Tuesday, December 04, 2012

The Obesity Puzzle

Obesity and well-being are not just a matter of carbs/no-carbs; the causal chain is not that simple.

There are almost as many theories about why obesity has exploded in America and the world since the 1980s as there are researchers compiling data.

The rise in Body Mass Index (BMI) appears to correlate with the rise of high-fructose corn syrup (HFCS), a simple carbohydrate.

Let's begin by comparing two charts from the Centers for Disease Control (CDC) which depict obesity levels on a state by state basis: the first in 1985 and the second, a generation later in 2008.

Clearly, obesity has exploded into a pandemic in just a single generation.

Interestingly, all the usual explanations--the rise of fast foods, women joining the workforce and thus the decline of the home-cooked meal and the decline of physical labor jobs--fail to explain the dramatic increase for the reason that all these conditions were already present in 1985.

Women had already joined the workforce en masse, fast-food outlets were already on every corner and jobs requiring hard physical labor had already dwindled to a small percentage of our post-industrial, service-dominated economy.

So what is different between 1985 and the present? At least one factor is the increased consumption of sugary beverages--soda, specialty coffees, iced teas, fake "juices" (colored sugar water with 10% actual fruit juice)--and the addition of HFCS to everything from snacks to breakfast bars to canned soups.

As a consequence, consumption of fructose (both "natural" and high-fructose corn sweetener, HFCS) has skyrocketed.

Reader R.W. recently submitted this account of his own family's experience, and what they discovered by consulting with one of the nation's leading experts in Pediatric Endocrinology.
I’ve attached a YouTube film of a lecture by Dr. Robert Lustig, head of Pediatric Endocrinology at UCSF Medical School. This is an explanation of the biological--and political--mechanism that causes obesity and Type 2 diabetes, and why they’ve become an epidemic.We were fortunate to find Dr. Lustig when my younger son, Pat was an adolescent. Pat was a very heavy boy who gained weight despite being vigorously active (for example, he played water polo year round) and really not eating that much. I finally persuaded Pat’s pediatrician that there was something wrong with the boy’s metabolism. Pat’s blood test showed he had cholesterol and triglyceride counts that would be extreme for an obese 60-year-old--into the high 300’s. 
There were no pediatric endocrinologists in our area at that time, so we were sent to UCSF. Dr. Lustig enrolled Pat in a study which I think is still ongoing. The upshot: cut out all fructose, and obesity and all its symptoms subside.
Pat, now 20, weighs 25 pounds LESS than he did in the 8th grade, although he is six inches taller. People literally do not recognize him. It is a very gratifying and amazing transformation. It was simple, but not easy. Pat worked very hard, and for a while was assisted with metformin. (He is now off the drug, and shows no ill effects or relapsed weight gain or high cholesterol or triglycerides.) But mostly it was about shunning all fructose, especially in drinks. 
Fructose is addictive for the same reasons, by the same mechanisms, and producing many of the same pathologies as alcohol, as Dr. Lustig explains in the lecture. One of his catch phrases is: “Fructose is alcohol without the buzz.”
It’s 90 minutes. Stick with it. It’s a little dense in spots, but overall, it is a compelling story. Dr. Lustig puts it all in context. I know he and Michael Pollan are aware of each other, though when I asked him he said they haven’t had any formal collaboration. But their views of our food delivery system are totally aligned.
I’m hoping that once you see this, you will feel that it deserves a wider audience.
Sugar: the Bitter Truth (University of California TV)

Here is the puzzle: Everyone agrees that "empty calories" contribute to obesity, and many see simple carbohydrates as the key cause of obesity.

On the other hand, I personally know many slim, healthy Asians whose diet is based on white rice and processed-flour noodles--the very sort of simple carbs that are supposed to make us all fat. Yes, they also eat small portions of fish and meat and significant quantities of vegetables, but you can't get away from the fact that much of their caloric intake comes from processed carbohydrates.

