FAT REFORM: OBESITY, FOOD POLITICS AND THE PERILS OF DIETARY CARBOHYDRATES
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Transcript of FAT REFORM: OBESITY, FOOD POLITICS AND THE PERILS OF DIETARY CARBOHYDRATES
FAT REFORM:OBESITY, FOOD POLITICS AND THE PERILS OF DIETARY CARBOHYDRATES
Jeffry N. Gerber, M.D., Denver’s Diet DoctorFamily Physician, Littleton Colorado DenversDietDoctor.comfacebook.com/DenversDietDoctor
Disclosures
None
Outline
History and Politics Science of nutrition & the evidence Re-write the nutritional guidelines Summary and action plan
Diabesity: A Twin Epidemic
The spectrum of Insulin Resistance
Obesity Statistics
Sources: TFAH, OECD, WHO, CDC, ADA
The progression of insulin resistance 44% obese in 2030 33% diabetic in 2050
Historical Perspective
Blame behavior and lifestyle choices Eating too much and exercising too little Obesity is caused by positive energy balance!
A simple explanation Health insurance will not pay for treatment
Its your fault, your problem, you fix it! The Lipid Hypotheses 1950’s
Avoid caloric dense fatty foods
“I am such a glutton and sloth”
USDA Dietary Guidelines 1977-1980
Less saturated fats, less calories More poly-unsaturated Vegetable oils More carbohydrates, starches, sugars More inexpensive food commodities Weak evidence, the wrong tools!
Phillip Handler : “A vast nutritional experiment”
Macronutrient Content
More refined carbohydrates and less saturated fat Total caloric intake increases from sugar consumption
-MMWR, Morbidity and Mortality Weekly Report, February 6, 2004 / Vol. 53 / No. 4
Does Saturated Fat Cause Heart Disease?
Outcomes looking at MI, death from MI and stroke Observational - 16 studies - No! Observational - 8 studies - Yes but problematic! Observational - 2 meta analysis, 350,000 subjects - No! RCT’s - Clinical trials - 2 well done - No! RCT’s - Clinical trials - 3 meta analysis - No! RCT’s - Clinical trials - 1 meta analysis - Yes but problematic!
http://www.awlr.org
Food Politics: Agriculture
Industrial revolution and the food commodities Corn, Wheat, Rice, Potatoes Sugars: Cane, Beet, HFCS Soybean and industrial Vegetable oils
Whole foods expensive: Animals and other Plants
Farming incentives, increase yields, GMO’s
Food Politics: Manufacturing and $ales
To sell refined and processed foods for profit Food commodities are the raw materials Tasty and addicting foods, eat more Deceptive advertising: “Healthy foods” Food lobbyists funding politicians Selling food not health
Our Ancestors Before Agriculture
Hunter gatherers and the Paleolithic era Whole foods, some carbs
Animals including Fish, seasonal Veggies, Fruits ,Nuts and Roots
Use of fire Agriculture and the Neolithic era
Cultivate Grains and domesticate Animals for Dairy Modern civilization changing nutrition
For better or worse
The Cost of Healthcare
World leader in healthcare spending since 1980 Treating chronic diseases
Medicare and Medicaid industry guidelines Treatment of illness and disease only
Obesity not a medical condition A reactive and costly approach to healthcare
Preventive services task force 2012, counseling Treating obesity complications is profitable
Evolution - Are You Kidding?
Nutrition changing humans in our lifetime!The Food Revolution: Andreas
Eenfeldt, M.D.
