How does Dr. Oz recommend we detoxify our livers?  Let’s read and see.

I like a simple cleansing fast as an easy, inexpensive means of flushing out toxins and rebooting the system (a juice detox, say, which involves a short-term diet of raw vegetables, fruit juices and water). But it is important to remember that detoxifying the liver, the organ responsible for detoxing our bodies, would take a month of healthy living.

Brilliant!

Let me see if I get this straight.  You detoxify your liver by a fruit-juice fast, right?  Which means throwing back at least three or four glasses of fruit juice a day.  Okay, got it.

Sounds great.  But bit of critical thinking.

What happens to the liver to cause it to need detoxifying?  How about fat accumulation?  A fatty liver is one that needs detoxifying.  Fatty livers are way more common than you might expect.  Studies have shown that about a third of Americans are walking around with fatty livers, a disorder called non-alcoholic fatty liver disorder (NAFLD).  No one really knows what the long-term effects of this problem are going to be, but it is known that fatty accumulation in the liver can lead to an inflamed liver, which can then go on to develop cirrhosis and possibly even liver cancer.  Since this epidemic of NAFLD has arisen fairly recently, it’s unknown how it will play out over the long haul, but I doubt that it will be a good result.

So where does all this fat in the liver come from?  Most researchers think it comes from excess fructose consumption.  The pathways of the metabolism of fructose lead to fatty accumulation in the liver, and giving laboratory animals a lot of fructose gives them fatty livers.  If you couple this information with the fact that fructose consumption has skyrocketed over the last three decades, it makes sense that at least part of the NAFLD we’re seeing comes from too much fructose.

With these facts in mind, let’s take a closer look at Dr. Oz’s recommendation to undertake a juice fast to cleanse or detox the liver.

If you go on a juice fast, how much juice do you drink.  Three or four glasses a day, I would imagine.  And I would also guess that these would be decent sized glasses.  Most people don’t drink an eight ounce glass of anything.  Eight ounces is only a cup, which really isn’t all that much.  Even those little weenie juice boxes that parents put in their kid’s lunches are 8.45 ounces, and most glasses of juice that people drink are larger than that.  A regular-sized soft drink can contains 12 ounces, which is probably much closer to the size of a glass of juice most of us would drink, especially if we were on a juice fast.  Four glasses of juice – a not unreasonable amount to drink in a day if that’s all you’re drinking – would end up being 48 ounces of juice.

I went through the USDA database of foods looking for all the juices I could find that had fructose broken out from the total carbohydrate figure and tabulated them.  Take a look at the chart below which is total carbs and fructose in grams.  And remember that 100 grams equals a half a cup.  So when you see something listed at 111.6 grams of fructose, that means more than a half cup.

It should be clear from this chart that a fruit juice fast provides a whole lot of fructose and a whole lot of carbs.  The fructose is particularly problematic in that it encourages fat accumulation in the liver.  The amounts in 48 ounces of any of these fruit juices would be more than enough to stimulate the synthesis and storage of fat in the liver.

How Dr. Oz thinks this would detox the liver is beyond me.

One other note on his cleansing fast.  It’s not just fruit juices; it includes raw vegetables, too.  I assume Dr. Oz recommends the raw vegetables for all of the flavonoids, carotenoids, lycopenes and other phytonutrients.  I guess he never learned that most – if not all – of these nutrients are fat soluble.  Consuming raw vegetables and fruit juices without some fat along with them means you don’t absorb any of the nutrients.  Dr. Oz must have missed that day at medical school.

So, the actual result of his cleansing detox that is supposed to “flush out toxins [while] rebooting the system” is that more fat accumulates in the liver, insulin goes up thanks to all the carbs and you don’t even absorb the phytonutrients.  Sounds like just a hell of a deal to me.

Let’s spend just another moment looking at yet a different piece of idiocy in this small, small piece of writing.

Says Dr. Oz:

Caffeine throws off all the systems, so drink green tea, which has only a quarter of the caffeine of dark tea or coffee but packs a powerful energy punch.

