December 13

Making worthless data confess

62  comments

A recent, well-financed study shows the glycemic index (GI) to be a less-than-optimal way of managing diabetes with diet.  Meanwhile, a major name in the world of mainstream nutrition comments on this study and shows his own bias.  Oh dear.  Let’s take a look.
Before we launch into this study, which we’re going to just briefly review because I want to spend more time on the commentary, I want to propose to you a thought experiment.  Suppose I ask you to design a study to see what happens when subjects with diabetes eat low-GI carbs as compared to what happens when they eat high-GI carbs.  It seems pretty simple.  If you’ve got half a brain, you would recruit subjects with diabetes, go through all of the randomizing rigmarole to ensure that both groups of subjects were as alike as possible, i.e., subjects in both groups were about the same size, same ratio of sexes, same degree of blood sugar elevation, etc.  Then you would start the subjects in one group on an amount of carbohydrate, let’s say 220 gm per day, that were mainly low-GI carbs and the other group on about the same amount of carbohydrate composed of high-GI carbs.  You would teach each of these groups how to follow their specific GI diets and would have a way of monitoring for compliance.  Then you would set them to it and recheck them in 3 months or 6 months or a year or whatever you decided your study length to be.  Pretty simple stuff, right?
Just for grins, let’s throw in a twist.
Let’s say I’m funding your experiment, and I come to you and tell you that I want you to add another group to your study.  I tell you: Look, I’m tired of Eades, Atkins, Taubes and the rest of these jerks babbling on about how wonderful the low-carb diet is.  We all know – wink, wink – that the low-GI diet is going to kick some tail in this study, so let’s add a group of subjects who will follow a low-carb diet over this same study period.  Then we can show that a low-GI diet is not only better for diabetics than a high-GI diet of the same number of carbs, but is better than the much-vaunted low-carb diet as well.  Or at the very worst, it’s the same as the low-carb diet.  If we can show the low-GI diet to be equal or better than the low-carb diet for the dietary treatment of diabetes, then we can shut those low-carbers up for good.
Sounds reasonable for a study.  But, remember, you are designing this study, and you are a reader of this blog.  You know that a low-carb diet will hammer a 220 gm low-GI diet in terms of weight loss, lipid improvement, blood sugar stabilization, etc.  It’s obvious that the money behind this study doesn’t want the outcome to be what you know it’s going to be.  What to do? What to do?  You wring your hands for a bit, then you hit on a brilliant idea.
You decide to put the subjects in the low-carb group on 200 gm of carbohydrate of their choice.  Hey, now.  200 gm of carbohydrate is lower than 220 gm of carbohydrate, so it’s perfectly legitimate to call the 200 gm of carb per day diet a low-carb diet because it is lower.  Right?
Problem solved.  You’ve set up your study to show just what you want it to show.
Which is pretty much what the folks did who performed the study we’re going to discuss.  Problem is, their study didn’t turn out exactly as they had planned.
Last year a paper with the ungainly title The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic index dietary carbohydrate in type 2 diabtetes: no effect on glycated hemoglobin but reduction in C-reactive protein was published in the American Journal of Clinical Nutrition (AJCN).  This paper describes a study pretty much like the imaginary one I described above.
Three groups of subjects were put on three diets: one group on a low-GI diet, another on a high-GI diet and the third on a low-carb diet.  Those subjects on the low-GI diet consumed an average of 233 gm of low-GI carbs while those on the high-GI diet consumed 220 grams of high-GI carbs and those on the low-carb diet ate 196 gm of all kinds of carbs.  As Dave Barry would write: I AM NOT MAKING THIS UP.
The subjects remained on their respective diets for a year and were then evaluated for differences in outcome.  In almost every condition tested for – body weight, HgbA1c, lipids, blood sugar, blood pressure – ended up not different among the three groups.  The only significant change was that the low-GI group ended up with lower C-reactive protein levels than the high-GI group with the so-called low-carb group right in between.  But, though there was a statistically significant difference between the high- and low-GI groups in terms of C-reactive protein, the measurement was in the normal range for all three groups.  So, the study doesn’t really militate in favor of a low-GI diet in any major way.
But, in my opinion, the study is so flawed that no conclusions should be drawn from it.  Why?  Because the data is so screwed up.  And you know what they say about garbage in, garbage out…
When the initial dietary history was taken on the study subjects to determine their baseline diets in an effort to design the diets for the study period, the researchers determined that these subjects were consuming, on average, about 1900 calories per day.  These were overweight people – both male and female – who were an average age of 60.  All the data needed to make the metabolic rate calculations wasn’t available in the paper, but I was able to extract enough valid data to run the numbers I needed.  And although my calculations aren’t exactly on the button accurate, they are, as they say, close enough for government work. (Which BTW is one of my favorite sayings, one that is positively pregnant with meaning.)
I’ll spare you the brain damage of how I did the calculations, but I applied the Mifflin-St Jeor equations (which are those deemed the most accurate) to the data at hand to determine the actual resting metabolic rates (RMR) of the subjects.  It turns out that the RMR is about 1500-1600 calories per day.  This is the RMR, which is the metabolic rate for lying in a bed barely breathing in a dark room.  To get total metabolic rate, it’s typical to multiply the RMR by a factor depending upon activity level.  For “seated work with no option of moving around and little or no strenuous leisure activity,” it is common to multiply the RMR by a factor of 1.4-1.5.  Let’s assume that these subjects are doing a little more than sitting in chairs all day and go ahead and multiply by the 1.5.  Doing so gives us a total daily energy consumption of from 2250 to 2400 calories, and that doesn’t include the thermic effect of food, which adds about another 10 percent.
Let’s go with 2300 calories, which is almost assuredly low.  If the subjects of this study were claiming to consume only 1900 calories per day (and they weren’t dieting), anyone with good sense would say, ‘hmmm, something isn’t quite right here.’  These subjects could not be weight stable on the regular diets they were on at 1900 calories per day.  They would have to be losing weight.  Over the course of the study – which was a year long – they maintained their weight, they didn’t lose an ounce. In fact, they actually gained a little. If you multiply 400 calories per day (the amount of the deficit between what they claimed to be eating and their total daily energy expenditure) over 365 days, you would find that these subjects had an average caloric deficit of 146,000, which at 3500 calories per pound of fat should mean that they lost about 42 pounds each, but they didn’t lose any weight whatsoever; they gained.  Something strange going on here.
Recall the people in Ancel Keys starvation experiment (which remember lasted only 24 weeks) got an average of almost 1600 calories per day and they became walking skeletons in just a few months.  How could these subjects consume a mere 300 calories per day more for an entire year and not lose anything?  The answer is that the data was incorrect.  And should have been fixed right at the start.
So, basically, the study is worthless. It doesn’t tell us squat other than that people lie about what they eat and some researchers are gullible enough to believe them.  Despite it’s worthlessness, however, this study inspired one of the big-names in mainstream obesity research – Xavier Pi-Sunyer – to use it to demonstrate his own bias or idiocy.  You make the call.
In the same issue of AJCN that the above study appears there was also a commentary by Dr. Pi-Sunyer.  In reading his commentary, I find it almost difficult to believe that so much mis- and disinformation can be accommodated in just a mere page and a half.
I had read the paper before I read Dr. Pi-Sunyer’s commentary, so I was pleased that right up front he got to the heart of the issue, which is the lousy data.  If you’re going to have a study looking at the differences between diets, it seems pretty obvious that food intake is your most important data.  This issue was not lost on Dr. Pi-Sunyer.  After starting off with the obligatory summary of the paper under review, Dr. Pi-Sunyer cuts to the chase:

[The paper] shows the difficulty of accurately measuring food intake in overweight persons. The average body mass index (BMI; in kg/m2) of the group was 31, and the range was 24–40. The average caloric intake reported with the 3 diets at baseline ranged from 1810 to 1930 with an average weight of [approx] 84 kg and at the end of the study ranged from 1800 to 2020 with a slightly higher average weight. Patients did not lose weight; they actually gained. But, even if he or she is very sedentary, a person weighing 84 kg requires more calories than are reported in the study to maintain weight. Thus, the reporting of caloric intake by diaries is shown clearly to be inaccurate, and there is significant underestimation of energy intake. Such underestimation has been reported previously from this laboratory [Pi-Sunyer’s] and by many others. The tools for measuring food intake in humans are very imprecise, as documented here. Yet investigators (and journals) persist in publishing such data as if they were accurate and persist in presenting percentages of macronutrients to one decimal place (see Table 3 in reference 1) as if there were any confidence in such decimals.

