan”.  Isn’t that the advice that pervades society, from agencies and health practitioners alike, repeated over decades?  Isn’t the hunger little more than a nuisance, to be ignored or managed as best as possible? Conquered, even? A test of one’s character?

There is the outcome on the individual directly of the attempt to endure sustained hunger (and of “failing” to do so). There is a whole extra set of problems when the professional/agency advice to put up with sustained hunger becomes incorporated into a general societal attitude that expands and gets passed down over generations.

There are rumblings (angry screaming?) that the persistent, excess hunger (and the other outcome of this professional/societal attitude that hunger can be safely ignored and, in fact, you are displaying approved behaviour if you do) is an unsuspected, slow-onset, toxic bomb that goes off in the individual and in society over the course of months, years, decades.

There are many people who have made this point long before me.

If “Hunger-Inducing-Treatment” is in doubt as a promising way forward, perhaps it is time to give the alternate approach (option 2 above) at least a good try.

Perhaps a useful term would be “Satiety-Focused Weight Health”.

To be continued …

Related articles:

  • They Starved, We Forgot  LINK to post on Ancestral Weight Loss Registry
  • Nov 21/12 LINK to new post by Gary Taubes, “What would happen if…? Thoughts (and thought experiments) on the calorie issue.”

Eating Disorders – Onset At Any Age

We are coming to a new understanding that eating disorders can onset at any stage of life.

Article from The Vancouver Sun  LINK

The National Eating Disorders Information Centre   www.nedic.ca

Conference on Obesity and Mental Health

I have just posted a new page with information and resources related to the conference I attended last week.  LINK

The conference Obesity and Mental Health was held in Toronto June 26 – 28 2012.

The Toronto Star has a good summary article. LINK

Sleep Link to Cravings

Just out is a study of sleep apnea in people with diabetes.  This is a small study, but worth noting.  LINK to report of study in Medical News Today.

They report:

“They found that in a small sample of clinic patients, the risk for sleep apnea was high among diabetics compared with non-diabetics, and that sleep apnea appeared to be associated with carbohydrate craving.”

The researcher comments:

“Previous studies have shown that sleep deprivation may lead to changes in hormones that regulate appetite and hunger,” Siddique said. “These hormonal changes can lead to significant craving for high-calorie carbohydrates such as cookies, candy, breads, rice and potatoes. The current study supports previous findings by validating this in a community sample of diabetics.”

Have a look at the article to get a better understanding of what was found and what it means.

Reference:

American Academy of Sleep Medicine. (2012, June 15). “Link Between Sleep Apnea And Increased Risk For Carbohydrate Craving Among Diabetics.” Medical News Today. Retrieved from http://www.medicalnewstoday.com/releases/246563.php.
Addendum June 16th, in response to the comment below regarding observational studies:
The many limitations of observational studies are well known and always important to keep in mind.  They do provide a useful role in suggesting directions to look when trying to figure out actual cause and effect.  For many of the questions we need answers for, studies that could validly test for cause and effect are hard to come by or even in practice not going to be done, due to issues of study size, study costs, or simply what would have to be done to the human subjects in the process of testing for cause and effect.
In the case of this study, you get some insight into the motivation to conduct the research when you look towards the end of the article:
“The management of patients with diabetes and or metabolic syndrome based solely on pharmacotherapy, exercise and nutritional modifications without taking into account the risk of sleep apnea may not lead to optimal outcomes for patients suffering from these chronic diseases.”
It seems they are looking to build a case for more attention to the problem of sleep apnea in the era of managed care and protocol-driven medicine. Notice they do not claim any proof of causation and they are not trying to use the study results found in order to justify an intervention of any sort (medication, lifestyle or otherwise), just to justify more awareness of the need to explore for possible sleep apnea in people with diabetes.  Obviously, the well-known “big neck” rule is not succeeding in getting the job done, leaving people suffering from sleep apnea undiagnosed.
Here is a post which links to a discussion between 2 couples regarding their experiences with low-carb, real foods living. Part of the conversation is about sleep apnea.  LINK

The Precious – Sleep Denial and What We Throw Under the Bus

This photo shows an owl perched at a tree bran...

