Beer Diet: What We Learned

The “Beer Diet” – I’m the doctor that supervised Evo Terra as he spent every October for the last three years drinking beer and eating sausages – and while doing this lost weight, lowered his cholesterol, lowered his body fat, and lowered his C-reactive protein and blood homocysteine levels (measures of the body’s inflammatory response).

Here are the Five big lessons we have learned from this experiment:
[Read more...]

Calorie Myths

Should We Replace the Calorie System for Weight Loss?
Calories may not be an adequate way to represent the energy we need or would store. We all know people who eat little but stay heavy, and those who eat loads of junk food but are as skinny as a rail. How can that be? Are the heavy ones sneaking excess calories (maybe) – are the skinny ones with nervous energy just have a higher metabolism (whatever that means – and maybe they do).

So here are six common myths about calories and a few simple eating rules for eating.

Myth: Calories provide our Energy
Calories are not what provide the energy to fuel our body’s metabolism. Our metabolism is fueled by complex chemical reactions and energy is obtained by breaking molecular bonds of chemicals like adenosine triphosphate. A calorie is not a biology/biochemistry term, but a term mechanical engineers first used and adopted by physics.  The technical term of a calorie is this: one calorie is the amount of heat needed to heat one gram of water one degree Celsius. The calories we use are kilocalories- so multiply that by a thousand.

So calories don’t provide energy but are a measurement of the potential energy in a food.

Caloric History –
Bridging caloric physics to biology is largely credited to Wilber Olin Atwater (1844-1907), who applied the first law of thermodynamics to food: energy can be transformed, but it cannot be created or destroyed.  With that he began the use of the term of calories to food – and started measuring how food affected people, by measuring their conversions of oxygen to carbon dioxide and the calories of food. Atwater concluded that people ate too many sweets and fats and didn’t exercise enough.

Using this equipment Atwater was able to determine the relative input of food and exercise

In the early years of determining calories they would put food into a machine called a “bomb calorimeter” burn it- and see how much energy the food contained. This process has been refined, so that we know one gram of carbohydrates has four calories, one gram of protein has four calories, one gram of alcohol has seven calories, and one gram of fat has nine calories.

Myth: A calorie is a calorie
It doesn’t matter how many calories you consume, it matters what your body does with them. Your body will process those 100-calorie snacks differently than 100 calories of beef, or 100 calories of fish.

Your body cannot store protein, so when you need protein to rebuild cells, or after some muscle breakdown, it relies on your diet to get it. The various proteins are broken down in the intestines into amino acids – and your body has no idea if those amino acids came from a plant or beef. So the calories that are available in protein may not be available for energy, but instead used for building. Protein beyond that which is needed for the body’s function can be broken down and used by the body, and if too much of it is available it will be stored as fat.

Many fish are rich in calorie dense fatty acids, but your body cannot make these, so it relies on your diet to get them. Thus, the calories that are available from omega-3 fatty acids may never be used as energy, or stored as fat, because your body will be using them to build various functions.

Fructose, in its refined form, is passively absorbed by the intestines and about 1/3 of it becomes fat.  Doesn’t matter how much your body needs the fuel, one third of all fructose consumed is processed into fat.

Graph from tutorvista.com showing the different pathways of glucose Gand fructose

Myth: Low levels of Glucose are good for you
There is an ideal range for blood glucose levels- too low or too high and you won’t function.  Glucose is important to the body because  every cell in your body needs glucose to function, from the brain to the muscles. Glucose is the currency your body uses to provide energy. Glucose is so important that your body actively absorbs glucose from the intestines to the bloodstream using specialized glucose transport cells. As your body breaks down food into is basic components in the intestine, when a  molecule of glucose is available the glucose is actively transported from the intestine to the bloodstream where it can be used as fuel.

Fructose, in contrast, cannot be used by the human body as fuel. Fructose has to be changed into other products. Fructose is passively absorbed in the intestines – which means if there is a lot of fructose present, it is absorbed into your bloodstream from the intestines. Fructose in fruit, is complexed  with the fiber, and the fiber cannot be absorbed – so you eat the 100 calories of fruit your body cannot absorb the fructose that isn’t free from the fiber. But drink 100 calories of juice, which has a lot of free fructose, and chances are you will get all of the fructose and 1/3 will go down the fatty-acid pathway.

