FOOD, FACTS and FADS

Exploring the sense and nonsense of food and health


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Discrimination in Health Care?

Diet and Health: With key to the calories. Lulu Hunt Peters, 1918

Will this become the norm in the United States?  There is already prolific fat shaming from the public and health care providers. Check out this article about the French HERE and what is being considered in Great Britain. This is all the more reason for preventing weight gain in the first place; much research supports the sad fact that losing weight and keeping it off is a daunting task and may even be almost impossible for some.

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Is the Ketogenic Diet for Weight Loss Safe?

 

What is the Ketogenic Diet?

Sally Feltner, PhD, RDN

Glucose is the preferred fuel for the body to use for energy. However, when carbohydrates are limited there may not be adequate glucose for energy use. The body can make some glucose from protein but it can also supply an energy source from fatty acids called ketones.

Ketones ( ketosis) are molecules formed in the liver from fatty acids and released in the blood when there is not sufficient carbohydrate. Ketosis can be generated in a ketogenic diet by fasting or by strictly restricting carbohydrate intake to less than 20-40 grams a day. Fat intake is increased to about 70-80 percent of total calories. Protein intake makes up the rest of the calories.

Ketone production is a normal response to starvation or to a diet very low in carbohydrate. Ketones can be used for energy by the heart, muscle, and kidney. After about three days of fasting, even the brain adapts and can obtain about half its energy from ketones. Ketones not used are excreted in urine. However, if produced in excess, they can build up in the blood. If severe in untreated diabetes, it can increase the blood’s acidity so much that normal body processes cannot proceed, eventually causing possible coma or even death.

The ketogenic diet was originally developed to treat children with epilepsy with some success. Lately, it has become a new diet trend in weight loss. When ketones are used for energy, the body can burn fat stores more efficiently often resulting in rapid body fat loss. Ketosis also lessens hunger helping to avoid excessive calorie intake.

In general, registered dietitians, but not all, do not recommend the ketogenic diet for weight loss due to some serious concerns about its safety. This is due to the lack of research especially on long-term effects. It may in some people cause adverse kidney function and bone metabolism leading to a reduction in bone mineral content. Since it is a carbohydrate restrictive diet, there may be other nutritional deficiencies that occur from a lack of fruits, vegetables, or fiber-rich foods. It is also generally a high fat diet causing some to question the safety of consuming high saturated fats and increasing heart disease risks.

There are other cautions. It is estimated that about 7 million people don’t know they have diabetes type 2. With a high number of people in the population that may have undiagnosed diabetes, the serious dangers of high levels of ketones in the blood can have serious consequences as previously discussed above.

Food choices should be monitored by a registered dietitian/nutritionist (RDN) in order to keep the carbohydrate content low and help the dieter choose healthy fats. Electrolytes such as sodium and magnesium should be assessed periodically. Lab values for total cholesterol, LDL, HDL, triglycerides, blood glucose and blood pressure should be monitored.

My opinion? Long-term use of the ketogenic diet is not recommended until more research tells us more about its safety. Perhaps it may help people  to lose weight on a short-term basis; however, please consult your physician before trying any version of a ketogenic diet.

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The Obesity Epidemic: Nature or Nurture?

Fat shaming is found in many aspects of our culture. The obese are described as fat and lazy and looked upon with disdain by even some of the health professionals they seek out to solve many of their health care needs. Perhaps we need to examine the complexities of the interactions that may have contributed to this so-called obesity epidemic to gain a better understanding of what the obese population has to contend with.

In 1960, only 13.4 % of Americans were overweight or obese. By 1990, about 23% were obese, and today, only two decades later, almost 36% are obese. Obesity affects both men and women and all racial and ethnic groups. As far as we know, we still had the same genes and physiology during these decades; however, the food environment or culture had obviously changed.

