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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by mattdds on October 18, 2003, at 17:24:04
Hey Lar (if you get this),
Physicians routinely spout off advice to eat healthy, but I am at a loss as to what this actually means. I would not bet on the food pyramid at this point.
I really want to start eating "healthy", but I have serious doubt that anyone really *knows* what that means.
I had suspected all along that lower carb diets might be healthier. Perhaps not to the extreme of <20 g of carbs daily that Atkins (RIP) advocated, but I had a sneaking suspicion that eliminating fat and "carb-loading" was making a lot of people fatter and sicker. Now this is being substantiated by quite a bit of good science.
Are there any reliable guidelines to "healthy eating"? Any authors you might recommend? I think I remember you were "Zone-ish" in your diet.
However, in the past, when trying these types of diets, I experienced *severe* constipation, and even developed hemorrhoids (sorry, but true)!
Any general advice you have on eating? I'm sorry the question is so vague, but to me, there are just too many "experts" that are saying too many different things.
Also, what do you think about CRON, or calorie restriction with optimal nutrition (advocated by the pathologist Roy Walford at UCLA)? Does it all just boil down to calories in vs. calories out in the end?
Thanks in advance Lar,
Matt
P.S. From a dental standpoint, low-carbing would be *excellent*, in terms of caries prevention. The principal bacteria involved in cariogenesis are S. mutans (mainly) and Lactobacillus (less), and these can only inflict their damage with carbohydrates as substrates. I bet pure carnivores would experience a near zero caries rate.
Posted by taylor18 on October 18, 2003, at 18:24:32
In reply to Larry - Eat Healthy! - What the heck is this?, posted by mattdds on October 18, 2003, at 17:24:04
In the book Nutrition and Physical Degeneration Weston Price chronicles his travels around the world examining the diets of many isolated groups. The book has detailed descriptions of the different diets, along with pictures of the "primitives" before and after being introduced to civilized diets.
Posted by Susan J on October 19, 2003, at 11:25:11
In reply to Larry - Eat Healthy! - What the heck is this?, posted by mattdds on October 18, 2003, at 17:24:04
Hi, Matt,
Hope you don't mind my jumping in. Larry will be sure to have some seriously good information on this. But it's a subject near and dear to my heart as well.
>>I would not bet on the food pyramid at this point.
<<I read that they released the food pyramid hoping people would eat fewer saturated fatty foods, especially red meat, and never saw the low-fat high-carb result of it! Thank the food companies for taking advantage of the food pyramid for maximizing profits on super-refined, low-fat foods. In reality, the FDA wanted us to avoid saturated fats, and still eat healthy fats.They issued a simplified version of this goal with the food pyramid, I guess because they didn't think we were intelligent or willing enough to really sort through it.
> I had suspected all along that lower carb diets might be healthier.
<<I'm not a nutritionist by any means, but I avoid refined carbs, like processed foods, white potatoes, white bread, and straight sugar (candy). Instead, I eat whole wheat everything, lean protein, eggs (eggs are good for you!), tons of veggies (steamed or raw), not as many fruits (with skins) as I should but I'm working on that, and cook with healthy fats like olive oil. I don't pay too much attention to fat/protein/carb content. I *do* however, try to get the recommended 25 grams of fiber each day. As long as I eat like this, have fat/protein/carbs/fiber at every meal, I feel really good, don't have energy dips, and I'm losing weight.> However, in the past, when trying these types of diets, I experienced *severe* constipation, and even developed hemorrhoids (sorry, but true)!
<<Hit the fiber. Americans get, I think, on average 12 grams a day and we need 25. We lose a lot of fiber in refined (low-fat/high sugar)foods. I like Kashi cereals.Good luck. It's really made a big difference for me, mood-wise and physically....