Common table sugar is made up of 1/2 fructose and 1/2 glucose. The high fructose corn syrup used to sweeten juices, soda, cookies, and many breads is higher in fructose than glucose. We recently wrote about the health risks of high fructose corn syrup.

The 100-calorie snacks are typically highly processed cookies, or snacks, and the processed sugar is broken down and quickly absorbed by the body and your body will store that excess as fat.

Calories Don’t Matter if Your Body Can’t Use Them or Get to Them
People cannot digest the cell walls of plants, like fruits and vegetables. This means humans cannot get at those calories without cooking or mechanically breaking down those cell walls. Raw foodies take advantage of this, unable to get most of the calories from vegetables and fruits; they are able to consume large amounts of calories and still lose weight.

Myth: Exercise burns calories
A patient came to me having gained a few pounds over a month and said, “I know for a fact that I exercise 1900 calories a day.” That is impressive, so I asked how he did it- he said that he used an elliptical machine for 45 minutes a day, and the calories he used were based on what the dials on the elliptical machine said. Funny thing – look at those machines or those iPhone apps and they tell you that you are burning hundreds of calories a day – but they are not only inaccurate, they are misleading.

The average male burns a bit over 2000 calories a day- and if you work out for an hour a day you will probably only burn another 100 calories in an  hour. Discouraged? Don’t be. The majority of your calories are burned by your heart pumping, your lungs breathing, your brain thinking. Plus all those things you do during the day matter. The more involved you are in what you do, and increasing your activity, the better you will feel and the less likely you will be to waste calories on crummy food.

The easiest way to increase what you burn is to increase the things you do daily. Remember when you were a kid, and you were always on the go? It is time to get that spirit back- walk more, play more, have more fun- get out of that chair and off the couch. That will burn more exercise than going to the gym and watching your friends work out. You know that tiny lawn you have- get a push lawnmower and use that.

Exercise is good – it is empowering, it gets you out of the house.  Get a Nike Fuelband or some monitor, and use it – plan to exceed your daily activity until you get to an average of 10,000 steps a day.

 

Just Do It

Myth: The reason you are not loosing weight is you are not eating enough

Fred weighed 400 pounds, and he decided to get a Lap-Band to help him lose weight. He hit a plateau after 18 months when he weighed 250 pounds, so he asked me, if he needed to eat more to lose weight.  My answer is, “Yes, it needs to be more fruit and more vegetables- not processed. What it does not need to be is yogurt, cheese, or nuts.”

Fred was eating a lot less food, less than he had in years, but it was still enough to sustain his weight at 250 pounds (he wanted to get to 190 pounds). It was a combination of not just how much he ate, but also when he ate.

If you eat all of your calories at one time your body has to decide to do with the excess fuel. Does it store it, or does it burn it. Sometimes it isn’t that you are not eating enough – sometimes it is that you need to spread that same amount of calories throughout the day.

it isn’t just how much you eat – it is also when you eat and what you eat that determines your health

Myth: It isn’t the calories it is the insulin response to calories
This popular theory goes like this: you eat too many carbohydrates, the insulin level spike, store that as fat while stimulating the fat to store yet more fat and drive a person to eat more simple carbohydrates. People like the simplicity often pontificate that we should eat our calories from protein – be they Paleo, Atkins, low-carb types, or proponents of the glycemic index. People who previously ate a lot of processed food and move into more protein will lose weight – but the body isn’t just that simple.

But the body is even more complex than that – and measurements taken are not insulin levels, but often glucose levels in response to what is believed to be insulin.

Some people just are lucky
Did you ever meet someone who could eat huge amounts of food and never gain an ounce? They can eat junk food, or violate every “rule” and yet not gain a bit. They are just burners.

So they can consume 5000 calories and yet look great – while you have ice cream every night for a week and come away with an extra pound.

Think of people like cars.  Some cars are very efficient at burning gas – the Toyota Prius, Honda Civic – they are like the skinny little friends who eat lots of junk food while looking slim.  Some cars are gas-guzzlers – they are larger, don’t look as sleek – that is like many people. Both get the same amount of gasoline, but they use it differently.