“The interplay between genetics and lifestyle is often illustrated by the higher incidence of obesity in Pima Indians living in Arizona than in a genetically similar group of Pima Indians living in Mexico. When this genetic susceptibility is combined with an environment that fosters a sedentary lifestyle and consumption of a calorie dense diet, the outcome is the strikingly high incidence of obesity seen in this population. The Pima Indians of Mexico are farmers who work in the fields and consume the food they grow. On the other hand, the Arizona Pima eat the high-calorie, high-fat processed foods,  found in the Standard American Diet (SAD) and lead a more sedentary lifestyle. Both groups have  higher rates of obesity due to their genetic susceptibility; however, the average BMI or the Mexican Pima is significantly lower than that of their American counterparts.” Smolin and Grosvenor, Nutrition: Science and Applications, Third Edition.

Check out my previous post HERE.

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Why Dieting Can Make Us Fat

Since we are a nation obsessed by weight loss, it is so important to realize that chronic dieting itself can make some people overweight or obese as a result. There are many reasons why our bodies resist weight loss and more than likely it is due to a fear of starvation. This involves the neuro-endocrine system and we have many mechanisms to prevent this threat to our existence.

This is more than likely involving our set -points defined as “a level at which body fat or body weight seems to resist change despite changes in energy intake or output.” The set point for each of us is largely determined by genes. Signals related to food intake affect hunger and satiety (feeling of fullness) over short time periods while signals from the adipose tissue trigger the brain to adjust to both food intake and energy expenditure for long-term regulation. The  two primary hormones involved are ghrelin and leptin. Ghrelin is a peptide hormone produced  by the stomach that stimulates food intake and leptin is a peptide hormone produced by fat cells that signals information about the amount of body fat. The interactions are complex and better left to more academic discussions than in this blog post.

If you diet frequently, you should understand some of the implications of these interactions. The following article is a long read but it is important to know the facts – the best action is to prevent weight gain if possible so that we do not have to deal with its effects later on.

Weight management is possible by putting into practice the following simple suggestions.

Balance your intake and output, for example, weight yourself once a week; if the number goes up, cut down your calories.

Cut down on calories, e.g. bring your own lunch rather than eating out.

Don’t get too hungry – fill up on high fiber foods.

Increase activity – Take a walk during lunch break or after dinner.

Avoid fad diets – they only lead to the problem.

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The Best Advice for Weight Loss

An article from Women’s Health provides sound and simple advice for weight loss that often gets missed or ignored when one follows fad diets. You have probably heard of most of these tried and true suggestions before, but when you put them all together, they just make a lot of good sense. No fads, just the facts based on evidence.

I might add to be aware of portion sizes. Follow the rules of measuring or estimating portions by using your hands: a fist = 1 cup; a cupped hand = 1/2 cup; a meat serving (3 oz) is about the size of your palm; a tablespoon = your thumb and a teaspoon = the tip of your  thumb. There is no need  to weigh foods on a scale. Keeping a food diary or journal is also a helpful idea to increase awareness of what you actually eat each day.

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Big Food in Brazil = SAD

Soon all the “healthy” traditional diets of the world will be replaced with ultra-processed “big food” loaded with sugar, fat, and salt. If we think that obesity and chronic disease rates are high now, just wait a few years. It is well known that as the so-called Western diet or Standard American diet (SAD) invades traditional cultures, heart disease rates and obesity increase. This appears to be happening in Brazil according to an article in the NYT. There is a link to the full article in Dr. Nestle’s post. It is a long read, but the bottom line is that the large food companies, like Coca Cola and Nestlé  (no relation to Dr. Marion Nestle) have found new markets and delivery systems in poorer countries. This quote says it all:

‘For some companies, that can mean specifically focusing on young people, as Ahmet Bozer, president of Coca-Cola International, described to investors in 2014. “Half the world’s population has not had a Coke in the last 30 days,” he said. “There’s 600 million teenagers who have not had a Coke in the last week. So the opportunity for that is huge.”

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