This photo shows an owl perched at a tree branch at night. According to Brit, this is Barred Owl (Strix varia). (Photo credit: Wikipedia)

The rock we are battered against.

The public health hill hardest to take.

The “precious”, gripped ever tighter in our hands no matter the consequences.

We wants it, the “precious”.*

OK, what on earth could I be referring to?.  Well, pick your metaphor or I’m sure you could come up with a few of your own.  What I am referring to is:

Denial of the need for adequate sleep.

Denial of the need for circadian rhythm health.

We don’t like being accountable. I sure don’t. It’s so boring and frustrating.  Aren’t we born to be free?  As a society, we’ve had to learn the hard lessons about money.  Now we are having to learn the hard lessons about food choices and weight health (and no, I don’t mean the simple calories-in-calories-out stuff).  Barely visible yet on the public radar are the hard lessons we will face about chronic under-sleeping and chronic circadian rhythm disruption.

When it comes to weight health, think of all the blogs and comments and tweets out there. I have seen countless posts and comments from people willing to turn their whole eating pattern on its head. (I have.) Willing to learn and chase the smallest details. (I have.)  Willing to spend hour upon hour tracking various people’s opinions and the latest commentary, insights and research. (I do.) Many put time and effort into being more active or engaging in a deliberate exercise program.  People talk about which medications might interfere with weight health.  Some pursue unusual techniques that are like grasping at straws. There are countless ways people take measures aimed at improving their ability to have and hold their chosen target weight.  Many times a lot of time, effort and loss of personal freedom is involved.

In all this, how often is a goal of adequate sleep and normalised circadian patterns targeted or achieved?

How much of all the other stuff we are doing is only necessary because of the chronic sleep/circadian issues?

In other words, what are we throwing under the bus in our attachment (sometimes fierce attachment) to keeping short sleeping hours and eating/sleeping/waking in disordered, non-rhythmic patterns?  One type of cost is the health impact from the sleep/circadian issues themselves.  This is a huge field of study and I won’t try to review it here.  A number of studies have linked sleep deprivation and circadian disruption with a tendency to gain weight.  (You can see some of this under the category “Sleep Heals” in the sidebar.)

The second type of cost is what we do to try to cope with the effects of the sleep disruption – instead of sleeping!  Just as an example, what if most of your tendency to gain weight would resolve if you just got well into a program of regular adequate sleep and a regular circadian patterns of sleep and meal timing?  How much less burden might there be from all the total things you do now that are for the purpose of helping you control your weight?  For example, research suggests that you would likely have some improvement in your ability to handle carbohydrates.  Research also suggests you would likely have less of a desire for sweets or reward foods.

If you have been chronically low on sleep, the benefits of getting regular adequate sleep are not going to be clear in the first weeks. In fact, there is a confusing phenomenon whereby people who have really been driving themselves and then get a night or two of unlimited sleep can suddenly feel much worse as the adrenalin levels fall and the body pushes you towards going into a “repair and recovery” mode of increased sleep for a while. This is very often mis-interpreted. People take this phenomenon, which is really an expression of the body’s desperation for sleep, as an excuse justifying their high-adrenalin habits.

The heart of the matter is time. We want more time. I don’t know of any other topic in weight control that can make so many people respond as if they are personally under threat.  In terms of emotional response, this topic is even worse than that terrible and much dreaded horrific topic – breakfast.

Of course, the topic of breakfast and skimped/skipped meals ultimately also involves time and time pressures for many people. (See the page “Restrict/Rebound” under Key Keys above.)

So, what are you “throwing under the bus” instead of turning the computer off and getting to bed?  I’ll be asking myself the same question more often.

*Lord of The Rings

The Four Faces plus Black Box of Low Carb

Tailoring a Carb Control Plan Just for You, Today and Tomorrow, Requires Understanding Your Personal Health Needs:

Part One: The Four Faces Plus Black Box of Low Carb

Did you know there may be wonderful health benefits even if you do not follow the kind of very strict low carb diets you may have heard of or may have undertaken yourself in the past?

Don’t let the goal of perfection cause you to lose out on claiming and keeping your gold nugget to be found within a controlled carb eating lifestyle.