Dr. Pi-Sunyer clearly grasps the notion that the data is totally flawed.  And I was heartened.  But then he goes on as if a) the data were valid and b) that the tiny differences in carbohydrate intake are meaningful.
After noting that there was no difference found in the levels of HgbA1c between any of the study groups, he writes:

…compared with baseline data, these mildly diabetic type 2 patients actually did worse with regard to HbA1c and weight while following each of the 3 experimental diets. This finding suggests that we must be careful about disrupting subjects’ or patients’ diets with radical, doctrinaire changes that may actually be counterproductive. Furthermore, the diets had carbohydrate contents that varied from 39% to 52% of energy intake, and yet this variability had no effect on the subjects’ HbA1c. This finding confirms previous reports that the proportion of carbohydrate in the diet is not very important in determining the concentration of fasting blood glucose and that variations of 10% to 15% of total calories make little difference to overall control in patients with early type 2 diabetes

Here we have our first two pieces of dis- or mis-information.  He says these data (that he has already deemed as useless) suggest “that we must be careful about disrupting subjects’ or patients’ diets with radical” changes that could make them worse.  Say what?  What’s radial about a diet that goes up a few calories and doesn’t do much of anything and obviously wasn’t followed anyway?  This is subtle anti-low-carb talk.  Then he comes out with the much less subtle anti-low-carb propaganda that this study (the one filled with meaningless data) “confirms previous reports that the proportion of carbohydrates in the diet is not very important…”
Indeed.  Readers of this blog know what would have happened had the third group gone on a real low-carb diet instead of the 196 gm “low-carb” diet the study subjects actually (supposedly) followed.  “Confirms previous reports that the proportion of carbohydrates in the diet is not very important..”  Are these the same reports that have appeared in most of the major scientific journals showing the low-carb diet to be superior for weight loss, blood sugar stabilization, reducing blood pressure and normalizing lipids?  Are these the reports he’s talking about?
Then writes he:

This report is unique in having followed subjects for 1 y and in using careful monitoring of the subjects’ diet and providing continued professional nutritional advice. It is interesting that the long-term results show that the 3 diets had little ultimate effect on either triacylglycerol or HDL-cholesterol concentrations. Thus, the arguments of the champions of a low-GI or a low-carbohydrate diet—that these 2 types of diets will result in lower triacylglycerol and higher HDL concentrations—have not been upheld in this careful, year-long dietary study.

Huh? “Careful, year-long dietary study.”  Dr. Pi-Sunyer, are you talking about the crappy year-long dietary study that you just trashed for having lousy data?  Or will lousy data do to promote your anti-low-carb bias.
He goes on and on dissecting out various tidbits of this finding and that, all of which are, of course, meaningless, but that doesn’t stop our friend from trying nevertheless.
At last Dr. Pi-Sunyer ends on a hopeless note:

Finally, for the proponents of a low-GI diet, the fact that these investigators, who are well known for their nutritional expertise, were able to provide a sustained difference in GI of only 8 units over 1 y attests to the difficulty of maintaining a low-GI diet over the long term. A realistic lower-GI diet that could be sustained in these patients with mild type 2 diabetes had no significant effect. Given the data from Wolever et al and the previous equivocal data with respect to this issue, it seems unwise at this point to burden type 2 diabetes patients with trying to pick and choose among different high- and low-GI foods.

“…these investigators, who are well known for their nutritional expertise…”  They are so adept at doing nutritional research that Dr. Pi-Sunyer spends the entire fist third of his commentary trashing their work.  Unbelievable.
Methinks Dr. Pi-Sunyer could almost be a contender for the Blackburn award.
But, sadly, such is the state of much published nutritional research these days.
Oh, and did I mention that Dr. Pi-Sunyer is on the scientific committee to determine the 2010 nutritional guidelines?


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  1. Another study that proves that you can not only make a pig, any pig, sing if you cram a speaker in its mouth and play music through it but you can make a pig sing any tune you want it do proving once again that it doesn’t really matter whether a pig can really sing so long as you can manipulate or otherwise misrepresent the data.
    This question is related to the anti-low carb bias. Dr. Eades do you (or anyone on this blog) know how many grams of glucose per hour the brain requires to function at the resting metabolic rate?
    Since the total glucose requirement in a fasting situation drop to about 120-130 gm per day. Most of this goes to the central nervous system. If we say that 90 gm per day goes to the brain (I’m just guestimating here – I don’t know the actual values), then we can say that 90/24 or about 4 gms per hour go to fuel the brain. Four grams of glucose is about a teaspoonful.

  2. Dear Doc,
    Well, Dr Piss On You might be depressing and all, but I did get a ray of sunshine tonight at dinner. I was talking to one of my nephews over dinner and he’s been studying a nutrition course or elective at Macquarie University and guess what? At least one the lecturers had rammed the PP rules into their undergraduate heads! He knew all about the required levels of protein and the need to reduce carbs in order to lose weight and for health.
    A ray of sunshine, but a ray only and that doesn’t make for a day at the beach. But nephew did know about you and your work. So there it is FWIW.
    Looks like you are famous in North Ryde (site of the University and, incidentally, birthplace of the Granny Smith apple)! World Domination will soon be yours!
    Best regards,
    Michael Richards
    I can’t tell you how much I look forward to world dominion. It’s been a long time coming.

  3. Unbelievable!!!!! So only about a 20g carb difference and no difference in results!!!! The real shame is I really would like to see what happened in an unbiased study such as this!!

  4. Unbelieveable. Instead of saying “Confirms previous reports that the proportion of carbohydrates in the diet is not very important..”, he should have said “Confirms basic grade school arithmetic that states that the difference between 220g and 196g is not that much.” The fact that these people are supposed to have a doctorate level education makes me wince even more.
    I am an undergraduate researcher in the computer science program at my university, and when I am reading an upper level research paper, I tend to respect it because I know the kind of hard work and intelligence it takes for these people to obtain the privilege of putting “Dr.” in front of their names. To read a paper from other so-called doctors (albeit in a different field) that is so ludicrously assembled and subsequently published… well, it just makes me wonder why I even try to do proper research when garbage like this can get published anyway. Thanks for dissecting this report for us, Dr. Eades, I appreciate your insight on these matters.

  5. Googling on Dr. Xavier Pi-Sunyer shows *extensive* industry affiliations from the *sugar*, chocolate, egg, dairy and other food-processing industries. I’m not surprised.
    Being a bachelor student myself, I can’t believe how supposedly trusted scientists can deceive public on purpose (the coming 2010 guidelines). I just hope they’re doing this in good faith, even if they’re wrong.
    One of my possible ‘doing this in good faith’ hypothesis is that they believe that the US economy highly depend on such high carb industries. An equivalence to the ‘necessary evil’ theories that lots of politicians and people high in power like.
    Thanks for enlightening us Dr. Eades, your posts are invaluable.

  6. Dr Eades how do we get someone who really understands low carb to have a voice on this damn committee?
    It’s absolutely insane that we still have the same biases every time and nothing changes and the population is getting fatter and fatter.
    By the by, the zero carb diet I am on now is awesome. My blood sugar has stabilized nicely and I can now go hours before having to eat again. Oh and I lost 8 pounds.
    My blood pressure is also going down. I may have to go back to my doc before my next 6 months check because shortly I think I won’t be taking my BP meds anymore.
    I take 50mg of Hydrochlorot but my blood pressure was 140/70 the other day so I only took 1/2 pill.
    Yesterday measuring before medicating it was 124/72 so I didn’t take anything.
    My sister takes my blood pressure (med asst.) daily.
    I’m so happy. 🙂
    I’m glad it’s all working so well for you. Congrats on your success.

  7. Mike,
    Once again, good work. Had I sought even to carry out the kind of work shown in the study, my dissertation committee would have run me out of town on a rail. How do these guys get away with this crap? Oh, I know…. they’re all sleeping with each other 🙂
    tony
    Hmmm. I never thought of that possibility. It explains everything. 🙂

  8. I am sitting here screaming!! This situation is so incredibly frustrating. I can only hope that eventually all the work you do here, dissecting all the bogus “science” at the heart of our health crises will be so widely disseminated that it can’t be ignored.
    Meanwhile I am wondering why you don’t suggest some form of Intermittant Fasting for those who can’t seem to lose on PP alone? Or for those who get stuck on a plateau.
    It worked wonders for me. Last year at age 65 I was still trying to lose the 30 pounds I had put on about 8 years ago. Doing a PP regimen worked for about 6 months at a loss of about 2 pounds a month. Then a 6 month stall. After reading your posts about IF I tried Fast-5. The rest of the weight fell off. After 6 months of Fast-5 I went back to three meals a day, but still low carb. I have maintained with ease for a year now. (I also finally saw a big drop in my LDL. It went from 228 to 154 on the Fast-5 PP combination. I am testing again to see where those numbers are now and will go back on Fast-5 if the LDL has not come down further. At that time I also had my first VAP test. It showed me as being mixed….I am also testing this again.
    I know you recommended some other test ..electro somthing for evaluating LDL, but this was all my Doc could offer. Could you please comment on the value of the VAP compared to the other one?
    Thanks again for all your work. Oh that reminds me: I recently sent the “bottom line” section of the Leaky Gut and the Autoimmune Response chapter of PP to a vegetarian friend who for years had some minor problems but consistantly ignored the information I was passing on to her about the dangers of high grain diets. I had just given up and kept my mouth shut for the last three years. But a few weeks she was diagnosed with a very serious autoimmune disease requiring lifelong steroids and some other horrendous flushing of the blood kind of treatment. As a last ditch attempt i sent her the clipping. She is now willing to give your purist plan a try. I hope it is not too late. Will let you know how it goes for her.
    Thanks again,
    Elliebelly
    Keep me posted on your friend’s progress if she does try the purist approach. Also, an IF is fine for those who stall on plain ol’ PP. But a lot of people are reluctant to try it. I may post on that whole subject again soon.

