New vitamin D recommendations

Despite mounting pressure to urge several Americans to sharply boost their vitamin D levels, latest government recommendations are not advocating a huge increase in the amount of the "sunshine vitamin" that people get.The United States and Canada asked the Institute of Medicine, which is division of the National Academy of Sciences,

Choline and Fatty Liver

I've been writing about non-alcoholic fatty liver disorder (NAFLD) since the early days of this blog, because it's an alarmingly common disorder (roughly a quarter of Americans affected) that is typically undiagnosed. It often progresses into its more serious cousin non-alcoholic steatohepatitis (NASH), an inflammatory condition that causes liver damage and can progress to cancer. In a number of previous posts, I pinpointed excess sugar and seed oil consumption as culprits in NAFLD and NASH (1, 2, 3, 4, 5).

Chris Masterjohn recently published two very informative posts on NAFLD/NASH that add a major additional factor to the equation: choline (6, 7). Choline is an essential nutrient that's required for the transport of fat out of the liver (8). NAFLD can be caused, and cured, simply by removing or adding dietary choline, and it appears to be dominant over other dietary factors including fat, sugar and alcohol. Apparently, certain researchers have been aware of this for some time, but it hasn't entered into the mainstream consciousness.

Could that be because the richest dietary sources are liver and eggs*? Choline is also found in smaller amounts in a variety of whole animal and plant foods. Most people don't get the officially recommended amount. From a recent review article (9):

Mean choline intakes for older children, men, women, and pregnant women are far below the adequate intake level established by the [Institute of Medicine]. Given the importance of choline in a wide range of critical functions in the human body, coupled with less-than-optimal intakes among the population, dietary guidance should be developed to encourage the intake of choline-rich foods.

I've dubbed beef liver the Most Nutritious Food in the World, Nature's Multivitamin, and I'll probably invent other titles for it in the future. Add yours to the comments. Learn to love liver! I think it's an excellent food to eat on a weekly basis.

Head over to Chris's blog and read about the classic studies he unearthed. And add The Daily Lipid to your RSS reader, because there's more interesting material to come!

The Sweet Truth about Liver and Egg Yolks
Does Choline Deficiency Contribute to Fatty Liver in Humans?


* For the brave: brain is actually the richest source of choline.

If you're around a baby, get whooping cough vaccine

Most Georgia infants get the vaccines they require to help protect them from pertussis -- a highly contagious disease better known as whooping cough.While Georgia has not observed high rates of the disease so far this year, outbreaks in other states are prompting public health officials to say another time that a vaccine for the baby isn’t enough. They advise all adults and teens who come into

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Eating orange and dark green vegetables linked to longer life

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Many fat women think they are slim: research

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Glucose Tolerance in Non-industrial Cultures

Background

Glucose is the predominant blood sugar and one of the body's two main fuel sources (the other is fatty acids). Glucose, in one form or another, is also the main form of digestible dietary carbohydrate in nearly all human diets. Starch is made of long chains of glucose molecules, which are rapidly liberated and absorbed during digestion. Sucrose, or table sugar, is made of one glucose and one fructose molecule, which are separated before absorption.

Blood glucose is essential for life, but it can also be damaging if there is too much of it. Therefore, the body tries to keep it within a relatively tight range. Normal fasting glucose is roughly between 70 and 90 mg/dL*, but in the same individual it's usually within about 5 mg/dL on any given day. Sustained glucose above 160 mg/dL or so causes damage to multiple organ systems. Some people would put that number closer to 140 mg/dL.

The amount of glucose contained in a potato far exceeds the amount contained in the blood, so if all that glucose were to enter the blood at once, it would lead to a highly damaging blood glucose level. Fortunately, the body has a hormone designed to keep this from happening: insulin. Insulin tells cells to internalize glucose from the blood, and suppresses glucose release by the liver. It's released by the pancreas in response to eating carbohydrate, and protein to a lesser extent. The amount of insulin released is proportional to the amount of carbohydrate ingested, so that glucose entering the blood is cleared before it can accumulate.

Insulin doesn't clear all the glucose as it enters the bloodstream, however. Some of it does accumulate, leading to a spike in blood glucose. This usually doesn't exceed 160 mg/dL in a healthy person, and even if it approaches that level it's only briefly. However, diabetics have reduced insulin signaling, and eating a typical meal can cause their glucose to exceed 300 mg/dL due to reduced clearance. In affluent nations, this is typically due to type II diabetes, which begins as insulin resistance, a condition in which insulin is actually higher than normal but cells fail to respond to it.