The key is to understand which benefits from carb control are important specifically for you. This will allow you to find the choices that bring the most benefit for the least “cost” in terms of changes you are willing to make.

Low carb eating is actually four medical interventions mixed together:

  • (1) it reduces the need for insulin, and thereby reduces the impact and expression of metabolic syndrome, which at its core is insulin resistance (with initially higher levels of insulin and later falling and inadequate levels of insulin) and inadequate control of blood glucose levels. Other aspects of metabolic syndrome include weight gain in the abdomen, a tendency to develop high blood pressure and changes in blood lipids, most specifically an increase in triglycerides and decrease in HDL
  • (2) it is a means to maintain abstinence for people who find that they have an addiction-like response to sweet or starchy foods OR to fatty or salty foods that are also sweet or starchy. They can learn that they do not need to eat any sweet or starchy foods and therefore abstinence is available as an option.
  • (3) it improves the ability to maintain a stable blood sugar within the healthy range by dietary means with or without the help of medications. It also can be used as a means to reduce the doses of medication needed, therefore reducing the risk of adverse effects.
  • (4) it allows a person to be in the metabolic state known as “nutritional ketosis“.

… and a black box:

Are there other basic mechanisms by which a low carb or controlled carb lifestyle can help your health?  Probably yes. There is a lot of discussion about other possible mechanisms of benefit.  Much is speculated and much more is unknown. The answers to many questions still lie in a black box that needs to be illuminated by research.

The biggest question is probably whether being on a very low carbohydrate diet with a resulting state of nutritional ketosis provides a “metabolic  advantage” in weight loss by leading to increased non-activity burning of calories.  There is some evidence that a low carb diet can lead to less systemic chronic inflammation.  The research on this is only in the early stages and it will be difficult to separate what effects are from the change in carbohydrate intake itself and what of the effects are from changes in adverse effects from specific food stuffs, like gluten.

By understanding your own health needs and responses, you can make plans you find to be worthwhile staying with long term and you can understand how to sensibly adjust your eating plans when needed.  This way, everything becomes about what you find worthwhile.  The more you understand about your options, and the more you understand about your individual needs, the better this will work out.

People are unpredictably different. This has to be kept in mind when listening to other people’s stories of how any particular thing they have tried has worked out for them.

This is especially true when hearing about other people’s experiences when they have decided to take control of the carbohydrate in their diet – whether by cutting back on sugar, or changing the type of carbohydrate foods they eat, or cutting down to a very low amount of total carbs.  The reason is that these kinds of changes in the diet can be beneficial in so many different ways.  For any one person who finds benefit from reducing or changing the carbs in their diet, any one of many different effects may be responsible for that benefit – or the benefit could come from many different factors acting together.  The story you are listening to may be the experience of someone whose health needs are not similar to yours.

Sources of Confusion Can Cloud the Picture

When people switch to controlled carb or low-carb eating, there are many things that occur that can affect symptoms and health that have nothing to do specifically with the change in carbohydrates themselves. For example, some of these could be:

  • the enthusiasm of starting something new
  • the breaking of old habits and patterns
  • change in meal times
  • an increase or, more often, a decrease in caffeine consumption, which can lead to various effects such as a severe withdrawal headache
  • starting to eat (or eat more of) some food the person has an adverse reaction to
  • more commonly, stopping eating (or eating much less of, at least for a time) some food that the person has an adverse reaction to. This can be very confusing and it is of great importance that such problems be actively sought out and identified (see my posts on the importance of recognizing gluten sensitivity even in those people committed to a low-carb and/or grain-free lifestyle).
  • a decrease in alcohol consumption, with various possible consequences up to withdrawal symptoms.

The list of things that can confuse the picture could go on and on.

What is meant by a “controlled carb” eating plan or lifestyle?

That term is used when a choice has been made to control the types and/or the amounts of carbohydrate-containing foods that are eaten.

“Controlled carb” can mean anything from:

  • “A” (what most would consider the first level of control – cutting back or eliminating liquids with sugar in them, such as soft drinks and fruit juice) but not trying to cut back on the total carbs in foods in a day, to
  • “Z” (a very low carb diet with less than 20 grams of carbs and only as much protein as needed for health)
  • and everything in between, which represents a vast array of choices.