Susan
Posted by Larry Hoover on October 20, 2003, at 14:24:00
In reply to Larry - Eat Healthy! - What the heck is this?, posted by mattdds on October 18, 2003, at 17:24:04
> Hey Lar (if you get this),
Get what? I don't get it. ;-)
Dude, did you still want that draft of the paper I wrote? I was waiting to hear if you could accept emails with massive attachments. I suppose I could put it in the body, too. Anyway, huge. Full of typos and other errors, too. It's an early draft.
> Physicians routinely spout off advice to eat healthy, but I am at a loss as to what this actually means. I would not bet on the food pyramid at this point.
<rant mode on>
The food pyramid should be torn down, burned at the stake, drawn and quartered, denounced, and buried. Not necessarily in that order. It's hogwash. The primary motivation for the food pyramid, with carbs at its base, was the overproduction of grains caused by the political (read money) manipulation of the American farm system, which was itself motivated by fear about becoming reliant on external sources for food, in case of war. They had to do *something* with the grain produced during the Green Revolution.
<rant mode off>
> I really want to start eating "healthy", but I have serious doubt that anyone really *knows* what that means.It's far easier to say what you ought not to do, than it is to say what you should. Generalizations would be avoid processed food. The more processed, the more avoidance should occur. Words in the ingredient list such as hydrogenated, hydrolyzed, modified, extract, should cause you concern. There may be exceptions, but they are few. If those words appear on the label, let the store keep it.
Just for an idea of a better way to eat, you might want to consider the Paleo diet. It's not hard and fast on what's in it or not, but it is an attempt to recreate a diet more like our pre-agricultural ancestors ate. An attempt to become more congruent with the diet that sustained our species during the greater part of its evolution, rather than the couple of per cent represented by our historical period.
I'm not meaning to advocate the Paleo diet per se, but it is a solid step in the right direction. Some Paleo freaks advocate eating bison and ostrich and weird stuff like that. Not necessary. Eating cow is fine, if it's free range, rather than grain fed.
Anyway, here's a starter link:
> I had suspected all along that lower carb diets might be healthier. Perhaps not to the extreme of <20 g of carbs daily that Atkins (RIP) advocated, but I had a sneaking suspicion that eliminating fat and "carb-loading" was making a lot of people fatter and sicker. Now this is being substantiated by quite a bit of good science.
Yes, it is. And contrary to the myths expressed by conventional medicine over the last few decades, it has been known for over thirty years that carb-restriction is better for you than fat-restriction. It wasn't just Atkins who had that idea.
Here are some recent abstracts, and some older stuff, too:
J Clin Endocrinol Metab. 2003 Apr;88(4):1617-23.A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women.
Brehm BJ, Seeley RJ, Daniels SR, D'Alessio DA.
University of Cincinnati and Children's Hospital Medical Center, Cincinnati, Ohio 45221-0038, USA. bonnie.brehm@uc.edu
Untested alternative weight loss diets, such as very low carbohydrate diets, have unsubstantiated efficacy and the potential to adversely affect cardiovascular risk factors. Therefore, we designed a randomized, controlled trial to determine the effects of a very low carbohydrate diet on body composition and cardiovascular risk factors. Subjects were randomized to 6 months of either an ad libitum very low carbohydrate diet or a calorie-restricted diet with 30% of the calories as fat. Anthropometric and metabolic measures were assessed at baseline, 3 months, and 6 months. Fifty-three healthy, obese female volunteers (mean body mass index, 33.6 +/- 0.3 kg/m(2)) were randomized; 42 (79%) completed the trial. Women on both diets reduced calorie consumption by comparable amounts at 3 and 6 months. The very low carbohydrate diet group lost more weight (8.5 +/- 1.0 vs. 3.9 +/- 1.0 kg; P < 0.001) and more body fat (4.8 +/- 0.67 vs. 2.0 +/- 0.75 kg; P < 0.01) than the low fat diet group. Mean levels of blood pressure, lipids, fasting glucose, and insulin were within normal ranges in both groups at baseline. Although all of these parameters improved over the course of the study, there were no differences observed between the two diet groups at 3 or 6 months. beta- Hydroxybutyrate increased significantly in the very low carbohydrate group at 3 months (P = 0.001). Based on these data, a very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women.