The precursor to diabetes is called glucose intolerance, or pre-diabetes. In someone with glucose intolerance, blood glucose after a typical meal will exceed that of a healthy person, but will not reach the diabetic range (a common definition of diabetes is 200 mg/dL or higher, 2 hours after ingesting 75g of glucose). Glucose tolerance refers to a person's ability to control blood glucose when challenged with dietary glucose, and can be used in some contexts as a useful predictor of diabetes risk and general metabolic health. Doctors use the oral glucose tolerance test (OGTT), which involves drinking 60-100g glucose and measuring blood glucose after one or two hours, to determine glucose tolerance.

Why do we care about glucose tolerance in non-industrial cultures?

One of the problems with modern medical research is that so many people in our culture are metabolically sick that it can be difficult to know if what we consider "normal" is really normal or healthy in the broader sense. Non-industrial cultures allow us to examine what the human metabolism is like in the absence of metabolic disease. I admit this rests on certain assumptions, particularly that these people aren't sick themselves. I don't think all non-industrial cultures are necessarily healthy, but I'm going to stick with those that research has shown have an exceptionally low prevalence of diabetes (by Western standards) and other "diseases of civilization" for the purposes of this post.

Here's the question I really want to answer in this post: do healthy non-industrial cultures with a very high carbohydrate intake have an excellent glucose tolerance, such that their blood glucose doesn't rise to a high level, or are they simply resistant to the damaging effects of high blood glucose?

The data

I'm going to start with an extreme example. In the 1960s, when it was fashionable to study non-industrial cultures, researchers investigated the diet and health of a culture in Tukisenta, in the highlands of Papua New Guinea. The eat practically nothing but sweet potatoes, and their typical daily fare is 94.6 percent carbohydrate. Whether or not you believe that exact number, their diet was clearly extraordinarily high in carbohydrate. They administered 100g OGTTs and measured blood glucose at one hour, which is a very stringent OGTT. They compared the results to those obtained in the 1965 Tecumseh study (US) obtained by the same method. Here's what they found (1):
Compared to Americans, in Tukisenta they had an extraordinary glucose tolerance at all ages. At one hour, their blood glucose was scarcely above normal fasting values, and glucose tolerance only decreased modestly with age. In contrast, in Americans over 50 years old, the average one-hour value was approaching the diabetic range!

Now let's take a look at the African Bantu in the Lobaye region of the Central African Republic. The Bantu are a large ethnic group who primarily subsist on a diverse array of starchy foods including grains, beans, plantains and root crops. One hour after a 100g OGTT, their blood glucose was 113 mg/dL, compared to 139 mg/dL in American controls (2). Those numbers are comparable to what investigators found in Tukisenta, and indicate an excellent glucose tolerance in the Bantu.

In South America, different investigators studied a group of native Americans in central Brazil that subsist primarily on cassava (a starchy root crop) and freshwater fish. Average blood glucose one hour after a 100g OGTT was 94 mg/dl, and only 2 out of 106 people tested had a reading over 160 mg/dL (both were older women) (Western Diseases: Their Emergence and Prevention, p. 149). Again, that indicates a phenomenal glucose tolerance by Western standards.

I have to conclude that high-carbohydrate non-industrial cultures probably don't experience damaging high blood glucose levels, because their glucose tolerance is up to the task of shuttling a huge amount of glucose out of the bloodstream before that happens.

Not so fast...

Now let's turn our attention to another study that may throw a wrench in the gears. A while back, I found a paper containing OGTT data for the !Kung San (also called the Bushmen), a hunter-gatherer group living in the Kalahari desert of Africa. I reported in an earlier post that they had a good glucose tolerance. When I revisited the paper recently, I realized I had misread it and in fact, their glucose tolerance was actually pretty poor (come on guys, you have to call me on this stuff!).

Investigators administered a 50g OGTT, half what the other studies used. At one hour, the San had blood glucose readings of 169 mg/dL, compared to 142 mg/dL in Caucasian controls (3)! I suspect a 100g OGTT would have put them close to the diabetic range.