This does not refer to choices made for reasons other than the amount or type or form of starch and/or sugar content of the food eaten.** For example, a person might decide to eliminate wheat due to concerns about immune reactions to gluten or concerns about other potential harmful effects from wheat (for example, the human digestive tract is not able to properly digest gliadin).  That wheat elimination would not be, in itself, a controlled carbohydrate program.  Many people who have decided to limit or control their carbs also have eliminated wheat with or without a full gluten elimination, but it is important to keep in mind the differences between metabolic effects (e.g. sugar), toxic effects and immune effects.  Because it is acting through the immune system, gluten can be an issue for people down to 20 parts per million, whereas it takes gram levels of sugar or starch to have an effect on metabolism.

An Aside: Keep in mind that no research studies can ever offer firm conclusions about what will be best for you personally. In the end, after all the research and information is looked at, it always comes down to three stepsFirst, the available choices must be considered in terms of their suitability for that particular person, in their particular circumstances and at that particular time.  Second, if an intervention (treatment or lifestyle change) is chosen and undertaken, it is always an individual trial-of-therapy and third, the results have to be assessed.  One can never take the expected results for granted.  Again, we are just so unpredictably different.

** Technically, the term “dietary carbohydrates” includes dietary fiber

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

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

Weight Health, Satiety and Carb Control – A Framework

I have added somewhat to my page previously called “About” and now called “Overview”.  Because this is meant to communicate the heart and soul of what the blog is about and why it exits, I post here the page content in full:

                        “over the past decade, everything has changed…. “

This is a blog dedicated to weight health and to the discussion of satiety as the guiding light and principal most likely to result in success for most individuals.

“Satiety”  (sa-TY-i-tee)  – as I will use it here, is the sense of having satisfied one’s appetite for food; one’s appetite has been satisfied by the food consumed.

“Weight Health” – refers to the fact that there is a lot more involved in a person’s health and well-being than simply how much body fat they may be carrying. The amount of body fat must not be such a dominant concern that other aspects of health and well-being are neglected, discounted or put in jeopardy.  A better term would be “body composition health” since it is now understood that many of the people who are slim or have a  body weight in the “normal” range are suffering harm from relatively small amounts of body fat, but tucked hidden within their bellies.

Why bother?

Because over the past decade everything has changed. Excitement and hope are the realistic, practical outcome.

We used to think we knew what we were doing when it came to weight (fat) loss.  If only people could be disciplined and follow the medical advice, all would be solved.  Just eat less and move more.  Go hungry, if need be. Even if you get very hungry, tough it out and above all “don’t break your diet”.  “Diet” always referred to a limit on the total calories consumed in a day. (The limit being a calorie number given or being a set limit on total food servings, which is just a less obvious way of setting a calorie limit.)

There is a growing chorus of voices suggesting/demanding a total re-thinking of the approach to weight control, from the basic concepts on up.

Why?

Calorie-restricted dieting has not saved us.  For the population as a whole, the message has not stopped a growing crisis of obesity.  For people who are individually prescribed such diets as part of their medical care, the long-term results are stunningly disappointing.  This reality is now just so obvious to everyone that it cannot be ignored or brushed aside any longer.  Yes, some people do well and we need to learn from them, but over-all we are getting further behind.

Calorie-restricted dieting may have unexpectedly and quietly caused long-term harm. There is a growing movement of rejection of calorie-restricted dieting for various reasons, suggesting that this practice might increase the risk of dis-ordered eating patterns, eating disorders, food addiction, depression, lowered metabolism, etc.  There is an urgent need for research to answer these concerns.

The past decade has brought us new information and understandings that profoundly change our options and demand a re-working of our concepts.

Such as:

Obesity itself is not a major cause of death or illness.  The amount of body fat is generally not the major factor in obesity-associated death and illness, other than at very high levels of body fat. Some people can be quite obese and not have much health impact (excluding effects related to physical size, such as stress on joints.)  The type of medical harms that we usually associate with obesity can show up also in those who are in the normal body weight category, but are “metabolically obese”.