N Engl J Med. 2003 May 22;348(21):2074-81.A low-carbohydrate as compared with a low-fat diet in severe obesity.
Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L.
Philadelphia Veterans Affairs Medical Center, University of Pennsylvania Medical Center, Philadelphia, USA. rick.samaha@med.va.gov
BACKGROUND: The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed. METHODS: We randomly assigned 132 severely obese subjects (including 77 blacks and 23 women) with a mean body-mass index of 43 and a high prevalence of diabetes (39 percent) or the metabolic syndrome (43 percent) to a carbohydrate-restricted (low-carbohydrate) diet or a calorie- and fat-restricted (low-fat) diet. RESULTS: Seventy-nine subjects completed the six-month study. An analysis including all subjects, with the last observation carried forward for those who dropped out, showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet (mean [+/-SD], -5.8+/-8.6 kg vs. -1.9+/-4.2 kg; P=0.002) and had greater decreases in triglyceride levels (mean, -20+/-43 percent vs. -4+/-31 percent; P=0.001), irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications. Insulin sensitivity, measured only in subjects without diabetes, also improved more among subjects on the low-carbohydrate diet (6+/-9 percent vs. -3+/-8 percent, P=0.01). The amount of weight lost (P<0.001) and assignment to the low-carbohydrate diet (P=0.01) were independent predictors of improvement in triglyceride levels and insulin sensitivity. CONCLUSIONS: Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, even after adjustment for the amount of weight lost. This finding should be interpreted with caution, given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study. Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed. Copyright 2003 Massachusetts Medical Society
Nutr Metab. 1978;22(5):269-77.Comparative studies in obese subjects fed carbohydrate-restricted and high carbohydrate 1,000-calorie formula diets.
Rabast U, Kasper H, Schonborn J.
45 obese subjects were fed a high-carbohydrate, relatively low-fat, or a low-carbohydrate, relatively high-fat 1,000-calorie (4.14MJ) formula diet. The diet provided for an isoenergetic substitution of 170 g of carbohydrates for 75 g of fat. Weight reduction up to day 30 was significantly higher in the subjects on the carbohydrate-restricted diet. There were no significant differences between the water and electrolyte balances. The mean total weight reduction achieved on the high-carbohydrate diet was 9.8 +/- 4.5kg with a mean daily weight loss of 298 +/- 80g, while the corresponding values on the carbohydrate-restricted diet were 14 +/- 7.2 kg and 362 +/- 91 g/day, respectively.
Int J Obes. 1979;3(3):201-11.Dietetic treatment of obesity with low and high-carbohydrate diets: comparative studies and clinical results.
Rabast U, Schonborn J, Kasper H.
In spite of numerous studies in the literature, it is still questionable as to whether the isocaloric exchange of carbohydrate and fat, in the form of a diet, leads to different degrees of weight loss. In comparative studies, obese patients given a low-carbohydrate (4.14 MJ [1000 kcal]) formula diet (diet Ia) lost 14.0 +/- 1.4 kg and those given an iso-energetic high-carbohydrate diet (diet Ib) 9.8 +/- 0.9 kg. The degree of weight loss was significantly different. Daily weight losses were 362 g and 298 g respectively. Comparative studies of high and low-carbohydrate (7.83 MJ [1900 kcal]) formula diets (diets IIa and b) with a greater number of calories did not show any significant difference. However, there was a greater mean weight loss with the low-carbohydrate diet (351 g/day) compared with that under the high-carbohydrate diet (296 g/day). Evaluation of 117 patients treated with formula diets resulted in a weight loss of over 9 kg in 102 obese patients and over 18 kg in 52 patients. The good response to the low-carbohydrate diet was partly responsible for the successful therapy.