Wait a minute, these guys are hunter-gatherers living the ancestral lifestyle; aren't they supposed to be super healthy?? While I was mulling this over, I recalled a discussion on Peter's blog hyperlipid where commenters were discussing their diabetic OGTT values while on a low-carbohydrate diet. Apparently, carbohydrate refeeding for a few days generally reverses this and allows a normal OGTT in most people. It turns out this effect has been known for the better part of a century.

So what were the San eating? The study was conducted in October of 1970. The San diet changes seasonally, however their main staple food is the mongongo nut, which is mostly fat and which is available year-round (according to The !Kung San: Men, Women and Work in a Foraging Society). Their carbohydrate intake is generally low by Western standards, and at times of the year it is very low. This varies by the availability of other foods, but they generally don't seem to relish the fibrous starchy root crops that are available in the area, as they mostly eat them when other food is scarce. Jean-Louis Tu has posted a nice analysis of the San diet on BeyondVeg (4). Here's a photo of a San man collecting mongongo nuts from The !Kung San: Men, Women and Work in a Foraging Society:

What did the authors of the OGTT study have to say about their diet? Acknowledging that prior carbohydrate intake may have played a role in the OGTT results of the San, they made the following remark:

a retrospective dietary history (M. J. Konner, personal communication, 1971) indicated that the [San], in fact, consumed fairly large amounts of carbohydrate-rich vegetable food during the week before testing.

However, the dietary history was not provided, nor has it been published, so we have no way to assess the statement's accuracy or what was meant by "fairly large amounts of carbohydrate-rich vegetable food." Given the fact that the San diet generally ranges from moderately low to very low in carbohydrate, I suspect they were not getting much carbohydrate as a percentage of calories. Looking at the nutritional value of the starchy root foods they typically ate in appendix D of The !Kung San: Men, Women and Work in a Foraging Society, they are fibrous and most contain a low concentration of starch compared to a potato for example. The investigators may have been misled by the volume of these foods eaten, not realizing that they are not as rich in carbohydrate as the starchy root crops they are more familiar with.

You can draw your own conclusions, but I think the high OGTT result of the San probably reflect a low habitual carbohydrate intake, and not pre-diabetes. I have a very hard time believing that this culture wasn't able to handle the moderate amount of carbohydrate in their diet effectively, as observers have never described diabetic complications among them.

Putting it all together

This brings me to my hypothesis. I think a healthy human body is extraordinarily flexible in its ability to adapt to a very broad range of carbohydrate intakes, and adjusts glucose tolerance accordingly to maintain carbohydrate handling in a healthy range. In the context of a healthy diet and lifestyle (from birth), I suspect that nearly anyone can adjust to a very high carbohydrate intake without getting dangerous blood glucose spikes. A low carbohydrate intake leads to lower glucose handling and better fat handling, as one would expect. This can show up as impaired glucose tolerance or diabetes on an OGTT, but that does not necessarily reflect a pathological state in my opinion.

Every person is different based on lifestyle, diet, personal history and genetics. Not everyone in affluent nations has a good glucose tolerance, and some people will never be able to handle starch effectively under any circumstances. The best way to know how your body reacts to carbohydrate is to test your own post-meal blood glucose using a glucose meter. They are inexpensive and work well. For the most informative result, eat a relatively consistent amount of carbohydrate for a week to allow your body to adapt, then take a glucose measurement 1 and 2 hours after a meal. If you don't eat much carbohydrate, eating a potato might make you think you're diabetic, whereas after a week of adaptation you may find that a large potato does not spike your blood glucose beyond the healthy range.

Exercise is a powerful tool for combating glucose intolerance, as it increases the muscles' demand for glucose, causing them to transport it out of the blood greedily after a meal. Any exercise that depletes muscle glycogen should be effective.


* Assuming a typical carbohydrate intake. Chris Kresser recently argued, based on several studies, that true normal fasting glucose for a person eating a typical amount of carbohydrate is below 83 mg/dL. Low-carbohydrate eating may raise this number, but that doesn't necessarily indicate a pathological change. High-carbohydrate cultures such as the Kitavans, Aymara and New Guineans tend to have fasting values in the low 60s to low 70s. I suspect that a very high carbohydrate intake generally lowers fasting glucose in healthy people. That seems to be the case so far for Chris Voigt, on his diet of 20 potatoes a day. Stay tuned for an interview with Mr. Voigt in early December.