Fat Reform is Healthcare Reform
Address obesity Save trillions treating
complications Food industry regulation! Healthcare delivery
Nutrition and center stage Re-define healthy nutrition Re-educate
The perils of dietary carbohydrates In defense of dietary fat
Nutrition and Metabolism 101
Food metabolism All macronutrients are not created
equal Carbohydrates are fattening and
inflammatory Fats and proteins
Obesity is a chronic metabolic disease Insulin resistance Inflammation
Carbs
Fats
Proteins
Insulin and Insulin Receptors
One of several hormones Regulate energy and energy storage
Dietary carbohydrates, the primary fuel Turn on the insulin switch
Dietary proteins and fats, secondary fuels Minimal effect on insulin, essential
Insulin receptors normal function Cells, muscle, tissue absorb energy and nutrients Excess food energy converted to fat and stored Normally insulin will suppress appetite insulin promotes the release of stored energy
Basic physiology
Insulin Resistance
Years of carbohydrate overload More insulin is required Excess energy, stored as body fat Receptors become strained and resistant Beta cells strained, abnormal response A disease of insulin overload
Insulin resistance makes us hungry Fat cells literally starve lean body tissues Hypothalamus, Nucleus Accumbens
Eventual loss of central signals
Increased InsulinProduction
IncreasedResistance
(Hunger)
Weight Gain
Regulation of Food Intake
Leptin – Insulin – Amylin – PP - Ghrelin - PYY - GLP-1 Resistance changes signaling
Promotes inflammation and mitochondrial dysfunction
Inflammation and Adiposity
↑ IL-6
↓ Adiponectin
↑ Leptin
↑ TNFα
↑ Adipsin(Complement D)
↑ Plasminogenactivator inhibitor-1
↑ Resistin
↑ FFA↑ Insulin
↑ Angiotensinogen↑ Lipoprotein lipase
↑ LactateType II
Diabetes
Hypertension
Dyslipidemia
Thrombosis
Atherosclerosis
InsulinResistance
Lyon CJ et al. Endocrinology 2003;144:2195-200; Trayhurn P et al. Br J Nutr 2004;92:347-55; Eckel RH et al. Lancet 2005;365:1415-28.
↑ CRP
Inflammation
Cancer
↑ IGF-1
Premature Ageing
Liver & Gut
Dementia
Fertility
Insulin Resistance Evaluation
Overweight Obesity Pre-diabetes(Metabolic Syndrome)
Type II Diabetes
Anthropometric measurements Medical and family history, physical 2hr OGT, GTT Metabolic markers of inflammation
HgA1c, c-peptide, Insulin, CRP, Thyroid, etc… Cholesterol testing as a marker for atherosclerosis
Insulin Resistance Treatment
The food is the medicine Remove the optional fuel
Less dietary carbohydrates Turn off the insulin switch Control hunger and appetite
Insulin Resistance Treatment
Dietary proteins Essential, healthy
Dietary fats and cholesterol Essential, healthy Caloric dense and filling NOT inflammatory or
atherogenic One exception
Carbs and fats together Standard American diet (SAD) Carbs are the catalyst
http://deliciouslyorganic.net
Insulin Resistance Treatment
Medication Physiologic drugs
Metformin, Byetta, Victoza, Bydureon, Symlin Rx appetite suppressants New and future drugs OTC market
Treat co-morbidities Nutrition center stage
Gastric bypass surgeryhttp://
peaceloveandlowcarb.blogspot.com
Eat Real foods
Focus on the carbohydrate content of food Avoid high glycemic foods, processed foods Eat low glycemic foods, whole and unprocessed
Healthy natural fats Butter, Animal fat, Coconut oil, Olive oil, Avocado, Fish oil
Low-Carb High Fat (LCHF), Ancestral diets Control of appetite and promote weight loss Enhanced fat burning during exercise Quantity, calories and portion’s not the focus
Comparing Diets Head to Head
Compare the macronutrient content % of calories from carbs, protein and fat
Very low fat <10%, high carb, low calorie Very low carb <10%, high fat, LCHF, 1860’s
LCHF vs. Ancestral diets Food quality important
What diets are healthy and safe? Low carb high fat (LCHF) diets improve health!