Oh dear.  Where do we start?  Green tea has almost as much caffeine as coffee, not a quarter of the caffeine.  And, please tell me Dr. Oz, where do we get the “powerful energy punch” from green tea if it’s not from the caffeine?
No sooner had I finished reading the Financial Times Oz recommendations, which, by the way, struck me much more as a prescription from a witch doctor than from a trained physician, than MD pointed out that the same Dr. Oz was on the cover of the Sunday magazine that comes with our local paper.  Yep, USA Weekend features our friend expanding on his recommendations.

I’m not going to go through them all (you can read them here), but one did catch my attention:

Ditch extreme diets. People almost always fail to lose weight because they try diets that are too radical to stick with. For a lifestyle change to succeed, it must be sustainable. So instead of eliminating all foods that fit into a certain category or counting every calorie, try making changes that are less noticeable but no less significant. If you can eliminate just 100 calories from your daily intake, for example, you will lose about a pound per month. How hard is that?

This is a blatant attack on the low-carb diet without saying it in so many words.  And the notion that “if you can eliminate just 100 calories from you daily intake’” you will lose weight over time is the ultimate recommendation of someone who is clueless about the operation of the energy balance equation.

Pitiful.

I’m going to leave you with a poem that I believe is prophetic for Dr. Oz and his nutritionally-unsophisticated compadres.  Sooner or later science will out and these folks will be shown for the idiots they are, and they will be left as part of the detritus of the desert of faulty nutritional thinking.  Too bad they will leave a lot of corpses in their wake.

The poem by Shelley is titled, appropriately enough, Ozymandias

OZYMANDIAS

by Percy Bysshe Shelley

I met a traveller from an antique land
Who said: Two vast and trunkless legs of stone
Stand in the desert. Near them, on the sand,
Half sunk, a shattered visage lies, whose frown
And wrinkled lip, and sneer of cold command
Tell that its sculptor well those passions read
Which yet survive, stamped on these lifeless things,
The hand that mocked them and the heart that fed.
And on the pedestal these words appear:
“My name is Ozymandias, king of kings:
Look on my works, ye Mighty, and despair!”
Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away.

*Said by Great and Powerful Oz
in The Wizard of Oz

First and foremost is the question about peri- and post-menopausal hormonal balance.  From long experience I can tell you that it is difficult for many women to lose weight in the peri- and post-menopausal years, especially the peri-menopausal years, without some hormonal balancing. It can be done, but it is more difficult.  MD keeps promising to post on the subject in detail, but right now she’s up to her eyes in another couple of projects that are consuming most of her time.  That time not consumed by her projects is consumed by little ole me, who needs his fair share.

There is a book on balancing hormones that I feel is the best one of the bunch out there right now.  It is by an acquaintance of mine, whom I run into at medical meetings all over the place.  His name is Uzzi Reiss, M.D, and he is the gyn doc to the stars.  I’m not kidding.  He probably takes care of half the peri- and post-menopausal Hollywood crowd.  He has an enormously busy practice.  I pushed him to write a book early on, but he deferred saying that he couldn’t afford the time away from his practice.  But he finally did come out with one.  It was published about 7 or 8 years ago, and so isn’t completely up to date, but, as I said, I think it’s the best of the bunch out there, written by someone who certainly knows what he’s doing.

At the time he wrote this book, he was using Tri-Est, which is a blend of all three forms of estrogen found in the normal female.  MD prefers more estradiol than found in Tri-Est for weight loss purposes; in fact, she, herself, uses only estradiol.  At the time Dr. Reiss’s book was written compounding pharmacies weren’t as common as they are today, so it wasn’t as easy to get estrogen compounded so specifically.  I think for those of you interested, Dr. Reiss’s book will give you a lot of information to get you started on your own quest.  Many women – MD included – started out on Tri-Est and starting fiddling from there.  The most important thing is to work with a physician who knows what he/she is doing to get your hormones working for you instead of against you.