Facebook Heartbreak Leads to Man's Asthma Attacks

We often hear that social networks can be fine for emotional health by reconnecting us with old friends, helping us build professional contacts and countering isolation, but Italian doctors have reported a case where logging onto Facebook made an 18-year-old man hyperventilate.The patient, whose asthma was well-controlled with steroid inhalers and Singulair pills, began having more asthma attacks

6,795 Reported Cases Of Whooping Cough In California So Far This Year

With the highest rates of whooping cough in 63 years and reports of flu starting coming in throughout the USA, Californian and other states' health authorities are urging people to get vaccinated. With apparently only 1 in 3 Americans getting a flu shot last year, public health experts are beginning to show some concern about the next months. Fewer than 1 in every 13 adults got vaccinated against

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Chronic Cough:A persistent, new cough or a cough that won't go away. Blood and/or mucus may accompany the cough and can be caused many conditions. In relation to cancer, a chronic cough with blood or mucus can be symptom of lung cancer. Cancer is an extensive term that encompasses more than one hundred unusual types of cancer. It is important to note that some types of cancer do not present any

Stem cell therapy helps victims of heart failure

A year and a half ago, Michael Jones' failing heart left him so weak he couldn't even climb stairs.But today, after receiving an infusion of his own cardiac stem cells, the 67-year-old handles stairs with ease, works his southeastern Jefferson County land on his tractor, indulges his love of woodworking and is making plans to begin jogging."I feel truly well," Jones said. "It's awesome. They're

Impressions from the Wise Traditions Conference

I spent last weekend at the Weston A. Price Foundation Wise Traditions conference in King of Prussia, PA. Here are some highlights:

Spending time with several people in the diet-health community who I’ve been wanting to meet in person, including Chris Masterjohn, Melissa McEwen and John Durant. John and Melissa are the public face of the New York city paleo movement. The four of us spent most of the weekend together tossing around ideas and making merry. I’ve been corresponding with Chris quite a bit lately and we’ve been thinking through some important diet-health questions together. He is brimming with good ideas. I also got to meet Sally Fallon Morell, the founder and president of the WAPF.

Attending talks. The highlight was Chris Masterjohn’s talk “Heart Disease and Molecular Degeneration: the New Paradigm”, in which he described his compelling theory on oxidative damage and cardiovascular disease, among other things. You can read some of his earlier ideas on the subject here. Another talk I really enjoyed was by Anore Jones, who lived with an isolated Inuit group in Alaska for 23 years and ate a mostly traditional hunter-gatherer diet. The food and preparation techniques they used were really interesting, including various techniques for extracting fats and preserving meats, berries and greens by fermentation. Jones has published books on the subject that I suspect would be very interesting, including Nauriat Niginaqtuat, Plants that We Eat, and Iqaluich Niginaqtuat, Fish that We Eat. The latter is freely available on the web here.

I attended a speech by Joel Salatin, the prolific Virginia farmer, writer and agricultural innovator, which was fun. I enjoyed Sally Fallon Morell’s talk on US school lunches and the politics surrounding them. I also attended a talk on food politics by Judith McGeary, a farmer, attorney and and activist, in which she described the reasons to oppose or modify senate bill 510. The gist is that it will be disproportionately hard on small farmers who are already disfavored by current regulations, making high quality food more difficult to obtain, more expensive or even illegal. It’s designed to improve food safety by targeting sources of food-borne pathogens, but how much are we going to have to cripple national food quality and farmer livelihood to achieve this, and will it even be effective? I don’t remember which speaker said this quote, and I’m paraphrasing, but it stuck with me: “I just want to be able to eat the same food my grandmother ate.” In 2010, that’s already difficult to achieve. Will it be impossible in 2030?

Giving my own talk. I thought it went well, although attendance was not as high as I had hoped. The talk was titled “Kakana Dina: Diet and Health in the Pacific Islands”, and in it I examined the relationship between diet and health in Pacific island cultures with different diets and at various stages of modernization. I’ve covered some of this material on my blog, in my posts on Kitava, Tokelau and sweet potato eating cultures in New Guinea, but other material was new and I went into greater detail on food habits and preparation methods. I also dug up a number of historical photos dating back as far as the 1870s.

The food. All the meat was pasture-raised, organic and locally sourced if possible. There was raw pasture-raised cheese, milk and butter. There was wild-caught fish. There were many fermented foods, including sauerkraut, kombucha and sourdough bread. I was really impressed that they were able to put this together for an entire conference.