Calories are Still Pretty Good for measuring
Overall, as we demonstrated with the beer and sausage diet as well as the eggs and beer diet – when you cut down on the number of calories you consume, you will loose weight. While there are some clear exceptions, the body isn’t simple, and the use of calories as a measurement of what you consume works out pretty well.

A few simple rules:

(1) Eat lots of fruit and vegetables.

(2) Lean meats are just fine

(3) Have fish twice a week

(4) Make sure you have nutrient rich foods

(5) Increase your daily activity – walk more, get up more – use that nervous energy

And if you think a lettuce wrap is better for you than bread – you are missing the point.

 

REFERENCES:

Here are some older references that I found -

Atwater, W. O. (1895). Methods and Results of Investigations on the Chemistry and Economy of Food. Bulletin 21, U.S. Department of Agriculture, Office of Experiment Stations, Government Printing Office, Washington, D.C.

Atwater, W. O., and Rosa, E. B. (1899). Description of a New Respiration Calorimeter and Experiments on the Conservation of Energy in the Human Body, Bulletin 63, U.S. Department of Agriculture, Office of Experiment Stations, Government Printing Office, Washington, D.C.

Atwater, W. O., and Benedict, F. G. (1905). A Respiration Calorimeter with Appliances for the Direct Determination of Oxygen, Carnegie Institute of Washington, Washington, D.C.

Stop Protesting and Start Cooking

Yes- someone is protesting Kraft because they use “artificial” colors in their Mac and Cheese. They then made up an entire post about how Kraft uses genetically modified wheat in their product.  While they generated a lot of buzz for this lets start with the obvious:

You’re feeding your kid processed food and protesting Kraft?  

Instead of protesting a food maker, why don’t you use that time to cook them a real meal?

In ten minutes you can have a spaghetti squash cooked in a microwave and ready to serve. We showed that in a video here. That has ten times the fiber of the pasta and one tenth the calories – and it tastes great.  Instead of their “cheese” you can grate some real Parmesan cheese on top, or you can heat up some other sauce you get from the store (there are some great healthy sauces out there). Now, in less time than making Kraft’s dinner you have made your own – it has a vegetable serving in it (something you don’t get with Kraft) – it tastes better, it is fresher, and it will cost you less.

Plus here is another advantage: you are showing your child that the kitchen you are in can be used for making real meals.  You are setting an example for them. JJ in the Kitchen

Over 200,000 signatures were gathered for this.  And Kraft met with them! Ok, the power of social media and all that. What an ego boost for their blogs (no, I won’t link to them because they are silly blogs that are quite anti-science). Here is their comment though, “We wanted to educate the American consumer and let them know what is in their food. We just picked an iconic food product to really get that message across.”

So protest away to Kraft, or anyone you wish- but if you would instead take the time to make real food for your kids you can save some of that energy and not have to worry about “chemicals.”

So here is my recommendation for all of you food bloggers out there protesting big industry because of how they process foods — get off your blog and show your kids how to cook – and not from a box.

And if you spent time worrying about what is in the box of Mac & Cheese – don’t. Just get in the kitchen and learn to cook. Your kids will love it, you will love it, and you will eat better – healthier, and live a much better life.

Get an apron, learn how to cook, it is the most empowering thing you can do for yourself.

In fact – one of my favorite chef’s said it best in an interview – well – here is the video of the interview:

Here is a video about how to do Spaghetti Squash

Pigs and GMO

pigs eating

Pigs that eat genetically modified foods have less inflammation than pigs that eat normal- the opposite of what the news reported

Pigs and GMO
So you read the headlines, or the news article and you see that pigs fed GMO had more stomach problems than pigs that were not fed GMO. Except that isn’t really what the article results show.