Metabolic syndrome (basically intolerance of carbohydrates, with insulin resistance and a gradual worsening of blood sugar control) and inflammation are the major “toxic factors” in both obesity and those who are normal weight but with deep belly fat. The increase in health problems that show up in studies on obese people are mostly from metabolic syndrome and inflammation – such as increased hypertension, diabetes, heart attack and stroke (among other impacts).  Diabetes then brings its own set of consequences such as kidney disease, eye disease, nerve damage and even further increase in risk for heart attack and stroke.  Researchers also feel that the inflammation and the carbohydrate intolerance increase the risk for cognitive dysfunction, dementia and cancer.  Most, but not all, people, who struggle with their weight have metabolic syndrome (or show evidence of being headed that way).  Most, but not all, people who have normal body weight do not (or not yet) have metabolic syndrome.

The signs of metabolic syndrome can be improved and often reliably and effectively treated by the use of an individually-adjusted carbohydrate-limiting food plan.  Also, and critically, most of the benefit of this treatment can be achieved with or without weight loss even close to “normal” range. “Carbohydrates” is the term used for any and all of the sugars and starches in foods.  There is carbohydrate intolerance, so lower the intake of total carbohydrates and change the foods eaten to lower the surge of glucose absorbed after a meal. For best benefit, also take other measures to improve carbohydrate tolerance, such as exercise.  When carefully applied and adjusted for the individual over time, experienced clinicians find that, almost universally, there is substantial improvement in blood pressure, blood fats and blood sugars and/or insulin levels (among other improvements).  (There is consistent clinical experience and some research showing this, more research would help.)

With effective relief from the burden of metabolic syndrome, with its accompanying elevated insulin levels, there is almost always a substantial reduction in excess body fat stores.  This is likely related mostly to reductions from previously elevated insulin levels.  When insulin levels are high, the body’s metabolic machinery favours turning the carbohydrate you eat into fat and storing it. High insulin levels also strongly resist the release of fat from stores to allow burning it off.

Relief from the damaging effects of metabolic syndrome/insulin resistance are much more important medically than whether there is substantial reduction in body weight. Studies into what is “the best” eating plan to achieve weight loss are off the mark on two counts (1) there will never be a best plan, it will depend on the individual metabolism and circumstances and goals and (2) it is vastly more important to find what are the best set of eating plans that, individually, allow the most protection from the harms associated with obesity, principally from metabolic syndrome and inflammation.

Control of body weight involves countless factors and very complex body systems, so no one intervention will ever be all that is needed.  Carbohydrate reduction/restriction is of major importance and benefit for those who have carbohydrate intolerance, but not all people who have high body fat have carbohydrate intolerance.  Unfortunately, low carb eating is not enough in itself to result in normal weight in all circumstances.  It is not magic.  Being on a low carb eating plan does not mean that you are living in a bubble, not affected by all the other factors that affect weight control such as high calories, poor sleep, food addictions, medications that promote weight gain, etc, etc.

If you have metabolic syndrome or a tendency to it, low carb eating can greatly improve your health and greatly improve your weight control while you work on finding the other things you need to do to further improve your weight control.

Nutritional ketosis is a powerful medical tool and can play an important role separate from any carbohydrate intolerance and separate from weight loss.

Low carb eating is actually four medical interventions confused together:

  • (1) as a means to protect the body from the various harmful effects of  carbohydrate intolerance/insulin resistance (metabolic syndrome), including lowering  blood insulin levels to allow a tipping of the balance from fat storage to fat release for burning and
  • (2) as a means to maintain abstinence for people who find that they have an addiction-like response to sweet or starchy foods or to fatty foods that are sweet or starchy (they can learn that they do not need to eat any sweet or starchy foods)
  • (3) as a means to improve the ability to maintain a stable blood sugar within the healthy range by dietary means with or without the help of medications (in the least dosages, thereby lessening medication adverse effects)
  • (4) as a means to be in the metabolic state known as “nutritional ketosis“.  Without going into the details here, nutritional ketosis is a normal physiological state that is part of your basic ancient metabolic flexibility.  In this state, you are burning fats and a fat-derived substance called “ketones” for almost all of your body needs.  In this state you need and burn a very small amount of glucose.  This small amount of glucose is critically needed, but your body can make it from protein and you don’t really need any from your food (if your body is working normally – this is not true in certain disease states and with certain medications, such as insulin and others that lower blood glucose).