The vendors. There was an assortment of wholesome and traditional foods, particularly fermented foods, quality dairy and pastured meats. There was an entire farmer’s market on-site on Saturday, with a number of Mennonite vendors selling traditional foods. I bought a bottle of beet kvass, a traditional Russian drink used for flavor and medicine, which was much better than the beet kvass I’ve made myself in the past. Beets are a remarkable food, in part due to their high nitrate content—beet juice has been shown to reduce high blood pressure substantially, possibly by increasing the important signaling molecule nitric oxide. I got to meet Sandeep Agarwal and his family, owners of the company Pure Indian Foods, which domestically produces top-quality pasture-fed ghee (Indian-style clarified butter). They now make tasty spiced ghee in addition to the plain flavor. Sandeep and family donated ghee for the big dinner on Saturday, which was used to cook delicious wild-caught salmon steaks donated by Vital Choice.

There were some elements of the conference that were not to my taste. But overall I’m glad I was able to go, meet some interesting people, give my talk and learn a thing or two.

World's First Stem Cell Clinical Trial to Treat Stroke Begins in U.K.

Doctors in Scotland, working with British biotech company ReNeuron, administered a sequence of injections in a patient over the weekend to test whether stem cell therapy could help those disabled by stroke. The patient, who is in his 60s, was severely disabled by a stroke 18 months ago and requires continuous care.Doctors injected

Bypass patients can benefit from a few drinks

Light alcohol consumption was associated with a 25 percent reduction in extra heart procedures, heart attacks or strokes in the study by Italian researchers, presented at the annual meeting of the American Heart Association in Chicago."The benefit of light amounts of alcohol consumption has been documented in healthy individuals, but our analysis showed a benefit from light alcohol intake in

Fitness For Men In Three Easy Tips

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The 7 best fat-blasters

Getty Images

By Su Reid-St. John

We all have days when there's no time to get to the gym. So we wondered: Which close-to-home cardio activities blast fat fastest?

Wonder no more. Here are the top seven fat-and-calorie burners, from Los Angeles based celeb trainer Ramona Braganza, who has helped shape the amazing bodies of stars like Jessica Alba, Halle Berry, and Anne Hathaway.

Try any one of these, and you'll boost your metabolism for up to a whole day afterward. One small workout, one giant payoff.

1. Inline skating
Burns 425 calories in 30 minutes

Surprised? While skating might be so much fun you forget you're actually working out, it's also numero uno on our list when it comes to blasting fat and calories.

The big burn stems from the side-to-side movement of your thigh and butt muscles (demanding more from your body than the straightforward motion of our number-two activity -- running). And your core gets involved in a big way to keep you balanced.

What's more, you get all these benefits without putting too much stress on your knees and other joints. Skate at a strong, steady pace. Don't forget your helmet, wrist guards, and knee and elbow pads.

Boost the burn: Alternate one minute of hard skating with one minute of medium-paced strokes.

Health.com: Get a beautiful butt in 4 weeks

2. Running
Burns 374 calories in 30 minutes

The typical runner's shape is sleek and lean, and there's a reason for that: The major running muscles -- legs, butt, core -- happen to be the biggest calorie-and-fat-burning muscles in your body.

To get the most out of each stride, swing your arms close to your body, don't lean forward, and keep your feet low to the ground. To lessen impact, land on the middle of your foot, then roll through to your toes.

Boost the burn: Alternate fast and slow intervals, or take to the hills.

Health.com: How to run faster

3. Jumping rope
Burns 340 calories in 30 minutes

You knew this workout had to be high on the list. After all, it's one of pro boxers' favorite ways to train.

To get the most from each jump, use a rope with handles that reach to just under your armpits when you stand on the middle of it, and follow these top-form tips: Jump with your feet slightly apart and body upright, and keep your jumps low to the ground. Don't have a rope? You'll get the same benefits by doing the movements rope-free.

Boost the burn: Frequently switch up your speed (slow, fast) and style (jumping with one foot, then two feet), or jump rope while you jog.

Health.com: How to jump the weight off

4. Hula hooping
Burns 300 calories in 30 minutes

There's a reason Marisa Tomei and Beyoncé hoop to keep their bodies beautiful -- it's a major fat-and-calorie torcher. To do it yourself, grab an adult-sized hoop (they're larger and heavier than kids' hoops, making them easier to spin); you'll know you have the right size if it reaches your chest when you stand it up in front of you.