The results show that pigs have a lot of stomach problems- regardless of the stuff that is fed to them.
From Table 3 of their study:

Pigs who were fed non GM foods had more erosions, more pin point ulcers than pigs fed GM foods.
(1) Of all ulcers there were equal numbers in both GM fed and non GM fed pigs.
(2) In terms of inflammation – all types – there were 69 in the non GM fed group and 64 in the GM group.
(3) If you look at nil inflammation (meaning zip) – pigs who ate genetically modified foods had much less inflammation than pigs who ate “organic” food.
(4) If you add the “nil inflammation” the numbers are 73 with inflamed stomachs of pigs who ate non genetically modified foods and 72 pigs who ate genetically modified foods had inflamed stomachs.

As a surgeon, who does a lot of stomach surgery – I would say that this study shows really no difference between the two groups of pigs- but when it comes to the severe issues there appear to be a lot more severe issues among the pigs that ate non-genetically modified food than the pigs that ate genetically modified foods.

What does this whole thing prove:
(1) GM and non GM are no different
(2) Pigs have a lot of stomach problems – who knew
(3) Journalists don’t read papers and analyze them, they instead read abstracts where the comments may not equal the results

It is sad that the Journal of Organic Systems – which says it is peer reviewed, but its agenda is not science, its agenda is organic farming and systems. A fine agenda, but when you allow the abstract and conclusion to read the way they did – you simply decrease the value of your journal.

As for you journalists out there – try reading and analyzing the data before reporting it.

What is Really in Juice Concentrate

When you buy juice and it says it contains orange juice, or any other juice in it- you probably think of it this way:

When you think of concentrated Orange juice you probably think about something like this

But if you thought more about it you would realize that to make juice you really don’t want the peel of the orange- or the peel of most fruits because they are bitter and not so sweet.

But if you thought about it you realize they would reasonably get rid of the peel and they do

Then if you peel an orange you see underneath the peel there is some pulp and unless the juice has added this back in, most of the time you think is that this material will have to be removed, because if you taste this- it is also kind of bitter and chewy:

Under the peel of the orange is some bitter pulp and in most juices you don’t want to have this

So when you really think about orange juice, or any juice- you think of the meaty part of the fruit- the tasty stuff and when you think of that you think this must be the stuff they make the concentrate from:

The beautiful inside of an orange – this must be what they put into the concentrate.

But then you think again, and realize that they have to squeeze the juice out of that. So you have juice. But that it isn’t really concentrated so what they have to do is some method to make the juice concentrated. So you imagine it looks something like you would see in a frozen can of juice – and would look like that.

But that isn’t what the companies do. What they do is they take that concentrate and they break it down further and make it into a powder that they can easily add to the other powders and ingredients that they make then bottle and sell you as juice. What does that look like?

Sugar – its just sugar

What they do is simply extract the sugar, and this means what you are drinking is a product from some oranges, or grapes, or whatever juice they say. It is just another excuse to give you more sugar, so you can buy more juice.

So next time you want some juice- remember – it probably isn’t really anything more than flavoring, coloring, and sugar. You want juice – get the fruits or vegetables and do it yourself because otherwise what you are eating is just junk food, and you are just fooling yourself.

Bacteria, Heart Disease, and Red Meat and eggs?????

Bad News for Red Meat: Well, read the fine print
There are more bacteria in your colon than people on planet earth. Without bacteria people couldn’t survive or thrive. Bacteria are responsible for us being able to get vitamins, they break down fiber into chemicals that protect us against colon cancer. Now, in a study recently published in Nature, proposing that red meat leads to heart disease through bacteria.

The mechanism is a byproduct of the metabolism of some bacteria called TMAO (trimethylamine N-oxide) which, in some studies, is correlated with an increased risk of heart disease.

is red meat healthy

In the experiments conducted they took meat eaters and vegans and fed them steaks. Why I wasn’t invited to participate is clearly an oversight – after all, steaks…. They discovered when red meat eaters ate steak their level of TMAO went up, but not if vegetarians ate it. They even discovered it wasn’t the meat, but rather the carnitine in the meat that did this (a common supplement in protein drinks for those who want to look like Arnold Schwartzeneger on steroids).

Takes a bit of presumption doesn’t it. But lets work backwards from this hypothesis and start with a favorite saying:

Correlation does not equal Causation
The evidence that red meat causes an increase in coronary artery disease is mixed, at best. The latest study showed there was no evidence that this was an independent risk factor. Smaller studies such as the Nurses Health Study and Health Professional Follow-up study showed an association with a relative risk factor of much less than 2. I blogged a summary of those studies.