Another subject I left off is sleep.  Numerous studies have shown that more good quality sleep will help with weight loss.  As we age, it becomes more and more difficult to get good quality sleep.  Often regaining the formerly lost weight brings on acid reflux and GERD, which tend to cause awakening in the middle of the night.  And once we get going again on a low-carb diet, we usually get into a little ketosis, which makes falling asleep a little more difficult yet.  There are a few things to be done.  First, the low-carb diet – even the second time around – typically gets rid of the reflux and GERD pretty quickly.  (I’ve got another post that I’ll probably put up next week about a supplement that will knock reflux on its head quickly.)  You can help with falling asleep, which is what most people are troubled with, by doing a couple of things.  First, get some low-dose sublingual melatonin tabs.  These you can dissolve under your tongue as you turn in.  It’s important that you take the melatonin right before you turn out all the lights – don’t take it and stay up and watch TV or read.  You want the room to be dark.  The pineal gland releases melatonin as a response to darkness, and its function is to help you get to sleep.  It has antioxidant properties, along with many other functions, but you will be taking it to sleep.  There is a fall off in melatonin release by the pituitary with aging, which is one of the reasons people have more difficulty sleeping as they get older.  So, try the melatonin if you’re having trouble.   The other thing you can do is to have a cup of herbal tea right before bedtime.  And sweeten the tea with either sugar or honey.  That’s right.  Real sugar.  A teaspoon of sugar is about 5 grams of carb, which won’t do a lot to hinder your weight loss, but it will be enough to shut down ketone production long enough to get you to sleep.  And if you think a teaspoon of sugar isn’t all that much, remember, it’s the total amount circulating in your blood if you have a normal blood sugar.

Another reason people have difficulty losing as they get older is that their livers don’t function as well.  As we get older we tend to have more aches and pains, and we take more Tylenol and Advil and similar OTC medications for them.  These drugs are metabolized in the liver, and, consequently, they consume some of the liver’s capacity.  Same goes for coffee.  No one likes coffee more than I.  But when I want to pick up my weight loss after I’ve gone off the wagon for a while, I cut back on my coffee.  Why?  Because caffeine is metabolized in the liver just like the above drugs.  It also consumes some of the liver’s capacity.  I switch to decaf for a few days whenever I’m getting back on the straight and narrow.  If you can’t stomach the thought of decaf coffee (and I don’t like it, myself) drink decaf Cafe Americano.  (Here is a YouTube on how to make an Americano starring yours truly.)  There is not as much difference (at least to my palate) between decaf and regular espresso than there is between decaf and regular coffee.  Finally, as we age, we tend to drink more.  Most people drink like fish during college, then slack off.  They start to pick it back up (never to college levels, though, thank God) as they drift into middle age.  Alcohol is detoxified in the liver just like caffeine and OTC pain relievers.  All these things add up to put quite a load on the liver.  And if you’ve regainded weight, you’ve probably got some fatty accumulation in your liver and it’s not working at peak levels anyway.  All these added substances that compromise the liver even more don’t help.

Insulin stays in the circulation because it is put there by the pancreas and because it isn’t metabolized in the liver.  A liver that isn’t functioning up to snuff won’t break down insulin as rapidly as it should.  Consequently, higher levels of insulin mean more difficulty in losing weight.  Plus, since the liver is the major organ involved in the entire metabolic process, it works a whole lot better to stabilize everything when it is unhindered by having to detoxify a lot of unnecessary stuff.  Which is why you need to baby your liver when you restart your low-carb diet.

I’m sure I’ve still forgotten some other factors, and I’m sure you all will remind me.  I think I’ve got some of the smartest readers in the blogosphere.  Thanks for chiming in.