No fancy moves required, either. Simply keep it going around your waist. To start, stand with one foot in front of the other and shift your weight back and forth (versus around in a circle). And don't worry if you're less than perfect at first; you'll still knock off major calories, plus get better every time you spin.

Boost the burn: Get how-tos for advanced moves and a fun workout at Health.com/hula-hoop.

Health.com: Hoop yourself slim

5. Tennis
Burns 272 calories in 30 minutes

Don't think you need to round up a partner or trek all the way to a court to break a super sweat with racket in hand. (Though if you have a pal and a nearby net, you'll burn the same calories.) Simply find a flat area near a wall or garage door that you can hit the ball against.

Alternate forehand and backhand shots -- then see how many you can do in a row without goofing. Stand 10 to 25 feet away, which will force you to hit harder. Even practicing your serve will get your body in burn mode, because you'll have to run and bend to pick up your missed balls.

Boost the burn: Try to hit the ball consistently for 50 or 100 strokes. "Having a goal will make you work harder to reach it," Braganza says.

Health.com: 30-minute workout, no gym required

Getty Images

6. Dancing
Burns 221 calories in 30 minutes

This may not be the biggest calorie-burner in the bunch, but it's still an excellent -- and fun! -- metabolism booster. (Just look at Kelly Osbourne, who jump-started her amazing 42-pound loss on Dancing with the Stars.)

The key is to keep the tempo high, choosing songs with fast rhythms like Latin or Bollywood, and don't rest between songs.

Try Braganza's favorite trick: Download a workout's worth of your favorite tunes. Begin with an upbeat inspirational song think "Just Dance" by Lady Gaga, then move on to songs with increasingly faster tempos. Slow the beat toward the end to cool down.

Boost the burn: Use your arms! Raise them in the air and move them to the beat.

Health.com: Dance your way to toner abs and legs

7. Walking vigorously
Burns 170 calories in 30 minutes

That's right, walking actually made our list. Full disclosure, though: A leisurely stroll with a friend won't cut it. You should be walking briskly enough that it's difficult to keep up a steady conversation.

To get the most from your biggest calorie-burning muscles -- legs, butt, and core -- take short, quick steps, keep your torso upright, and pump your arms back and forth (not side to side) in time with your stride. With each step, land on your heel and roll through to your toes.

Boost the burn: Alternate two minutes of brisk strides with one minute of as-fast-as-you-can-go walking (or jogging).

Yoga gives a boost to person's mood

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Burn seasonal calories, stress with yoga

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Yoga asanas for a healthy heart

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The Twinkie Diet for Fat Loss

The Experiment

I've received several e-mails from readers about a recent experiment by nutrition professor Mark Haub at Kansas State university (thanks to Josh and others). He ate a calorie-restricted diet in which 2/3 of his calories came from junk food: Twinkies, Hostess and Little Debbie cakes, Dorito corn chips and sweetened cereals (1). On this calorie-restricted junk food diet (800 calorie/day deficit), he lost 27 pounds in two months.

Therefore, junk food doesn't cause fat gain and the only thing that determines body fatness is how much you eat and exercise. Right?

Discussion

Let's start with a few things most people can agree on. If you don't eat any food at all, you will lose fat mass. If you voluntarily force-feed yourself with a large excess of food, you will gain fat mass, whether the excess comes from carbohydrate or fat (2). So calories obviously have something to do with fat mass.

But of course, the situation is much more subtle in real life. Since a pound of body fat contains roughly 3,500 calories, eating an excess of 80 calories per day (1 piece of toast) should lead to a weight gain of 8 lbs of fat per year. Conversely, if you're distracted and forget to eat your toast, you should lose 8 lbs of fat per year, which would eventually be dangerous for a lean person. That's why we all record every crumb of food we eat, determine its exact calorie content, and match that intake precisely with our energy expenditure to maintain a stable weight.

Oh wait, we don't do that? Then how do so many people maintain a stable weight over years and decades? And how do wild animals maintain a stable body fat percentage (except when preparing for hibernation) even in the face of food surpluses? How do lab rats and mice fed a whole food diet maintain a stable body fat percentage in the face of literally unlimited food, when they're in a small cage with practically nothing to do but eat?

The answer is that the body isn't stupid. Over hundreds of millions of years, we've evolved sophisticated systems that maintain "energy homeostasis". In other words, these systems act to regulate fat mass and keep it within the optimal range. The evolutionary pressures operating here are obvious: too little fat mass, and an organism will be susceptible to starvation; too much, and an organism will be less agile and less efficient at locomotion and reproduction. Energy homeostasis is such a basic part of survival that even the simplest organisms regulate it.