Ann Nutr Metab. 1981;25(6):341-9.Loss of weight, sodium and water in obese persons consuming a high- or low-carbohydrate diet.
Rabast U, Vornberger KH, Ehl M.
Isocaloric 5.61 mJ (1,340 kcal) formula diets involving the isocaloric exchange of fat and carbohydrate were fed to 21 obese persons selected for sex, height, and weight before the start of the treatment and distributed over three groups. The weight loss observed during the carbohydrate-restricted diets was significantly greater than during the high-carbohydrate diet. After 28 days of treatment the weight loss recorded on the high-carbohydrate diet was 9.5 +/- 0.7 kg, as compared to 11.4 +/- 0.7 kg (p less than 0.05) on the corn oil-containing diet and 12.5 +/- 0.9 kg (p less than 0.01) on the butter-fat-containing diet. The weight loss achieved was not dependent on the type of fat administered (saturated vs. polyunsaturated). When calculated cumulatively, sodium excretion during the first 7 days was significantly greater on the low-carbohydrate diet, whereas after 28 days the total amount of sodium excreted was highest on the high-carbohydrate diet. Potassium excretion during the low-carbohydrate diets was significantly greater for as long as 14 days, but at the end of the experimental period the observed differences no longer attained statistical significance. At no time did the intake and loss of fluid and the balances calculated therefrom show significant differences. From the findings obtained it appears that the alterations in the water and electrolyte balance observed during the low-carbohydrate diets are reversible phenomena and should thus not be regarded as causal agents of the different weight reduction.
> Are there any reliable guidelines to "healthy eating"? Any authors you might recommend? I think I remember you were "Zone-ish" in your diet.
Zone-ish describes it. I do not adhere to any guidelines with religious zeal. I'm a big meat-eater, because that suits my temperament. I'm learning to restrict carbs. I'm also waiting on the results of bloodwork to determine if I have clear evidence of gluten-sensitivity. It's hard to avoid wheat altogether. I'm not going to try, unless I can get some clear evidence that it's worth it. Milk products might also get on my hit-list. There are opiate-active compounds generated during the digestion of wheat and cow's milk, that may be a significant factor in my ill-health.
> However, in the past, when trying these types of diets, I experienced *severe* constipation, and even developed hemorrhoids (sorry, but true)!
I'm sorry it's true, but I'm not worried about the topic. I can't quite fathom constipation arising, though, as substitution for carbs generally involves enhanced intake of fiber, via fruits and veggies. Care to enlighten, vis a vis diet components?
> Any general advice you have on eating? I'm sorry the question is so vague, but to me, there are just too many "experts" that are saying too many different things.Paleo is my best advice, for an eating template. Carbs were not a routine part of the hunter-gatherer diet. You just didn't come across them that often, and seasonally, if you did.
> Also, what do you think about CRON, or calorie restriction with optimal nutrition (advocated by the pathologist Roy Walford at UCLA)? Does it all just boil down to calories in vs. calories out in the end?I'm unfamiliar with CRON. I'll come back to that another time, 'kay?
The myth that a calorie is a calorie is a calorie is about to be totally exploded. Each of the abstracts I posted above shows that type of calorie is an important consideration with respect to weight (loss). The Second Law of Thermodynamics does not literally apply to organisms. The presumption that the release of energy from different categories of food (e.g. fat, carbs, and protein) occurs with identical energy efficiency, is probably wrong. I'm sure the 2nd Law holds, but we haven't accounted for all the inputs and outputs.
> Thanks in advance Lar,
>
> MattMy distinct pleasure.
> P.S. From a dental standpoint, low-carbing would be *excellent*, in terms of caries prevention. The principal bacteria involved in cariogenesis are S. mutans (mainly) and Lactobacillus (less), and these can only inflict their damage with carbohydrates as substrates.Take a gander at Paleo dentition. Most have not a single carie.