I have never seen ducks force fed, and had always imagined it to be pretty brutal, so I was interested to read the following:

To animal welfare groups, the obscenity of force-feeding, known by the French word “gavage,” is self-evident. But Ginor and his partner Izzy Yanay, who runs the farm, accuse their critics of anthropomorphism and ignorance of duck anatomy and behavior. They say the practice is as benign as it is ancient, since waterfowl lack a gag reflex and have sturdy throats that easily tolerate grains, grit, stones and inflexible gavage tubes. To understand gavage, they say, is to accept it – as they insist poultry researchers have, after examining birds for signs of undue suffering during gavage and finding none.

I visited Hudson Valley Foie Gras recently, seeing gavage for the first time. I saw no pain or panic in Yanay’s ducks, no quacking or frenzied flapping in the cool, dimly lighted open pens where a young woman with a gavage funnel did her work. The birds submitted matter-of-factly to a 15-inch tube inserted down the throat for about three seconds, delivering about a cup of corn pellets.

The practice, done three times a day, for a month, followed by slaughter, seemed neither gentle nor particularly rough. It was unnerving to see the tube going down, and late-stage ducks waddling bulkily in their pens, but no more so than watching the epic gorging at an all-you-can-eat buffet, where morbid obesity is achieved voluntarily with knife and fork. (my italics)

The synchronicity of all this came when just as I was reading the last words of the article, the flight attendant put before me a plate of – you guessed it – foie gras. (It was Air France, after all) I’ve had foie gras a few times before, and I can take it or leave it. But, admittedly, I ate this batch with a little more interest.

When I looked closely at the piece of almost solid fat before me, I reflected on the author’s comment about how humans can make their own livers foie gras-like with knife and fork. He’s absolutely right. I’ve taken care of many, many overweight patients who had fatty livers, and, in fact, fatty liver is becoming a major health problem.

People who consume too much alcohol over too long a time period develop first a fatty infiltration of their liver cells, then inflammation that progresses to fibrosis, then ultimately, if the drinking doesn’t stop, to cirrhosis and possibly even liver cancer. This same exact progression takes place in the livers of many people who are overweight and/or insulin resistant. It is indistinguishable from the alcoholic variety, and is diagnosed only by the fact that the patient doesn’t drink to excess. The disorder is called non-acoholic fatty liver disorder (NAFLD) and is widespread. How widespread? A recent study in the American Journal of Physiology determined that 33.6% of subjects from an ethnically diverse population in Dallas County (Texas) had fatty infiltrations of their livers to a significant degree. Thats one third of the people!

I can across a report of an even more alarming statistic. Jeffrey Schwimmer, MD, a pediatrician and director of the fatty liver clinic at Children’s Hospital and Health Center in San Diego presented data at a Digestive Disease meeting in New Orleans earlier this year that is truly frightening. In an autopsy study of 238 children ages 9-19 from the San Diego area, 17% were found to have fatty livers. Among obese children, the statistics were even more dreadful: 45% had NAFLD. As Dr. Schwimmer noted, based on those statistics and with an estimated 9 million obese children in the US today, “that’s a lot of kids walking around with liver disease that no on knows about.”

How is it treated? In my opinion it is treated most effectively with a low-carb diet. My wife and I have both treated many hundreds of patients with NAFLD with a low-carb diet. And we’re not the only ones who believe in this kind of nutritional therapy. A study was published late last year by researchers from Johns Hopkins University in Digestive Diseases and Sciences who concluded:

There were no significant associations between either total caloric intake or protein intake and either steatosis [fatty infiltration], fibrosis, or inflammation. However, higher CHO [carbohydrate] intake was associated with significantly higher odds of inflammation, while higher fat intake was associated with significantly lower odds of inflammation. In conclusion, present dietary recommendations may worsen NAFLD histopathology.

So there you have it. As you’re pondering all this, remember, they don’t gavage the ducks with steak, eggs, and ham – they gavage them with GRAIN, that wholesome stuff that most of the brain-dead nutritional advisers recommend you eat a half dozen times a day (the ducks only get it three times per day, and look at their livers). So, to avoid having the fate of the gavaged ducks befall you, avoid grains and other high carb fare and eat your steak and eggs. Or even eat your foie gras, just don’t become it.