  9. Thanks. This stuff is very confusing and frightening. We have to live this. It amazes us who do so that doctors can be so crappy about data. As Taubes points out, few have much scientific training. That people are living and dying on this stuff is truly frustrating. How dare these “physicians” make life-changing decisions for us without really knowing of what they speak. Tread carefully doctor, but thank you for publicly sparing. We are listening. And our lives matter to us.

  10. The state of medicine on this front is so sad. It’s interesting that this adherence thing is such a big deal to the researchers – maybe it’s the only thing they can grasp onto at this point because somewhere, deep inside, they understand the evidence.
    But, my high-fat, low-carb diet is SO much easier to maintain than anything I’ve EVER tried before. It does get hard when there are cookies in the break room, etc. but if I’m not hungry (because I had some fat/protein and a cup of delicious tea or coffee), and I’ve seen results, it’s much easier to say no.
    Thanks for the informative post.

  11. Dr. Eads
    I have been recently tapped for the committee to promote banging ones head against a brick wall. A year ago I did a study featuring a control group who did not bang their heads against a brick wall and an experimental group that banged their head against a brick wall once a week. My findings, not only did the experimental group show no signs of skin cancer but they also on average burned 20 more calories a week while stumbling around their house trying to regain composure and make an ice pack. Uggh.
    Okay enough with the facetiousness on my part and lets shift to my anecdotal story. I have struggled with my weight all my life. I would never sit down with a small bowl of chips and converse with friends. I would instead bring the entire bag of chips into my room and I would not leave until the bag was emptied. In an attempt to get fit before Christmas(I was 5’10 260) I purchased the p90x fitness program and decided that nothing was gonna stop me. The diet they recommended is like Protein power or atkins, yet they say to keep some bread and fruit in your diet(because no carb is crazy!) Well despite working myself to nausea on the fitness plan I still felt tired and hungry. I decided to try and eliminate all carbs and just workout with weights once a week in the morning.
    For the first few days it seemed that the High carb, low calorie people were right. Although I lost a couple pounds, I was very lethargic. Despite this I was determined to carry on as most low carb advocates say there will be some adjustment period as the body depletes itself of sugar. Then, on Wednesday of this last week I woke up at 5 in the morning for my workout and I felt great! But then came the moment of truth, I was afraid that without carbs I would not even be able to pick up a 10 lb dumbbell. Well not only did I smash my own maxes I felt great the rest of the day. Two weeks ago, for instance, I would bicep curl 20 lbs for 10 reps and be drained. This last week I knocked out 2 reps of 35 lbs no problem. I can also now do 45 push ups, a month ago I struggled with 18.
    In the last few days I have experimented with intermittent fasting. Mainly the 23/1 high protein approach and my energy levels have gone even higher. The problem now isn’t staying motivated but rather finding new things to do around my apartment to keep me busy.
    just fyi
    my weight this last monday was 262. I am currently at 250. I have lost about 2 inches off my waist. I still go to the gym everyday but instead of running like a hamster on the treadmill, I put some soothing music on my ipod and walk around the track.
    Great to hear of your success. Once you got past the adaptation period, looks like everything came together. Keep me posted on your progress.

  12. This makes me nuts! 200 grams of carbs per day is 30-40% of the total calories, only about 150 too many, especially for sedentary persons. Heck, the original Weight Watchers program only had about 130 gms/day. Yeah, don’t do anything radical to diabetics’ diets; better to just let ’em go their way and increase business for prosthesis manufacturers and rehab facilities. My friend’s diabetic mother just had to have her foot amputated, so this has touched a nerve right now. She says she needs to get up and moving soon because she has to go back to work in January, but for how long before the next amputation? I keep thinking about her dogged adherence to the erroneous advice of these so-called medical professionals who’d rather maim people than admit that low carb diets have tremendous benefits for diabetics. It’s criminal for the health industry to keep trying to prove that low carb doesn’t work by these twisted methods.

  13. In Pi-Sunyers last entry he dispels low-GI, which i’m assuming he likens to low carb also, as too difficult to follow so he then makes his medical evaluation based on a higher GI diet? Am I understanding this correctly? Yikes. Then he says “it seems unwise at this point to burden type 2 diabetes patients with trying to pick and choose among different high- and low-GI foods”, which again I’m assuming he’s throwing low carb in there. Being as how he threw possible benefits of low-GI out the window for being inconvenient, is he likely to tell a cancer patient, don’t burden yourself with chemo – it’s a drag?
    Also, this entry focuses a lot on calories which bring to mind a question I’ve always wondered about – how exactly do they determine how many calories in a food? it seems like there is so much discrepancy regarding this and it is so easy to underestimate consumption.
    They determine calories by burning various foods in a bomb calorimeter to determine oxygen consumption. Once they have the figure for the food, it is then modified by an estimate of what total absorption of said food is.

  14. Part of Pi-Sunyer’s flawed analysis may be his age of 75. I recall reading (on this forum) about another old geezer incorrectly criticizing GCBC. That 70-something formerly respected doc was also flawed in his reasoning. Why do these old farts need to maintain an office and title? They demean themselves and corrupt their proteges.
    That’s how scientific progress gets made. Not by new discoveries, but by deaths of the old guard.

  15. Wow. I don’t think I’m exactly naive about nutritional research – I’ve read too much of it for that, in addition to my native skepticism. But this will really make me think twice about anything I read…no, make that three or four times, and then try how it plays in my body, if I want to take the chance.
    Would you like to make some suggestions on how to find and evaluate good nutritional information, especially for someone who is not a scientist and primarily interested in the bottom line, i.e., how might this apply to me? I mean in addition to your blog, of course, which I am really pleased to have found.
    Thank you.
    Andrea
    It’s tough unless you know how to read the medical literature yourself. (Here is an old post of mine describing how you can do that.) Almost anyone who interprets it for you is going to add his/her own bias to it.

  16. Makes me angry and sad to see such an article published and called science. I have been restricting my carbs and have made a great impact on my blood glucose. I have found I can eat up to 20 carbs at a meal and my blood sugar will remain under 120. If I ate the carbs, low GI or not, they recommend in that paper, I would run my BG up into the 200’s. Thier so-called low carb diet would be way too many carbs for me to handle. Guess they want everyone on medication – lots of it.
    It is nonsense to say that a person’s life should not be disrupted by diet changes. If the diet a person is following is detrimental to health, then it should be fixed. Doctors don’t seem to have any problem with disrupting a life with medications that have toxic side effects. Is it because a medication is easy to prescribe and helping a person do a dietary change takes time?
    Dietary changes are not easy. I know. I have non-celiac gluten sensitivity and have been on a gluten free diet for the past 5 years. I have now added carb restriction because of high post prandial blood glucose. I continue to look for ways to optimize my health. I feel great.

  17. Dr. Pi-Sunyer’s attitude seems to be deeply ingrained in the medical community, unfortunately. In 2003, while working at Deborah Heart and Lung Institute, I was working with a patient who, after a bit of conversation, told me that Dr. Atkins was her personal physician (just prior to his death). I had recently started very low-carb at that time and we naturally hit it off. One of the cardiology residents, who must have overheard us talking enthusiastically about low-carb, walked in and, uninvitedly and sort of sneeringly, declared that “I think it’s an unhealthy diet”. Of course he did not factor into this comment my weight loss, blood pressure stabilization and blood sugar stabilization. (My endocrinologist has recently warned me that I will most likely become diabetic and actually urged me to maintain low carb, interestingly enough.) To my knowledge, most medical schools in this country offer very little in the way of nutrional education. So for a resident to make such a final statement about nutrition is pretty far out and I feel betrays ignorance. But it shows the institutionalized attitude. Most of the doctors I work with think I’m making a big mistake in low carb eating.
    Has anyone offered a commentary on Dr. Pi-Sunyer’s commentary? Has anyone else made a commentary on the study? I would tend to doubt it due to the herd mentality out there, but I’d be interested to know. I think you did a great job in dissecting both the study and Dr. Pi-Sunyer’s commentary.
    One small critique – the saying is more along the line of garbage in, garbage out (GIGO), but I got your meaning immediately anyway.
    Last but not least I really enjoyed your photo food diary. It was just great and I think made an important point about low carb and about food and eating in general – and lifestyle (though I probably won’t be imbibing in pickle juice any time soon). I was fascinated by the commentator who told you that you have no idea how hard it is to lose weight – and one of the reasons is that you’re a man. Absolutely hilarious. Let me say that you and MD are big inspirations for me and I’m a big fan of your published work and this blog. Keep up the very good work and thank you. Jim
    Thanks for the kind words. And thanks for the heads up on the GIGO, which is what I meant to write. I’ve gone back and changed it. Don’t knock pickle juice until you’ve tried it. 🙂

  18. Based on my own experience, I wouldn’t necessarily assume that the study participants are misrepresenting their food intake. I’m mid-40s, and I’ve noticed that I can maintain or gain on increasingly less and less food. I’ve been tracking on Fitday for years and I measure my food carefully. Right now, to maintain my weight of 140 or so at 5-5, I need to keep calories under 1800 AND carbs under 30. And I exercise regularly–interval cardio and weights.
    Because of Holiday “splurging” I’ve gained 8 pounds (!) in the past 2 weeks consuming an average of 1898 calories and 35 net carbs daily. I can’t even imagine what would happen if I ate 200 g carbs per day.
    Dr. Eades, you have a lot of middle-aged women in your practice–is this common?
    If you take a look at this post, you can see the difference between a lower-calorie low-carb diet and a lower-calorie high-carb diet. There is a huge difference. Most people can maintain on fewer low-carb calories than they can on low-fat diets.
    It is common among middle aged women.