> I bet pure carnivores would experience a near zero caries rate.
Hard to know, but it looks like a good guess.
Lar
Posted by mattdds on October 20, 2003, at 23:30:17
In reply to Re: Larry - Eat Healthy! - What the heck is this? » mattdds, posted by Larry Hoover on October 20, 2003, at 14:24:00
Hey Lar,
First, thanks for the response. I'd be quite curious to see your paper on TEGDMA resins (right?). How big of an attachment are we talking here? I'll email you my high speed email, which I think accepts big attachments.
>Just for an idea of a better way to eat, you might want to consider the Paleo diet
Very interesting, I read a little about this and it all sounds quite convincing. I mean, our genes just did not have time to catch up with the rapid development of agriculture.
Using paleo as a template sounds like a fantastic idea. I am looking to make it as practical as possible. Obviously, you can't get bison at the corner deli in NYC. I'll have to settle for beef ;), perhaps even grain-fed. Hey, I have to make some compromises. Right now, I think any improvement I can make on my diet will be helpful. When doing diets in the past, I would tend to become perfectionistic - following them to the tee. This resulted in getting burned out and a rebound carb-pigout phenomenon that immediately erased all my results.
>I'm learning to restrict carbs.
Damn, this is hard, isn't it? With their availability, convenience and just really good taste!
>I can't quite fathom constipation arising, though, as substitution for carbs generally involves enhanced intake of fiber, via fruits and veggies. Care to enlighten, vis a vis diet components?
Strict "induction-phase" Atkins, with <20 g carbs (and the carbs I elected to eat were usually not high in fiber). It was awful dude. I literally felt like I was in labor - struggling to give birth to a large river rock. Honestly though, I didn't eat nearly enough fiber. Paleo seems more to encourage more fiber, right? I took it way too fast, also. This is typical of me, I jump into things way too fast.
>Carbs were not a routine part of the hunter-gatherer diet.
You mean, like mashed potatoes and rice, right? Did they eat fruit, nuts and seeds occasionally? I sure hope nuts are on the OK list, I could do well on a diet of meat, nuts, fruits and veggies. Eggs? I would imagine eggs are OK, no?
The abstracts are convincing, indeed.
Lar, thanks again. You truly are the "go-to guy" here. We all appreciate the time you spend on your replies - they're always extremely helpful and thoughtful.
Best,
Matt
P.S. I think it's interesting that carb restriction diets used to be prescribed by neurologists to control seizures. I wonder if this has any implications for psychiatry.
Posted by Larry Hoover on October 22, 2003, at 16:14:46
In reply to Re: Larry - Eat Healthy! - What the heck is this? » Larry Hoover, posted by mattdds on October 20, 2003, at 23:30:17
> Hey Lar,
>
> First, thanks for the response. I'd be quite curious to see your paper on TEGDMA resins (right?).That, and other substances of similar chemistry.
> How big of an attachment are we talking here?
1 mb? I don't know for sure.
> I'll email you my high speed email, which I think accepts big attachments.
You did give me an email address a few weeks ago, but I didn't record it.
> >Just for an idea of a better way to eat, you might want to consider the Paleo diet
>
> Very interesting, I read a little about this and it all sounds quite convincing. I mean, our genes just did not have time to catch up with the rapid development of agriculture.That's the argument, in a nutshell.
> Using paleo as a template sounds like a fantastic idea. I am looking to make it as practical as possible. Obviously, you can't get bison at the corner deli in NYC. I'll have to settle for beef ;), perhaps even grain-fed. Hey, I have to make some compromises.Exactly. For me, Paleo is an attitude, rather than a diet. When I can, I get free-range meat. If not, I still get meat.
> Right now, I think any improvement I can make on my diet will be helpful.
Another very good attitude to hold. Increments do matter.
> When doing diets in the past, I would tend to become perfectionistic - following them to the tee. This resulted in getting burned out and a rebound carb-pigout phenomenon that immediately erased all my results.