Greater weight loss, improved lipids and blood sugar Dozens of RCT’s, Stanford 2007, Duke 2004, Penn 2003, 2011 Meta analysis , Santos 2012
Calories consumed equal, Atkins LCHF diet better controls insulin, weight and appetite
Lipid profile improved on Atkins LCHF
Effects of LCHF diet on emerging plasma markers, Richard J. Wood, et al. J. Nutrition. 136:384-389, February 2006
Advanced Lipids and LCHF Diets
Favorable LDL subclasses or particle sizes Triglycerides decrease, healthy HDL-C
increases Other markers
Apo-B, LDL particles Lpa, genetic markers
Advanced labs Berkeley Heart Lab NMR Liposcience VAP Cholesterol
Marcia at 262 lbs, BMI 41 lost 70 lbs, now 192 lbs, 27% loss TBW, BMI 30
Female age 45, 5’7”, 262 lbs, BMI 41 OGT performed, FBS=96, 1HR=180, 2Hr=129 HgA1C=6.4%, c-peptide=4.7 TRG=221, HDL=36, TC=148, LDL=69, NON-HDL=112, TC/HDL=4.2, LDL
Pattern A/B
8 months later lost 70 lbs, 192 lbs, BMI 30, 27% loss of body weight FBS 76 HgA1C=5.1%, ?c-peptide TRG=147, HDL=40, TC=186, LDL=121, NON-HDL=151, TC/HDL=5.2, ?particle
size
Dr Gerber Patient: Marcia
David at 312 lbs, BMI 40 http://mendosa.com
lost 153 lbs, now 159 lbs, 49% loss TBW, BMI 20
Male, age 71, 6’3”, 312 lbs, BMI 40 OGT: FBS=105, 1HR=219, 2HR=201 HgA1C=6.8% TRG=193, HDL=28, TC=225, LDL=158 , NON-HDL=197
2 years later, lost 153 lbs, 159 lbs, BMI 20, 49% loss of body weight OGT: pending, FBS normal HgA1C=4.6% TRG=109, HDL=40, TC=155, LDL=93, NON-HDL=115
Dr Gerber Patient: David
Patrick at 220 lbs, BMI 32 Lost 45 lbs, now 175 lbs, 20% loss TBW, BMI 24
Dr Gerber Patient: Patrick
Male, age 53, 6’, 220 lbs, BMI 32 OGT performed, FBS=86, 1HR=148, 2HR=103 HgA1C=5.4%, c-peptide=4.1 TRG=133, HDL=47, TC=238, LDL=164 , NON-HDL=191,
TC/HDL=5.1
7 moths later lost 45 lbs, 175 lbs, BMI 24, 20% loss of body weight FBS=77 HgA1C=5.1%, c-peptide=0.9 TRG=75, HDL=78, TC=200, LDL=75 , NON-HDL=122,
TC/HDL=2.6
Age 43, lost 10 pounds on a Paleo diet, 183 lbs, BMI 25 Berkeley Heart Lab
Triglycerides and HDL-C improved, LDL-C, Apo-B unchanged LDL subclasses (particle size) remained favorable, 9p21 genetic markers at risk
Carotid IMT, 39 yrs., heterogeneous plaque <20%
Dr Gerber Patient: Eric
Author: Gary Taubes
2002 New York Times Magazine: What If It’s All Been a Big Fat Lie
2008: Good Calories Bad Calories 2010: Why We Get Fat: And What
To Do About It 2011 New York Times Magazine:
Is Sugar Toxic 2012 Newsweek: Why the
Obesity Campaign is failing
Nutrition and the history of weak scientific evidence
Nutrition for the New Millennium
Re-defining healthy nutrition Less refined and processed foods More whole foods including natural fats New federal dietary guidelines
Food industry regulation Re-define healthcare delivery
Nutrition centerstage Control the cost of healthcare
Good Food is Good Medicine!
Jeffry N. Gerber, M.D.DenversDietDoctor.comfacebook.com/DenversDietDoctor