Not only is it clear that we have an energy homeostasis system, we even know a thing or two about how it works. Early studies showed that lesioning a part of the brain called the ventromedial hypothalamus causes massive obesity (3; this is also true in humans, when a disruption results from cancer). Investigators also discovered several genetic mutations in rats and mice that result in massive obesity*. Decades-long research eventually demonstrated that these models have something in common: they all interfere with an energy homeostasis circuit that passes information about fat mass to the hypothalamus via the hormone leptin.

The leptin system is a classic negative feedback loop: the more fat mass accumulates, the more leptin is produced. The more leptin is produced, the more the hypothalamus activates programs to reduce hunger and increase energy expenditure, which continues until fat mass is back in the optimal range. Conversely, low fat mass and low leptin lead to increased hunger and energy conservation by this same pathway**.

So if genetic mutants can become massively obese, I guess that argues against the idea that voluntary food intake and energy expenditure are the only determinants of fat mass. But a skeptic might point out that these are extreme cases, and such mutations are so rare in humans that the analogy is irrelevant.

Let's dig deeper. There are many studies in which rodents are made obese using industrial high-fat diets made from refined ingredients. The rats eat more calories (at least in the beginning), and gain fat rapidly. No big surprise there. But what may come as a surprise to the calorie counters is that rodents on these diets gain body fat even if their calorie intake is matched precisely to lean rodents eating a whole food diet (4, 5, 6). In fact, they sometimes gain almost as much fat as rodents who are allowed to eat all the industrial food they want. This has been demonstrated repeatedly.

How is this possible? The answer is that the calorie-matched rats reduce their energy expenditure to a greater degree than those that are allowed free access to food. The most logical explanation for this behavior is that the "set point" of the energy homeostasis system has changed. The industrial diet causes the rodents' bodies to "want" to accumulate more fat, therefore they will accomplish that by any means necessary, whether it means eating more, or if that's not possible, expending less energy. This shows that a poor diet can, in principle, dysregulate the system that controls energy homeostasis.

Well, then why did Dr. Haub's diet allow him to lose weight? The body can only maintain body composition in the face of a calorie deficit up to a certain point. After that, it has no choice but to lower fat mass. It will do so reluctantly, at the same time increasing hunger, and reducing lean mass***, muscular strength and energy dedicated to tissue repair and immune function. However, I hope everyone can agree that a sufficient calorie deficit can lead to fat loss regardless of what kind of food is eaten. Dr. Haub's 800 calorie deficit qualifies. I think only a very small percentage of people are capable of maintaining that kind of calorie deficit for more than a few months, because it is mentally and physically difficult to fight against what the hypothalamus has decided is in your best interest.

My hypothesis is that, in many people, industrial food and an unnatural lifestyle lead to gradual fat gain by dysregulating the energy homeostasis system. This "breaks" the system that's designed to automatically keep our fat mass in the optimal range by regulating energy intake, energy expenditure and the relative partitioning of energy resources between lean and fat tissue. This system is not under our conscious control, and it has nothing to do with willpower.

I suspect that if you put a group of children on this junk food diet for many years, and compared them to a group of children on a healthy diet, the junk food group would end up fatter as adults. This would be true if neither group paid any attention to calories, and perhaps even if calorie intake were identical in the two groups (as in the rodent example). The result of Dr. Haub's experiment does not contradict that hypothesis.

So do calories matter? Yes, but in a healthy person, all the math is done automatically by the hypothalamus and energy balance requires no conscious effort. In 2010, many people have already accumulated excess fat mass. How that may be sustainably lost is another question entirely, and a more challenging one in my opinion. As they say, an ounce of prevention is worth a pound of cure. There are many possible strategies, with varying degrees of efficacy that depend highly on individual differences, but I think overall the question is still open. I discussed some of my thoughts in a recent series on body fat regulation (7, 8, 9, 10, 11).


* ob/ob and db/db mice. Zucker and Koletsky rats. Equivalent mutations in humans also result in obesity.

** Via an increase in muscular efficiency and perhaps a decrease in basal metabolism. Thyroid hormone activity drops.

*** Loss of muscle, bone and connective tissue can be compensated for by strength training during calorie restriction. Presumed loss of other non-adipose tissues (liver, kidney, brain, etc.) is probably not affected by strength training.