I don't cook with recipes (except when baking....no choice if you want it to turn out). I'm not a formulaic type guy. One bowl of ice cream isn't going to kill me. Nor is a carb-laden food. Once in a while. It's the trend that matters.
> >I'm learning to restrict carbs.
>
> Damn, this is hard, isn't it? With their availability, convenience and just really good taste!The food-processing industry really should be called the carb-processing industry.... :-/
> >I can't quite fathom constipation arising, though, as substitution for carbs generally involves enhanced intake of fiber, via fruits and veggies. Care to enlighten, vis a vis diet components?
>
> Strict "induction-phase" Atkins, with <20 g carbs (and the carbs I elected to eat were usually not high in fiber). It was awful dude. I literally felt like I was in labor - struggling to give birth to a large river rock.Codeine does that to me. I *hear* ya. I don't understand the need for the induction-phase, in any case. Your body is going to adjust. Why make it a massively overt manipulation? Whatever.
> Honestly though, I didn't eat nearly enough fiber. Paleo seems more to encourage more fiber, right?
In a general sense. Paleo won't make you eat fruit and veggies if they're not your normal choices, right? You still have to make good choices.
> I took it way too fast, also. This is typical of me, I jump into things way too fast.
No! You? I *never* would have guessed that. ;-)
> >Carbs were not a routine part of the hunter-gatherer diet.
>
> You mean, like mashed potatoes and rice, right?They were occasional dietary supplements, in the appropriate season. Agriculture was a shift to having these foods available in large quantities by direct manipulation of the environment. Nibbling on some rice or grain or potatoes once in a while isn't a problem. It's eating quantities of them every day.
> Did they eat fruit, nuts and seeds occasionally? I sure hope nuts are on the OK list, I could do well on a diet of meat, nuts, fruits and veggies. Eggs? I would imagine eggs are OK, no?
For sure. I see nothing wrong with eggs (and many good things about eggs).
Think about wandering through the landscape. Finding this tree in fruit, that tree with nuts, a bird on its nest, blah blah. You'd never find a 160 hectare monoculture field of corn or wheat in a natural scenario.
> The abstracts are convincing, indeed.
>
> Lar, thanks again. You truly are the "go-to guy" here. We all appreciate the time you spend on your replies - they're always extremely helpful and thoughtful.My pleasure. I'm just glad my postings are appreciated.
> Best,
>
> Matt
>
>
> P.S. I think it's interesting that carb restriction diets used to be prescribed by neurologists to control seizures. I wonder if this has any implications for psychiatry.I bet depression incidence would be lower if everybody ate Paleo.
Lar
P.S.
Depress Anxiety. 2002;16(3):118-20.
A cross-national relationship between sugar consumption and major depression?
Westover AN, Marangell LB.
Mood Disorders Center (MDOC), Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA. anwestover@yahoo.com
We have preliminarily investigated the hypothesis that sugar consumption may impact the prevalence of major depression by correlating per capita consumption of sugar with the prevalence of major depression. Major depression prevalence data (annual rate/100) was obtained from the Cross-National Epidemiology of Major Depression and Bipolar Disorder study [Weissman et al., 1996]. Sugar consumption data from 1991 was obtained from the Food and Agricultural Organization of the United Nations. For the primary analysis, sugar consumption rates (cal/cap/day) were correlated with the annual rate of major depression, using the Pearson correlation coefficient. For the six countries with available data for the primary analysis, there was a highly significant correlation between sugar consumption and the annual rate of depression (Pearson correlation 0.948, P=0.004). Naturally, a correlation does not necessarily imply etiology. Caveats such as the limited number of countries with available data must be considered. Although speculative, there are some mechanistic reasons to consider that sugar consumption may directly impact the prevalence of major depression. Possible relationships between sugar consumption, beta-endorphins, and oxidative stress are discussed. Copyright 2002 Wiley-Liss, Inc.
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