  19. ME: “Most of this goes to the central nervous system. If we say that 90 gm per day goes to the brain (I’m just guesstimating here – I don’t know the actual values), then we can say that 90/24 or about 4 gms per hour go to fuel the brain”.
    I think you are about right. I am willing to bet that this information does not exist or if it does it has not been published.
    Please bear with me. I am trying to take this issue somewhere.
    My next 2 questions are:
    1. What is the approximate glycogen storage capacity (in grams) for a 150 pound male subject?
    2. How much glucose does a gram of glycogen yield?
    If you include both muscle and liver glycogen, your talking about around 200-300 gm storage capacity. Maybe a touch more, but not much. Since glycogen is, like starch, just a bunch of glucose molecules hooked together, it should yield almost a gram of glucose for each gram of glycogen.

  20. Wow, more than 200 grams of carbs for a diabetic person over 60 and still called low carb? I need those scientists when I am ready to start selling Brooklyn Bridge soon.
    So let me get it right, using their logic , if I weight 220 pounds at 5″‘9 among other two groups of people who weight 250 and 270 pounds respectfully I would be in a skinny group? If 200 carbs is still low carb, I am at 220 pounds a fitness model. How come noone yet called me? Shocking, I must fire my agent!
    Dr Mike how are those football picks going? BTW are you betting on college football or NFL?
    Strictly NFL. I’ll do a little betting on the bowl games, but that’s about it for college. Going so so this year. I’ve got a bet right now on Dallas -3 points that’s looking pretty good, but it ain’t over til it’s over.

  21. Am I correct in thinking that the data are ALSO of insufficient quality to make any resounding conclusions regarding the glycemic index?
    You are correct.

  22. Pi-Sunyer isn’t just a flak for the food industry; he’s also lined his pockets with money from Weight Watchers and pharmaceutical companies that produce weight-loss drugs.
    He’s one of the bigwigs promoting the idea that obesity is a disease — which it isn’t. It can be a symptom of disease (insulin resistance and Type II diabetes, for example) but it’s not a disease in and of itself. But if he can get it officially classified as a disease, then weight-loss drugs will qualify for insurance coverage, greatly enriching his benefactors.
    He doesn’t want low-carb diets (true low-carb diets, that is) to become the preferred treatment for weight loss; how the heck would Lilly and Knoll make any money from that approach? How would Weight Watchers continue selling their high-carb, low-fat “Smart Ones” meals?

  23. Dr. Mike:
    Right on about the pickle juice. Actually the less people that know how good it is the better for us, as in MORE for us. I can’t tell you how many fights we had over the pickle juice when I was a kid still living at home. Now I can have it ALL.

  24. ME: If you include both muscle and liver glycogen, your talking about around 200-300 gm storage capacity. Maybe a touch more, but not much. Since glycogen is, like starch, just a bunch of glucose molecules hooked together, it should yield almost a gram of glucose for each gram of glycogen.
    So about 800-1200 calories worth of glycogen is the storage maximum. Far less than the typical energy requirement for a day.
    I found a paper recently (sorry I can’t locate it right now) where the researchers discovered that gluconeogenisis shares a common pathway with glycogen. Specifically, glycogen can either be converted directly to glucose in one path or through an indirect path with gluconeogenisis.
    Up until this research was done it was thought that glucose was produced directly from gluconeogenisis. But the researchers found that glycogen is produced as an intermediate and that glucose is then produced from glycogen. No one seems to discuss this. But I think there is significance to this shared pathway.
    As I understand it all these pathways are in action all the time. At any give time, one is dominant, but they are all still operating to some extent. There probably is significance in the shared pathway.

  25. Dr Eades you bet against my NY Giants! Congratulations though, you won! My girls lost tonight, but we have lots of injuries, not that its ever an excuse in football! Everyone goes through that!
    On another note, did exercise ever factor into this study ?
    On another seperate note, if one eats lots of carby junk while being in ketosis and than does HIIT exercise. After intense work out, would that person be out of ketosis, or given the fact that that person used up that carb junk for exercise, he or she would still technically be in ketosis?
    Exercise did not factor into this study. I doubt that one would be in ketosis after a HIIT workout if one had loaded up on junk carbs before.

  26. He doesn’t want low-carb diets (true low-carb diets, that is) to become the preferred treatment for weight loss; how the heck would Lilly and Knoll make any money from that approach?
    They would create a mutant breed of steer with three eyes, patent it, call it NuCow and charge us $1,800 for a protein-style burger.

  27. I agree with the Contessa. Of course food diaries are wildly imprecise and people may be especially inclined not to write things down when they’re non-compliant. Still, I’m pretty sure I’m not alone in the observation that 1500 calories biased towards simple sugars would have me at best maintaining even though my BMR is allegedly 1350 and my activity level is relatively high (exercise 4-7 days/week)…I am still a good decade from middle-age and first noticed this in my early 20s.

  28. Speaking of worthless data here we go again on the ‘genes are the cause of obesity’ theory.
    “Seven new gene variants discovered by scientists suggest strongly that obesity is largely a mind problem”.
    http://news.bbc.co.uk/2/hi/health/7783088.stm
    But wait. There is a voice of sanity.
    “However, Professor Peter Weissberg, of the at the British Heart Foundation, expressed caution.
    He said: “This research adds to the growing body of evidence that some people are more at risk of becoming obese because of their genes.
    “However, this cannot be the explanation for the current epidemic of obesity since these genes have been present for centuries and the obesity epidemic is a relatively new phenomenon.”
    True. But blockbuster drugs are a new phenomenon. And the gene theory opens the door to the lucrative field of the drug treatment of obesity.

  29. Oh, for pity’s sake. A 10% reduction, more or less, is a low-carb diet? That’s like taking pack-a-day smokers, cutting them down to a mere eighteen cigarettes a day, and then concluding that quitting smoking doesn’t provide any measurable reduction in emphysema and lung cancer.
    Good analogy.

  30. I am skeptical of the Mifflin equations because I know I can maintain on fewer calories than they calculate. Do you know the percent error rate (hard for me to find)? Do you know if their original data set included people of BMI > 40? Middle aged women? just curious thanks
    You can read all about it here. The papers indicate the the Mifflin-St Jeor equations are the most accurate of all the equations out there, but don’t hit the nail on the head in all cases. Another study out there that was a poster presentation and can’t be linked to, shows that the Mifflin-St Jeor equation worked the best in determining the RMR for obese middle-aged females.

  31. Dear Dr. Mike,
    I ‘d like to thank you for all the valuable time that you consume educating the readers of your blog. For every commenter who is annoying or idiotic (not on this post, but on several of the recent ones), there are at least hundreds of us who read your blog faithfully, pass your wisdom on, and pray that you won’t wear yourself out before your philosophies do indeed achieve “world dominion.” The difference that you have made in my health and the health of many of my friends is extraordinary. I have all of your books and will be ordering your new book through this website. I have also asked my library here in King County (Seattle area) to order your new book (this might not help your bottom line much, but it might help the poor vegan souls who seem to populate this area of the world–well–maybe not).
    Thanks once again for keeping up the good fight.
    Thank you for the kind words. They are greatly appreciated. I’ll be in your neck of the woods at the end of this week for a few days pursuing my mission to change the world plus I’ve got a seat in one of the executive boxes in Seahawk Stadium to watch the Seahawk – Jets game. Hope the weather is good.

  32. hey doc
    Just asking a question as it’s something I don’t know much about. Are carbs required at a higher level in the diet during childhood and early adult development?
    I’m actually a carbohydrate chemist and got into the argument of whether or not there were essential carbohydrates (analogous to amino acids) and although I was successful in the adult argument of proving there isn’t, I just don’t know enough about childhood development to have any idea.
    There are no diseases of carbohydrate deficiency in childhood either. Children are better able to tolerate carbohydrates than many adults, but carbs are not required nutritionally for growing children. Eskimo kids get on fine with the lowest of low-carb diets. But many children in primitive societies who consume low-carb diets are breastfed longer (by several years) than children in Western societies. Breast fed does contain a higher carb level than a strick low-carb diet, but I still don’t think that carbs are essential for the diets of children.