Your Gut and Bugs
The bacteria in your gut are important. They protect you- by simply occupying space, they prevent bacteria that are harmful to you from finding a home, as well as  parasites, yeast, and perhaps some viruses.  It has been estimated we have over four pounds of bacteria in our gut. Just a few other numbers that are fun: it is estimated there are over 100 trillion bacteria in our gut (the human  being is made up of about 10 trillion cells, so there are more of them than there are of us – or, a philosopher might ask – who are we really).  We have grown only about 70% of the bugs found in our gut, or so we guess. The byproducts of these bacteria include chemicals that prevent fungus from taking hold,  prevent other bacteria from getting close, and they alter the pH of the gut to keep it comfortable for us and our friendly bacteria, but not so much for the bad bacteria.

These friendly bacteria help produce vitamin K, and biotin. In addition to helping ferment other substances that our body cannot break down, and by breaking down those substances make them available for us to get nutrients from them. While humans cannot digest fiber, some of the bacteria in the gut can digest fiber, and the byproduct of that digested fiber is an agent that decreases the risk of colon cancer (our poop has stuff that bacteria eat and bacteria poop keep us from getting cancer). Is it possible that the bacteria in our gut could create something that makes it more likely for us to have heart disease, or cancer? Yes, it is quite possible.  What you eat does alter your gut bacteria. Who you kiss alters your gut bacteria. Who your parents are alter your gut bacteria. When you get an antibiotic, your gut bacteria change.

With some antibiotics and a combination of stomach acid reducing agents (Prevacid, Nexium, etc) a bacteria that overgrows the colon called Clostridium difficile  (C diff).  This bacteria so overgrows the colon and as a result people can develop ulcers, bleeding, toxic mega-colon, and perforation as well as death. This is a concern for surgeons, something we encounter far too often.

Some people can get overgrowth of bacteria in their small bowel that can lead to malabsorption of nutrients including bloating, nausea, diarrhea, constipation, and long term problems like  anemia from iron malabsorption, and has been linked with some auto immune diseases.

Think of your gut like an eco-system. If it is in perfect harmony, you benefit from it. If not, an overgrowth of one or another bacteria can lead to problems. 

Diet certainly affects which bacteria inhabit your gut. The big question remains, is there a diet, or set of foods, that will encourage the gut to have more “friendly” bacteria and less “bad” bacteria. Here is the realm of speculation – other than a diet rich in fiber being healthy, we don’t have a great answer.  This doesn’t stop people from speculating about one diet or another being better.  In this case, the speculation would be that vegans and vegetarians eat a diet that keeps the bacteria that produce TMAO to a minimum.

And the colon- remember, people have been telling you for years about how bad the colon is- from Kellog and his enemas (he died in his 60′s from heart disease, was a perfect vegetarian and loved colonics) to modern day colon cleansers.  No doubt there will be on Walgreen’s supplement shelves a pro-biotic that will get rid of the bugs that make TMAO.

Gut bugs and Diet
There are three types of gut flora that have been described based on the diet that people have. The “enterotypes” are descried as Prevotella, Bacteroides, and Ruminococcus.  Each one associated with a specific type of diet. Prevotella comes from diets with lots of simple sugars, or high-glycemic index carbohydrates. Bacteroides is associated with animal proteins, or the typical western diet. It is those people who have the Prevotella species that had a higher TMAO blood level. Oddly 3 our of 4 of the subjects that had the Prevotella species were omnivores.

In another study showed that these broad enterotypes were associated with long-term diets. When people were fed a controlled diet the enterotypes remained the same during the ten day study. While some bugs changed quickly, it appears your gut ecology takes a while to change – which, if you think about it, is not surprising.

You are probably thinking- 100 trillion bacteria, and the population of some types more than others?  Think of the United States with its population and other countries with their population. In Norwegian countries there are more Scandinavians, in Italy there are more Latins – now think of your gut. In Vegans, there are going to be more bacteria that do well with their host who eats vegetables – and in omnivores, the bacteria that populate it will likely be more of those that like chewing on remnants of meat.  The hypothesis here is that those bacteria produce more TMAO, and thus meat eaters, when given meat, make that harmful substance that leads to more cardiac deaths (forget that this is a poor correlation in any study looked at, just go with it for a bit). Now- bacteria don’t just eat meat and poop out TMAO – there are enzymes involved in the conversion to this “deadly” substance – and one of them is Vitamin B2, which is typically LOW in vegetarians.