Are there more than these four types of basic elements of the effects of carb control or low carb eating on health?  There is a lot of discussion on this topic, but its too early for conclusions.

By understanding the needs of each unique person in regards to what aspects of carbohydrate control are most important for them, a fully individualised eating plan can be worked out that allows the greatest flexibility and freedom, with the least amount of restriction that achieves their goals and is consistent with their circumstances and informed choices.

Nutritional ketosis is a medical intervention which helps control appetite – independent of whether the person is insulin resistance or not.

Because nutritional ketosis is a tool in itself, it can be targeted more specifically as a goal if the benefits are considered worthwhile in any given person’s situation.  This may involve avoiding high intake of protein, use of MCT oil (a coconut oil derivative that readily converts to ketones in the liver), use of metformin to reduce abnormally excessive production of glucose by the liver, and other strategies. (MCT oil is stripped of all other nutrients and could only be used sparingly and thoughtfully as a medical intervention.)

Research and clinical experience over decades have improved the understanding of fully individualised carb-controlled eating as a long-term, essentially permanent lifestyle option, so the medical benefits are available in a sustained way (essentially acting like a long-term medication).

Food addiction-like responses, food triggering and brain sensitization have received increasing attention and come to be understood as key factors in weight control.  For people who have addiction responses to foods containing sugars and/or starches, the understanding that full abstinence is an option (there is no health requirement for intake of carbohydrates and they can be avoided except for those consumed daily in salads and non-starchy vegetables) can change their lives.

There is also improved understanding of dis-ordered eating patterns and the eating disorders.

This blog is my contribution towards putting into words the facts, concepts and options at play.

This blog is full of hope and enthusiasm that current new understandings and information, along with the networked communication of informed and determined people, can bring the needed tools into the grasp of many (possibly even most) people even with what we know and can share right now.

Let none be left behind – if you have a particularly difficult time achieving weight loss to your best healthy weight, then we all have something to learn from your journey.  I have had a personal life lesson in never, never, never, never, never, never, never, never, never give up and I encourage you (though some days you may need to pause from the striving) to put one try ahead of another. Given the massive research effort and the opportunity the internet gives us to put our heads together, hope is actually a very realistic attitude.

CONTEXT

My viewpoint is that all the researchers, clinicians, academics, policy makers and commentators are motivated from a true and honest heart.  Each one is striving for the goal of the best health and best fulfillment of life for individuals and for society as a whole.  Because there will not ever be one right best answer for weight health, and because not one of us knows yet the full collection of interventions/treatments that will bring access to weight health to all people, there are many different opinions.  Passionate discussion and rebuttal is the result.  But, “we fight because we care”.  Individuals who just want to collect their pay and go home would not waste time and energy on vigorous debate.  The more the crisis grows, the more testy the interactions can get.  We are all striving for the same goal.

This blog is written mostly from the point of view of the usefulness af low-carbohydrate nutrition  – as ONE OF the useful interventions to consider. There are countless factors that act together in determining an individual’s body weight at any particular time.  The vast majority of people who struggle with their weight will need to make use of a number of different interventions/treatments/lifestyle changes in their lives to achieve and maintain their desired healthy body composition.  Low-carb eating is not the sole intervention needed, nor is it important for all.

I’m not advocating for low-carb eating for all, I am advocating for the best health and fulfilling life for all, by whatever means prove to be best.  The proper stance of any physician, researcher, etc., is “let the truth win out”.  I write about low-carb nutrition because I think it is critically important that this option be more widely known and better understood.  There is a tremendous amount of confusion and mis-information about low-carb nutrition. This is hindering people from achieving what could be life-changing benefits.  What I am advocating, also, is that each person be aware that carbohydrate intolerance could be a factor in their health and that they receive knowledgable help, now and over the stages of their lives, in evaluating this impact and what it means for their health and for their food choices.

What I would like to see is carbohydrate awareness and carbohydrate literacy.

Each person’s body weight and composition is their own business. I would like to make a contribution towards improving the degree to which it is also their own free choice.

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