  33. ME: As I understand it all these pathways are in action all the time. At any given time, one is dominant, but they are all still operating to some extent. There probably is significance in the shared pathway.
    OK, so we agree here. This raises a number of issues. The first being “what is the purpose of glycogen reserves”?
    Papers on glycogen and gluconeogenisis typically state “Glycogen reserves are quickly exhausted by vigorous exercise or fasting”. It seems apparent that glycogen reserves can not possibly serve as a storage repository for endogenous glucose production sufficient to carry us through extended fasts. Glycogen storage has only a small fraction of the energy capacity of fat storage. And once the limited glycogen storage repository is full, any excess glucose is converted to saturated fat through the process of glycolysis and stored as abdominal and visceral fat.
    If we agree that gluconeogenisis and glycogen conversion are simultaneously active then it seems probable that the glucose to glycogen path is some sort of buffer for glucose surges resulting from excess exogenous carbohydrate loads (‘excess’ is probably anything over and above a small carbohydrate load). The reasoning behind this theory is that while it is true as many carbohydrate proponents claim that the brain requires a steady supply of glucose to function they fail to mention that the brain requires a steady supply of glucose in a very tight BG range for optimal function. If the brain runs exclusively on glucose it seems reasonable that some sort of process would be in place to manage glucose surges arising from exogenous glucose loads which can only come from carbohydrate.
    Can you buy into the above theory?
    First, excess glucose is converted to fat in the liver through the process of lipogenesis, not glycolysis.
    Second, you may have to explain it to me again. I’m not sure I’m getting your point.

  34. I’m one of those plateau’d middle aged women, but right now I’m perplexed by a rash that only shows up when the carbs are kept really low. They are on the … er… bra line on one side but not necessarily on the other. Am I outgassing some kind of toxins with my sweat during ketosis? I do work out fairly seriously, 3-5/week, and it seems to require both sweat and ketosis.
    I doubt that your ‘outgassing’ any toxins that might be causing the problem. I would think it would be more like either an allergic reaction or a sensitivity reaction to something on the bra in that area. Once a rash occurs in a certain spot, then it often comes back there because the skin changes a little. Not forever, but for a period of time during which several rashes may break out. I can’t think of why it occurs only when your in ketosis other than it may affect the acidity level of the sweat.

  35. “Apparently low-carb makes us more stupider fastly.”
    I don’t know how you can argue with 17 subjects tested over 2-3 weeks. Sound pretty conclusive to me! It sounds like an undergraduate class project (from the MBA program).
    Quality notwithstanding, “He who buys the most science wins”. The Egg Nutrition Center, located conveniently in the center of poultry heartland, Washington DC, is fighting back. Send them your low-carb dollars.
    “New study ‘pardons’ the misunderstood egg.” … “Research has found that overweight men who eat eggs while on a carbohydrate-restricted diet have a significant increase in their HDL levels (the “good” cholesterol) compared to men who do not eat eggs.(2) ”
    ‘scuse the cynici$m.

  36. Dear Dr Mike! I have a question for you even though it might not be your expertise or another question on line that is so hard to answer not knowing other details. However I will give it a shot. My husband needs to lose way in the worst way. I was finally able to convince him to try low carb at least until the end of the year. That was out deal! Yesterday was his first day. He said he ate few nuts and drank few protein shakes. He drank ton of water with lemon in it with a bit of salt per my recommendation to prevent dehydration. This morning while asleep he was whispering ”call an ambulance please” few times than kept saying why noone believed him that he was fainting. Mind you he was asleep. I woke him up and he said he didint feel good. He claimed he had a nighmare and was kind fainting in his sleep and couldnt wake up. He was visibly shaken and his heart rate was really fast. He also complained of very dry mouth like a sandpaper and bloated stomack. I wanted to go to the hospital but being the macho man that he is, he refused. He did some push ups, lol, dont know why and felt better. He felt weak and kind of bloated for a little while and went to work. Her is a truck driver and at times sleep deprived. He said he is still not hungry at all and food is the last thing on his mind. Dr Eades have you ever heard of anyone feeling faint in their sleep or is my husband a freak of nature? could all those symptoms be withdrawal and panick attack from ketosis? I know its hard to say but any guestimation based on your experience?
    I couldn’t possibly make a diagnosis based on the information given without examining your husband. If I had to make a stab at what happened, I would say that he probably was a little dehydrated and a little sodium and maybe even potassium depleted from being in ketosis all day. But that’s just a guess.

  37. the study noted above is fairly suspect, especially considering the title and thesis focuses on the negative effects of low carb but notes this at the end:
    “low-carb dieters actually responded better than low-calorie dieters during the attention vigilance task.ts in this study…. the only mood difference between dieters was confusion, which was higher for low-calorie dieters during the middle of the study.”
    reading the above tells me the story could have easily been titled “low carb diets shown to improve attention vigilance and mental clarity over traditional low-calorie high carb diet”
    i get confused and sloppy if i dont get a morning coffee becuase i have one every day, of course if you take it away i fall apart, how could a short term study take what could be widthdrawl symptoms and implicate low-carb? hogwash!

  38. Hey Dr. Eades,
    I’ve been reading your site for quite some time now and I’ve just now felt compelled to share something. I stumbled upon a recent study and I’d like to get your take on it since you seem to be one of the foremost experts in sifting through you know what!
    http://jama.ama-assn.org/cgi/reprint/300/23/2742
    All the Best,
    Andrew R
    This isn’t a bad study. It simply shows that lower glycemic carbohydrates tend to produce lower blood sugar levels in diabetic patients than do higher glycemic carbs, which would be expected. The interesting thing about this study – to me, at least – is that the high glycemic diet was also a high fiber diet, and the fiber didn’t do squat to counter the blood sugar raising properties of the high glycemic carbs.

  39. Just read about results of a study presented at the American Society of Nephrology’s 41st Annual Meeting in Philadelphia linking low potassium to high blood pressure. Is this suspect of the same type of manipualtion? They did mention a possible genetic link and the fact that the study did not consist of a controlled diet. They are now doing a more controlled study with strict diet to determine how strong the genetic component. A case of which came first, the chicken or the egg, or deja vu all over again?
    I think there probably is a correlation between low potassium and high blood pressure. People who get plenty of dietary potassium typically have lower blood pressure, so it makes sense that those with low levels may well have high blood pressure.

  40. 200g. That’s what they’re calling low carb. Right.
    Are there any other areas of science where they could get away with such obvious academic fraud? I mean if you put out a paper claiming that you’ve come to a conclusion about a certain subject, don’t you at bare minimum actually have to be studying the the subject you claim?
    One would think so.

  41. The GOV recommendation is for 45-65% of your calories to come from carbohydrate. For 2300 calories, that is 260-374 grams. For most Atkin-ers, they consume under 100g of carbs/day. Whatever that study was, it wasn’t what they claimed. First, they were all under the recommended carb intake, and yet the low carb wasn’t low enough to be considered ‘low carb’
    Let’s see someone try a real study…
    60-70% carbs (low GI)
    60-70% carbs (high GI)
    10-20% carbs (low GI)
    10-20% carbs (high GI)

  42. Dr. Eades,
    Sorry to go off topic but have a question for you. While I try to eschew all sweeteners, natural or artificial, if one has to choose a sweetener to cook with, what would you recommend?
    I assume a natural sweetener that is low in fructose, no? Or perhaps stevia or Splenda?
    This post here: http://www.modernforager.com/blog/2008/04/18/what-sweetener-should-you-choose-sugar-honey-agave-nectar/
    ends with the recommendation of: none.
    Any insight? Thanks in advance.
    I would prefer no artificial sweeteners, but if I had to use one, I would use Splenda. It’s what we use whenever we use an artificial sweetener. If we choose products containing artificial sweeteners, we choose only those that contain Splenda or Acesulfame-K or both. We avoid aspartame. Occasionally we drink Diet Tonic Water, which, for whatever reason, is always sweetened with saccharine.

  43. Just want to thank you for the recommendation on the Lux Aeterna. I decided to start with the Polyphony/Britten Sinfonia. It arrived yesterday, and I stuck it in my PC optical drive – and then sat there in a trance through all five movements. This will take a lot more listening… wonder how much rehearsal it took before the choir got it, especially the Introitus.
    In answer to your question about the GSD, yep that’s our boy. He just turned 1yo. Handsome fella, isn’t he? He’s on a low carb diet too 🙂 Oh and have fun in Seattle. Weather is looking fine, if you’re a skier.
    I’m glad you enjoyed Lauridsen’s Lux Aetarna. I just got the same recording you did, which I like a lot. The one I listened to the most is the other, the recording with the LA Master Chorale. I also listened to it all over Europe with my wife’s choral group. They did a very good job on it. And the European audiences loved it.

  44. Dear Dr. Mike
    Thought you might find this interesting…Apparently Paul McCartney (I suppose that he is a “Sir” now), presumes to lecture the Dalai Lama both on nutrition and right living:
    “In his never-ending fight for the cause of vegetarianism, Beatle Sir Paul McCartney has lashed out at The Dalai Lama for eating meat – and supposedly contradicting his Buddhist beliefs.
    The famous singer initially tried to convert the Tibetian Spiritual leader to vegetarianism, insisting that it was “wrong” to eat meat.
    In his tirade, McCartney wrote to The Dalai Lama to highlight that meat eaters create suffering for animals, and that this fact contradicted a basic tenant of Buddhism that its followers should “not cause suffering to any sentient beings”.
    When the Dalai Lama explained that he had been told by doctors to eat meat for health reasons, this wasn’t enough for the passionate superstar.
    “I found out he was not a vegetarian, so I wrote to him saying ‘Forgive me for pointing this out, but if you eat animals then there is some suffering somewhere along the line’.” He told prospect magazine.
    “He replied saying that his doctors had told him he needed it, so I wrote back saying they were wrong.”
    The high profile champion of the vegetarian cause has not made his invective exclusive to his holiness; he recently labeled celebrity chef Gordon Ramsay “stupid” for making disparaging comments about the vegetarian cause.”
    http://imusicparadise.blogspot.com/2008/12/mccartney-lashes-out-at-meat-eating.html
    Perhaps this is an example of vegetarian brain shrinkage?
    Thanks for all you do!
    I suspect it is an example of vegetarian brain shrinkage along with having too much money. Why should anyone listen to what Paul McCartney has to say about anything that doesn’t involve music? Does he have any expertise in nutrition other than his obvious bias? Why the media bothers to report anything that a twit like this has to say about anything other than music is beyond me.