What about TMAO and the Nature Article?
One arm of the human study was with six people.  Five of them were meat eaters and there was one vegan. This is little more than an observation, and hardly  enough of an observation to make headlines.  That one vegan didn’t make TMAO means nothing. It could be that the vegan had antibiotics recently, it could be that they are an exception, it could be a lot of things. The one vegan was a male, and the non-vegans were females – and when the statistics were examined carefully – well, not a difference. But significant, even as an observation – nope.

Of course of the 23 vegans/vegetarians and 30 omnivores they looked at the bacteria in their stool (reminds me of the movie The Madness of King George – when they were obsessed with his stool) – and found the different types of bacteria attempting to correlate those bacteria with meat eaters or vegetarians. The problem was, some of the individuals with the “good bacteria” were omnivores.

The Nature article also looked at a mouse study. Mice are not humans, but with mice they didn’t feed them steaks. Instead they used carnitine. Carnitine is an amino acid, often used in supplements, but your body makes this amino acid naturally. To date there have not been studies that show that carnitine rich foods increase TMAO, in fact the one food that elevates TMAO is some seafood. Seafood, by the way, is associated with decreased risk of heart attack.

In the mouse study they fed them enough carnitine to the equivalent of a human eating about a thousand steaks a day. And I would submit if you eat that many steaks a day you might have some problems. The other issue is this: the gut bacteria of the mouse are not the same as the gut bacteria of the human. Are you a man or a mouse can apparently be answered by checking your fecal bacteria.

AND NOW EGGS?

It is the same argument and discussion for eggs. Turns out that the correlation with eggs and heart disease is zip. In fact, one of our patients finished a month of eating nothing but eggs and saw his cholesterol drop! Again, this is just a bad article with a lot of bad press.

A House of Cards
This study and news report is a part of a house of cards. Conclusions built upon conclusions, with a benign observation from one vegan, and a study in mice. In their conclusion the Nature paper stated that this went along with evidence of risk reduction for non red meat eaters and they cited the Mediterranean diet study in NEJM.  What they fail to grasp is that diet didn’t show a decrease in heart attacks, or heart related events, only a decrease in risk of dying from a stroke – and no absolute decreased risk of dying.

This study again falls into the “red meat is bad,” and shows two things: studies that make headlines in newspapers show that in the slow death spiral of print media they fired their science reporters first  and second, if you want your study to get headlines, find something that shows what the popular press thinks is true.

Saturated fat and cholesterol in beef don’t cause heart problems, and your body makes more carnitine than you get from your diet by a factor of six (unless you are a mouse that is force fed).  TMAO is a huge byproduct of fish, and fish eaters seem to have longer lives and less heart disease.

So- this study make sense to you? Is there maybe a message here? One thing is certain: vegetables are not bad things for you. While some of the omnivores in this group had “good gut bacteria” it could be because they ate a lot of vegetables. So- if I were you, I’d make sure I had plenty of that good old fashioned fiber in my diet.  Who knows, maybe that helps the good bacteria from having heart attacks.

steak and beans

REFERENCES:

The red meat article, published originally on Nature.com

Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013 Apr 7  Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, Britt EB, Fu X, Wu Y, Li L, Smith JD, Didonato JA, Chen J, Li H, Wu GD, Lewis JD, Warrier M, Brown JM, Krauss RM, Tang WH, Bushman FD, Lusis AJ, Hazen SL. PMID: 23563705

Here is the article showing that fish and other sea products give rise to increases in TMAO more than meats.

Dietary precursors of trimethylamine in man: a pilot study. Food Chem Toxicol. 1999 May;37(5):515-20.  Zhang AQ, Mitchell SC, Smith RL. PMID: 10456680

Here is an outstanding article by Chris Masterjohn that gives a far more in depth analysis than I did.