The famous Mediterranean Diet is based on pasta as well as olive oil, fish, vegetables and wine: The Island Where People Forget to Die:
She found that her subjects consumed about six times as many beans a day as Americans, ate fish twice a week and meat five times a month, drank on average two to three cups of coffee a day and took in about a quarter as much refined sugar — the elderly did not like soda. She also discovered they were consuming high levels of olive oil along with two to four glasses of wine a day. 
Social structure might turn out to be more important. In Sardinia, a cultural attitude that celebrated the elderly kept them engaged in the community and in extended-family homes until they were in their 100s. Studies have linked early retirement among some workers in industrialized economies to reduced life expectancy. 
In Okinawa, there’s none of this artificial punctuation of life. Instead, the notion of ikigai — “the reason for which you wake up in the morning” — suffuses people’s entire adult lives. It gets centenarians out of bed and out of the easy chair to teach karate, or to guide the village spiritually, or to pass down traditions to children. The Nicoyans in Costa Rica use the term plan de vida to describe a lifelong sense of purpose. As Dr. Robert Butler, the first director of the National Institute on Aging, once told me, being able to define your life meaning adds to your life expectancy.
If carbs were the sole cause of obesity, then the Asians I personally know who probably get up to 60% of their calories from white rice or white-flour noodles should be grossly obese--instead, they're thin. (They only get fat if they live in the U.S. and start eating an American-style diet.) How do we explain this paradox?

I recently corresponded with David B. Collum, Professor of Chemistry at Cornell University, who noted two potentially important factors:
I was in Germany a month ago and noticed (1) the grocery stores no longer look like markets but rather supermarkets with all the brightly colored packages of processed food, and (2) the Germans are getting fat. 
I am wholly convinced now that hidden carbs--not the potatoes and rice but the carbs in the processed foods--are what is putting on the pounds. After months of pondering why I was struggling to control weight despite some effort and listening to an econtalk podcast on the evils with carbs (and containing a nice dose of real biochemical flavor to the discussion), I dropped the carbs and dropped 30 lbs within 6 months. 
In this Econtalk podcast (time: 1:20) Taubes on Why We Get Fat, author Gary Taubes presented some interesting rat studies along with the following model: (1) carbs trigger insulin, (2) insulin triggers fat deposition, (3) insulin with carb depletion triggers carb craving (after dinner foraging). I think the complex vs simple carb issue finally makes sense to me also. Simple carbs spike the insulin but the complex carbs are released more slowly and thus spike the insulin less. We eat carbs AND fat with the carbs sending the fat to the muffin top. The Asian diet may be carb-rich/fat poor.
I think there is plenty of evidence to support these two points:

1. That there are significant amounts of simple carbs (HFCS etc.) "hidden" in the processed foods Americans consume in quantity, and

2. It is the ratio and type of fats and carbs that generates weight gain, not carbs alone--that is, a carb-rich, low-fat diet based on legumes and vegetables typical of traditional Asian diets does not lead to obesity, even though the carbs consumed are simple/processed white rice and white-flour noodles.

I would add a third factor, which is the paucity of vegetables, fruits and legumes in the American diet. Just avoiding carbs does not make one healthy.

It's not just avoiding carbs that counts, it's avoiding all processed foods and sugar-laden beverages.

Lastly, let's not forget exercise, which dramatically alters our metabolism, blood sugar and psyche. Cutting our processed foods and simple carbs (empty calories) is only the first step--the second equally important step is getting fit via daily or almost-daily exercise of the sort that builds muscle mass and endurance. People who live long healthy lives are always on the move, and are doing so with purpose.

Gary Taubes' books:

This book presents evidence that vegetables and complex carbs are essential, meat less so:

These articles were written by a physicist who decided to investigate/experiment via his own weight loss program:

NOTE: I will be taking a few days off from online work, so I will be unable to respond to email. Thank you for your understanding. 

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