  45. @ Kelly,
    Weirdly enough, I have the same problem. I’ve gone back to near 0 carbs for the past few weeks to lose the extra pounds that slam on from autoimmune thyroid trouble, and have gotten recurring outbreaks only on the right side.
    Mike, do you think the change in acidity could make us more susceptible to the staph already present?
    Perhaps, but it would be a change in acidity the other way that would make on susceptible, I suspect.

  46. Hello DR EADES !! And Merry Christmas to you, your friends and families !!
    Good to see you again !! You know doctor, i am a person who respects other people’s personal choices. And i respect whatever people want to do and think about with their own personal lives.
    However i like to critisize society and its problems. For example, i critisize how USA society puts so much emphasis on food, on getting pleasure out of eating, on killing emotional pain with junk fattening foods.
    I mean i think that it is a revolutionary time for the revolutionary anti-corporate doctors of America to take the obesity-bull by its horns and tackle the problem of obesity with no biases and no bulls. No matter what corporate medical establishment says. If the problem of America is the excess of carbohydrates, then let’s attack it without mercy.
    It is time for a real war on the real terror of America which is the excess of carbohydrates in the plate of americans. It is time for USA as a whole to find other hobbies, to motivate people to do other pleasurable hobbies other than eating, perhaps more social-related hobbies, more social actitivities. Me and my dad went to Kroger Supermarket today for some christmas food and i am outraged by the excess of cakes, pies, fattening junk christmas foods literally all over the supermarkets, forcefed on our eyes.
    And no wonder why America is fat. And i really think that this *slavery to food* kills the will of people to participative in other more healthy addictions other than eating.
    Here is an article which talks about the excess of eating and gluttony around christmas time
    THE GHOSTS OF CAPITALIST CHRISTMAS, AND THE BINGE-EATING OF APPLE PIES, PECAN PIES, EGG-NOG, HAM, BREADS, TURKEY, AND DESSERTS, IN CHRISTMAS
    By Charles Sullivan
    http://www.informationclearinghouse.info/article18785.htm
    11/28/07 “ICH” – — Everything about America is done to the max—super sized—including ourselves. Americans are fond of excess, fond of glitz and glitter, the bright beads and trinkets of capitalism; the symbols of conspicuous consumption. Millions of us live in McMansions, drive fast cars and hulking tanks and work at high stress glamorous jobs that provide enormous financial reward but leave us spiritually empty.
    We tell ourselves that these events signal that we have arrived and achieved greatness worthy of respect and envy. They are a declaration that we have played the game and won; that we have acquired economic power that results in elevated socio-economic status and disproportional influence over the lives of the less successful; and those who have utterly failed or refused to participate.
    We love to consume and waste with an appalling sense of entitlement. Our lives are enacted amid heaping mounds of swelling garbage and filth, while some of our fellow human beings pass lives of quiet desperation in cardboard boxes beneath our nation’s highway bridges, like beetles that move beneath the bark of trees: out of sight, out of mind, inconsequential—or so we think.
    It’s a jungle out there where only the fittest survive. Those who cannot compete must not survive to reproduce; they must be expelled from the gene pool. Modern capitalism is economic Darwinism carried to the extreme.
    America is a land of extraordinary contradictions. She has produced not only George Bush and Dick Cheney but also George Carlin, Upton Sinclair, Eugene Debs and Howard Zinn. This is a land of extremes; enigmatic even to itself. It is a place of posh surroundings with all of the amenities money can buy; but it is also a land of unknowable hardship and destitution that often exists in close proximity to stupendous wealth.
    Just as the continent holds lush temperate rain forests, so it also harbors deserts where only the strong and well adapted survive the harsh conditions of heat and drought and oscillating cold.
    Surely the national pastime must be shopping, which has acquired the stature of a genuine addiction; a disease on a par with alcoholism and played with the passion of a competitive sport. Witness the insanity of black Friday, the busiest shopping day of the year where people are annually trampled at the doors of Wal-Mart in the quest for the latest incarnation of the X-Box. He with the most toys wins and the losers are trampled underfoot, ground into dust. Possessions matter more than people.
    And we are a restless, fiercely competitive people—constantly on the move; a people that cannot countenance open spaces or unmanaged nature.
    Hundreds of thousands of shopping centers and strip malls bear ample testimony to our excess, as do the mountains of debt that rise out of our spending habits like a newly spawned volcano swelling above a rising column of molten magma. Eventually they will become our gravestones—monuments to our lack of empathy and testaments to our unbridled greed and contempt for the earth.
    The developers cannot relax until every inch of the earth is urbanized and paved and there is a McDonald’s and Wal-Mart on every street corner; a development in place of every orchard and farm. We cannot relax until everything wild and natural has been eradicated or imprisoned in zoos and admission is charged. Imagine a continent sized gated community for the well-heeled and the wealthy. The poor and destitute need not apply.
    More than democracy, more than liberty, more than life—give us our shopping malls so that we can purchase happiness and fill our empty lives with possessions. Our senses are incessantly assaulted by merciless commercialism—we are programmed to consume and to be consumed by our programmers in the advertising industry whose job it is to plant the seeds of want in our all too receptive minds. Conspicuous consumption is the cornerstone of mature capitalism and no people in history have been more prominent consumers than we Americans—as measured by the girth of our waistlines and the girth of our mounting debt.
    But as much as we are the products of Madison Avenue advertisers, we are also products of arrested psychological and spiritual development. We exhibit extreme pathologies because our lives are not rooted in nature and community; nor are they rooted in reality. Like spoiled adolescents, we have locked ourselves away with our box of toys and we call the world our own. We are a danger not only to ourselves but to the entire world. Quarantine should be drawn around us lest we infect the rest of the world with our madness.
    Oblivious to the consequences of our own excess, our sphere of caring rarely extends beyond the self and our immediate families to the communities in which we are embedded that in turn spill into the great world beyond. We have erected psychological and physical barriers that isolate us from the rest of the world which have given rise to pathological visions of grandeur and exceptionalism. And, like a run-away virus, we are replicating our madness to the rest of the world which is, thanks to the disciples of Milton Friedman, seeking to emulate our example.
    Better the world turn away and run for their lives as if we were infected with a new strain of pox or rabies. Better they should save themselves and let us perish, as will surely occur when we are consumed by the festering sewers of our swelling vanity.
    We call ourselves a free people but we are prisoners of our own petty desires; prisoners of greed and excess and manufactured want; the products of capitalism taken to the extreme—replicating with the ease of cancer cells unrestrained by reason or empathy for others and for the earth. The world cannot tolerate another America . She cannot much longer sustain the one she already has. We have a carbon footprint vastly disproportional to our numbers and we are not only blotting out the sun; we are stamping out countless species of plants and animals and casting them into the abyss of eternal extinction. The ecological cost of our excess is incalculable.
    We go on as if there are no consequences to what we do, ignoring the wolves baying at our door and the grim reaper peering at us through the curtain. We tell ourselves they are only apparitions of conspiracy theorists and alarmists, the ghosts of misplaced conscience.
    Millions of Americans are experts at self-denial and delusional to the extreme, while others are realists and components of active resistance. But, cause and effect rarely enters our vocabulary. History, science and ethics are not our strengths—we prefer to go shopping or watching television, giving no thought to the kind of world we are leaving our children and their off spring, much less the offspring of other species. We hold that the universe turns on its axis and we are its center; but it is not so.
    As a result of our excesses, terms such as ‘peak oil’ and ‘peak water’ have come into existence. Gluttony occurs on one end of the supply chain at the expense of the other; just as food webs are affected by events occurring at all parts of an ecological web the size of the world. One cannot pluck a flower without also troubling a star. All things are interconnected.
    How easily we forget that commercial exuberance rests on the broken bodies of the exploited worker; it rests on the scrolls of flora and fauna that have been pushed out of existence because there isn’t enough room for them and us with all of our precious, energy consuming toys.
    Thus we live in a world that is not enriched by our example but is diminished by us. Injustice is a byproduct of commercial exuberance as manifested by declarations of superiority through class warfare and other avenues of inequality. And it is felt in the dimly lit sweatshop somewhere in the belching slums of industrialized China , engulfed by the droning hum of sowing machines that never cease behind bolted doors; and guided by gnarled hands attaching Nike labels to athletic apparel destined for upscale Target and Macy’s stores in the US .
    True, capitalism has made cheap products available to the voracious American consumer; but it has also given the world preemptive war and famine, global corporatism, pestilence and wage slavery; it has stoked the fires of mass extinction, global warming and ecological collapse—all of which have acquired an unstoppable momentum of their own with unimaginable consequences that extend indefinitely into an already uncertain future. There are consequences to everything we do, just as there are consequences to inaction.
    Yet it is increasingly obvious that too few of us care enough to take action, as long as we are free to buy and to consume. We keep the consequences of gluttony out of sight and out of mind and pretend they aren’t there. But they are present and they matter.
    And this brings me to the main point of my essay: it cannot go on. The age of exuberance—like the age of cheap oil—is mercifully drawing to a close. So I will say what was never meant to spoken aloud in the land of excess; and I will say it loud and clear so that it cannot be mistaken: Americans must dramatically simplify their lives to want less and learn more. We constitute less than five percent of the of the world’s population while usurping more than a quarter of her bounty. This is not acceptable—nor is it ethical.
    No one has a moral right to take more than their fair share when that taking jeopardizes the chances of others of living a decent life, or makes nil their chances for survival—including other species.
    Contrary to what one might think, we do not have to live like third world nations or like the hunters and gatherers of the past. But we must dramatically reduce our consumption and shrink our carbon footprint. Not only must we live within our own means but within the means of the planet to support us.
    The majority of our food should be locally grown and mass transit must supplant the gluttonous and polluting automobile that proliferates on our nation’s highways. Moratoriums on development and urban sprawl must be enacted in order to protect critical habitat and rainwater recharge areas. Cities and towns must be redesigned and revitalized with sustainable industry. Goods and services, including work and jobs must again, as they were in the past, be rooted in vibrant, small scale local economies; and free trade agreements revoked.
    Technological advances—no matter how boldly they are touted as saviors of humankind cannot increase the world’s carrying capacity and they cannot invoke justice. The latter is entirely up to us as sentient beings endowed with conscience. And this brings me to a second point: we must reduce the human population through adoption and cease to procreate for at least one generation—so that the earth can recover her carrying capacity. What better way to save the world, literally.
    Simultaneously simplifying our lives by wanting less and reducing the human population will allow room for other people and other beings to share the bounty of the earth. And it will almost certainly have a beneficent rather than pathological social and psychological consequence: it will end our isolation and reconnect us to the rest of the world. We could finally realize our enormous potential to become world citizens and good neighbors worthy of respect and love.
    Rather than an economy based upon savage greed and exploitation, let us create an economy based upon justice and equality, need rather than excess; a society that does not leave people behind but invites the full participation of everyone and recognizes that, “An injury to one is an injury to all.” Let it be all inclusive and worthy of respect: where every woman, man, and child, every being of this earth is the same under the law and equally respected and valued—a great global community seeking harmony rather than competitive advantage.
    In the end, equality is beholden to the system we choose. Did we ask that the world be run on the profits of greed, or the prophets of wisdom? Where was that democratic choice? The profits of greed have given us voracious greed, consuming everything in sight; but they didn’t give us a choice; they took away our freedom and made us into lesser beings. But, if we are to muster ourselves to call ourselves Human one last time, where the prophets of wisdom really did have something to say, where people and the planet are put before profits in the Golden Rule, and where we have one large collective foot standing on the profit of greed then maybe, maybe YES we will turn this thing around: http://www.planetization.org/.
    Charles Sullivan is a nature photographer, free-lance writer, and community activist residing in the Ridge and Valley Province of geopolitical West Virginia .
    He welcomes your comments at http://us.f362.mail.yahoo.com/ym/Compose?To=csullivan@phreego.com.

  47. “First, excess glucose is converted to fat in the liver through the process of lipogenesis, not glycolysis.”
    My mistake. But this is incidental to the issue I am trying to get at.
    “Second, you may have to explain it to me again. I’m not sure I’m getting your point.”
    We agree that gluconeogenisis produces glycogen as an intermediate step in the synthesis of glucose, that gluconeogenisis and glucose/glycogen conversion are simultaneously active and that the conversion between glycogen and glucose is on 1/1 ratio. I could be wrong, but I suspect that the conversion between glucose and glycogen is a fairly fluid process. Everything I have read until I found this information suggests that gluconeogenisis only becomes active when glucose levels falls below a certain threshold. If gluconeogenisis is active concurrently with the glucose/glycogen conversion process there has to be a very good reason for this.
    Do agree with this conclusion?
    I figured that you simply made a mistake on the first. Just wanted to make sure.
    I’m not sure I impute the importance to the fact that gluconeogenesis and glucose/glycogen conversion operate to some extent simultaneously. I look at the process as kind of like driving a car in traffic: you are constantly using both the brakes and the accelerator with the goal being to move the car along without an accident. These processes are the same: they are constantly keeping the body functioning with a little glucose brake and accelerator.

  48. I have lost 7st of FAT – yes FAT not water not muscle but FAT – Adipose Tissue it has FINALLY gone. And i’m still losing weight.
    23 and i was 24 stone. I got to 21st the “healthy-way” but then it kept fluctuating between 21 & 20 and i still looked morbidly obese. Then one day at the library, with a couple of hours to use up, i decided to look up how the body creates Fat cells.
    Low and behold, i discovered that via the use of Alpha Glycerol Phosphate/Glycerol it binds Triglycerides & Fatty Acids together = Adipose Tissue. And people who already have fat only then need Glycerol to make more. AGP, I found could be discovered in Insulin and we secrete insulin (the fat producing hormone – why did it get that name i wonder? – this is a rethorical question) in response to the Carbohydrates in our diet.
    Then it hit me why i lost, & put on, all the weight so quickly when i previously did a Low Carb diet = very low insulin production = turns to the body’s fat stores for it. Then when i missed my bread – going back to a high Carb diet again of pasta, bread, rice = high insulin = because i couldn’t burn it off quick enough FAT.
    People then say its just because low Carb = low Kcal thats why! YOU ARE DEAD RIGHT !
    I agree with you but why is THIS LOW KCAL diet that the FAT Is NOW Going?…
    Why not when i religiously did all the other lowkcal diets provided by my Dr ?
    I didn’t do it and say i’ll never eat carbs again. I went back to the current ‘healthy’ diet – sticking to the rules and i gained 1st 2lbs in 2days – I was initially going to eat Carbs for 2weeks but that was all the evidence i needed to show me they are the problem.
    Removal of them, by a limited amount 20g, i’m now 14st. And to people who want to argue against it saying its water loss, muscle loss. Try telling my family i had even 2st worth of muscle on me and you’ll be laughed at and water loss? Well its strange that loss of water also means loss of adipose tissue and also strange its all from the waist 54inches to 32.
    And now after reading & watching Gary Taubes the science has been completely confirmed.
    The ‘healthy way to eat’ is not similar to 1st law of thermodynamics as it has no arrows of causality and they need to be dependant variables.
    The science behind low Carbs walks all over the effectively failed low Fat/kcal hypothesis.
    ”What right, has the federal government to propose that the American people conduct a vast nutritional experiment, with themselves as subjects, on the strength of so very little evidence that it will do them any good? They say that they won’t except any new evidence unless it is backed by overwhelming evidence to the contrary.”
    What are they going to need do you think Dr Eades ? They never had overwhelming evidence to place this to begin with. Atkins has showed that its worked on 25,000+ people. Ancel Keyes’ data has shown to be wrong in many areas. What will it take do you think for them finally to wake up and see they are promoting the wrong diet.
    It will probably take the deaths/retirement of the current crop of ‘experts,’ most of whom are in their 70s right now. Sadly, science doesn’t forge ahead because of new discoveries but by the loss of the mainstream standard bearers by attrition.

  49. Hi Dr. Eades I’m writing to let you know I’ve just learned about your blog. It’s wonderful, helpful and truthful.
    A dear friend and colleague of mine Dr. Heidi Dulay, has had your book “Protein Power” on her recommended reading list for her nutrition students and clients for ten years.
    Plus she uses your carb counter – over Atkins1.
    Dr. Heidi also wrote a short report … “Did the Surgeon General Get It Wrong about Weight?” Given your perspective on low carb, I thought you might enjoy it.
    http://wholefoodnation.com/newsite/articles/surgeon_general/page1.html
    It is based on what you teach and what she has learned from Taubes and other researchers.
    I look forward to learning more about your site and work. And I will pass it along to others.
    Robin Plan
    Thanks for the link. Nice summary of the problems with low-fat, high-carb, low-calorie diets.

  50. Quote of the day: Behold the Woman
    “Whatever you give a woman, she will make it greater. If you give her sperm, she’ll give you a baby. If you give her a house, she’ll give you a home. If you give her groceries, she’ll give you a meal. If you give her a smile, she’ll give you her heart. She multiplies and enlarges what is given to her. So, if you give her any crap, be ready to receive a ton of shit.”
    Dr Mike do you agree with it? Lol, I definitely do!
    BTW tell me if its truly that loud in Seattle Seahawks home like people calim to be. And whos fan are you in NFL or you just like to pick your team and root for your bets?
    I am a fan of the team I have my bet on. If I have no bet involved, I tend to root for the Denver Broncos and the Dallas Cowboys. But I almost always have a bet if I watch a game.

  51. I’d suggest that Ms. Murphy go to Nordstrom’s to have her bra fit; most women are wearing the wrong size, and that will make any tendency to rash a lot worse. If the low-carb was for weight loss, she may have lost enough to make the band too lose, so it rubs more.

  52. @Daedala I have already looked at that issue as a possibility, I don’t think that’s it for several reasons. Several google searches indicate some people blame acidity changes and yeast for these rashes.
    Rash seems to be subsiding after several weeks, it is not troubling me even after yesterdays utter burner of a workout in honor of our dojo holiday party.
    @Leslie – I think if it were staph I’d be toast, I seem to be susceptible. Thanks!
    -K

  53. Dr. Eades,
    I read your material every day and share the highlights with my wife. Low-carb and no-grain works great for both of us.
    In her work my wife encounters a wide range of research in the sciences. We thought you might be interested to know (if you don’t already) that Ross L. Cagan at Mount Sinai has developed Drosophila as a whole animal model system for studing type II diabetes. It turns out the flies develop all kinds of diabetic syndromes as well as aspects of fatty liver, kidney and heart disease when fed a high sucrose diet, but not on high fat or high protein.
    fyi.
    Thanks. Sounds interesting. I didn’t know the Drosophila model had been developed.

  54. ME: These processes are the same: they are constantly keeping the body functioning with a little glucose brake and accelerator.
    Exactly. But I think the system exists mainly to handle exogenous glucose loads as opposed to endogenous glucose loads generated through gluconeogenesis. The fact that no one seems to be talking about this process suggests that not much consideration has been given to it. But I think it deserves more attention.
    Think about what happens when teenager with a robust BG management system consumes a typical lunch consisting of several hundred grams of carbs from a large order of fries drowned in ketchup, a giant burger, 2 or 3 16 ounce (or larger) soft drinks and a giant sundae for dessert. You talked about this in an earlier post where people in line for food keep filling up their large cups with Coke or whatever. A meal like this would dump about 40 teaspoons of sugar into the digestive system of which a good part of it may be quickly absorbed glucose in the form of liquid sugar.
    A potent first phase insulin response would blunt the initial glucose surge and keep BG under 140 mg/dl. Within 3 hours (maybe less) BG would back to the baseline of 85 mg/dl. As I understand the process the first and then the second phase insulin responses drove the glucose into the cells. Assuming the teenager was sitting around socializing with his friends he would not be burning more than maybe 6-7 grams of glucose per hour (1.5 teaspoons). So where did the rest of the 140 grams of sugar go? We know that the fructose went to the liver for processing. But if half the load was unbound glucose from HFCS this still leaves 60 grams of glucose. After insulin drove the glucose into the cells it had to have been converted to glycogen. But there has to be a limit on the rate at which glucose can be converted to glycogen. If the cells can’t convert glucose fast enough then one of the options available would be to start blocking (i.e. resisting) the entry glucose.
    There is also a limit as to how much glycogen can be stored. You think it is around 200-300 grams. You could be right. But has anyone actually researched this? Based on the principles of carbohydrate loading it seems likely that glycogen reserves would be maximal with a high carb intake and minimal when the carb load is low. If so, then this suggests that glycogen reserves and glucoseglycogen conversion exists to manage exogenous glucose loads. If so, what happens when the rate of glucose intake exceeds the functional limits of the first phase insulin response and glucoseglycogen conversion. Not good things I am willing to bet.
    I think the system was designed (by the forces of natural selection) to handle endogenous glucose loads, not exogenous. But our modern diet has forced it to try to handle an enormous endogenous glucose load, which is why we have a problem. The very best way to control blood sugars and other parameters of metabolic health is to leave them to the liver to manage. It’s only when we ingest a large load of carbs that the override mechanisms come into play and ultimately fail is if abused enough.

  55. Dr. Eades,
    So I’m eating dinner with some friends last night, and we begin to get into an argument over red meat. Of the three other people there, one says he has scaled it down because he has heard it causes cancer if eaten too much. The other two say that is true and that red meat causes cancer. I begin to argue with the other two that humans have been eating meat, including cows, for a long time, and people didn’t get colon cancer like they do today, hundreds of years ago. They argue with me that it only increases your risk, and that genetics plays into it, as well. They think that because one graduated having studied oncology pharmacology (or some variation of those terms) and the other biology, that gives them a better understanding of these studies (which I personally doubt they have read) and thus the ability to say red meat is bad. We came to a dead end when I refused to agree with them. Now, I haven’t seen the study or studies they claim are recent and in fairly respectable journals, but knowing you and your wife’s work, and your blog here, I felt justified in blindly disregarding their claims. I cannot tell you what a frustrating experience it was, however, especially having no information to directly argue their points. I can only imagine what you two have gone through in arguing yours. Have you recently read or addressed any of these studies that have come out? I can’t point to any specific ones (though I could try to call their bluff and tell them to point me to the correct ones) and have you had any opinions on them if so? I was just so mad; I need to get back at them! Haha. Thanks!
    Just ask them to direct you to the studies they believe show that red meat causes cancer. If they are able to muster up any studies, I’m certain that they will be epidemiologic (observational) studies, which are meaningless in terms of proving causation. Epidemiologic studies can be used only the develop hypotheses, not to demonstrate causality. And they can be fudged in oh so many ways as to make them totally unreliable for anything other than for people who don’t do real science to get their names on published papers. In order to prove that red meat causes cancer, researchers would have to gather a group of subjects, randomize them into a red meat group and a non-red meat group, feed them their respective diets for a number of years, then see who gets cancer and who doesn’t. No such studies have been done, nor are such studies likely to ever be done. In the absence of such studies, there can be no proof that red meat causes cancer irrespective of how many worthless epidemiologic studies show that it does. For what they’re worth, here are a couple of epidemiologic studies that show that meat should be part of a healthy diet. (You can get free full text of these studies by clicking on pdf in the upper right.) And these come from one of the Nature family of journals. Since Nature is probably the world’s most prestigious scientific journal, it will be hard to discount them by saying that these studies are from second class journals.

  56. ME: I think there probably is a correlation between low potassium and high blood pressure. People who get plenty of dietary potassium typically have lower blood pressure, so it makes sense that those with low levels may well have high blood pressure.
    From what I have read on magnesium if cellular magnesium levels are low and one is also deficient in potassium the magnesium balance must become positive before potassium will have any significant effect on BP. In terms of magnesium and its effect on hypertension when it is a factor it seems to take fairly large doses of supplemental magnesium to have an effect (about 800 mg/day). A lot of research intended to determine magnesium’s effect on hypertension failed because the dose was too low and/or forms of magnesium such as magnesium oxide were used.
    There was also at least one study where magnesium was given to one group of subjects and an anti-hypertensive medication was given to another to see if they would lower BP. Both groups had normal BP at the start of the study. As would be expected the medication lowered BP but the magnesium supplement did not. The researchers then concluded that magnesium has no effect on BP. But they forgot to stipulate ‘in subjects with normal BP”.
    I can’t imagine how someone could get plenty of dietary potassium and not get plenty of magnesium. It could happen, of course, with supplementation. But a whole-food diet high in potassium should be pretty high in magnesium as well.

  57. ME: I can’t imagine how someone could get plenty of dietary potassium and not get plenty of magnesium. It could happen, of course, with supplementation. But a whole-food diet high in potassium should be pretty high in magnesium as well.
    A diet of whole foods would be high in magnesium and potassium. But a diet high in refined carbs, especially sugars, is not only low in magnesium but the resulting high BG levels which will cause a loss of what little magnesium is in the food. In addition, if a grain allergy has resulted in long term polyuria and urinary urgency such as I suffered with for many years then one can become chronically magnesium deficient. I realize now that for all these years I was leaking magnesium like crazy every time I urinated. The problem is that unless one figures it out like I did it is unlikely that any health care professional will clue in.
    One of the strongest indications I had of the existence of a serious magnesium deficiency was heart palpitations so strong at times that they literally shook my whole body. My grandmother also suffered from such palpitations which suggests that I may have a genetic requirement for more than normal amounts of magnesium. One of the first things I remember as an infant was hearing my heart pounding in my sleep.
    Now after several months on high doses of magnesium I am free for the first time of any palpitations so much so that I can’t even feel my heart beating when I place my hand over it on my chest. In addition, a chronic problem of dry flaking skin and spotty inflammation on my face that I have had since I was a teenager has also cleared up so remarkably so that people have started to comment on how young I look.
    Before I started taking high doses of magnesium I took large doses of potassium with no effect whatsoever on my BP.
    Interesting history. Thanks for passing it along.

  58. Red meat doesn’t give you cancer. A study told that people who eat more meat got more cancer. They could have eat more sausages with a lot of shit ingredients and they could have folloing the advice to use instable polyunsaturated oils in their cooking.
    Red meat and butter is probably only good for your health.
    A low carb high fat diet is the ultimate diet for all humans. That means less than 60gram carbohydrates a day. Look at Weston A Price to see what I’m talking about.
    Guts and grease!!

  59. I have a question though and I hope you will be able to answer it soon, though it is not entirely related to this topic … On a low carb diet – what do you eat when you have a stomach virus? There has been a bug sweeping through our community and it got me the other day. Basically, I fasted until the symptoms began to subside. When that happened, though, I did NOT feel like eating eggs, meat, or cottage cheese!!! I ate crackers, bananas, and some chicken noodle soup … I’m just wondering what you would recommend during illness that would be palatable to the ill stomach but still on the list of good food choices.
    The best thing is to sip clear liquids at first (Gatorade light isn’t a bad choice), then I like to move on to bouillon.

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