PCIP Premium Decrease (HHS)

According to recent press, the federal government has indicated that it plans to decrease the premiums for the federal PCIP (temporary risk pools) by 20% in order to encourage greater enrollments. Apparently enrollment in the new PCIP has been lackluster at best.I do not yet know if the decrease will be applied to the CA PCIP as it is being run by the state (MRMIB) and not a direct federal risk

Fast Food Kids' Meals Still Unhealthy

Despite pledges made by some of the leading fast food chains, many seem to still be promoting mostly unhealthy meals and choices to children, according to a new report by researchers from Yale University's Rudd Center for Food Policy & Obesity in New Haven, Conn.The latest report examined the marketing of 12 top fast food chains, and then looked at the amount of fat calories, fat, sugar, and

Yoga can enhance mood and reduce anxiety--study

Practicing yoga on a regular basis can enhance mood and give a boost to the sense of well-being by reducing anxiety, suggest researchers from the United States National Institutes of Health (NIH).Yoga can fight against stress, reduce heart rate and blood pressure, raise our lung capacity, and improve our muscle relaxation and body composition.Previous studies have proved that yoga is effective in

Something you should know

Observations from France

I recently got back from a trip to the UK and France visiting family and friends. It was great to see everyone, eat great food and even do some unexpected foraging (chestnuts, mushrooms, walnuts, blackberries). French people are in better general health than most industrialized nations. The obesity, diabetes and heart disease rates are all considerably lower than in the US, although still much higher than in non-industrial cultures. Here are a few of my observations about French food:

1. The French diet generally contains a lot of fat, mostly from traditional animal sources such as dairy and pork fat. Industrial seed oils have crept into the diet over the course of the 20th century, although not to the same degree as in most affluent nations. People seem to think that eating a lot of fat is unhealthy, particularly the younger generation, but they do it anyway. I had dinner with my family at a traditional restaurant in Lyon (a "bouchon Lyonnais" called Stepharo) last week. Before we ordered, they immediately brought out crispy fried chunks of pork skin and fat (I'm not claiming this is healthy!). The entree was a salad: a bed of lettuce piled high with chicken livers, herring, and "pig's feet". The pigs feet were essentially gobs of pork fat. It was a very good meal that I'll continue describing later in the post. I think it's worth pointing out that Lyon is in Southern France. Is this the "Mediterranean diet"?
   
2. French people eat organs. Yes, they never got the memo that muscle meat is the only edible tissue. A typical butcher or even grocery store will have liver, tripe, kidney and blood sausage on full display next to the meat. If you want to make a French person angry, try selling them a chicken or a rabbit without the liver, gizzard and heart. The main course at Stepharo was a large "andouilette", or tripe sausage, baked in mustard sauce. This was a typical traditional restaurant, not a hangout for gastronauts.
   
3. French people fiercely defend the quality of their food. Have you heard of the abbreviation AOC? It stands for "Appellation d’Origine Contrôlée", or controlled designation of origin. A familiar example is Champagne, which has the AOC label. You can't call your sparkling wine Champagne unless it comes from the region Champagne. However, that's only half the story. AOC also designates a specific, traditional production method, in this case called the "méthode champenoise." The AOC label can apply to a variety of food products, including wine, butter, cheese, honey, mustard and seafood, and is a guarantee of quality and tradition. 44 cheeses currently have the AOC designation, and these are commonly available in markets and grocery stores throughout the country (1). These are not fancy products that only the wealthy can afford-- many of them are quality foods that are accessible to nearly everyone. AOC defines many aspects of cheese production, often requiring a minimum amount of pasture time and specifying livestock breeds. The US has a few products that are regulated in a similar fashion, such as Bourbon whiskey, but generally we are far behind in assuring food quality and transparency.
4. French people cook. There is less outsourcing of food processing in France, for several reasons. One reason is that restaurants are generally expensive. That trend is changing however.

I don't think the French diet is optimal by any means. They eat a lot of white flour, some sugar, seed oils and other processed foods. But I do think the French diet has many good qualities, and it certainly poses a number of problems for the mainstream concept of healthy food. Hence the "French paradox."

Health Net CA Blackout Coming Up

Health Net of California has announced a blackout for individual & family coverage plans (IFP) in a couple of weeks. The blackout will be lifted when the new PPACA-compliant plans are approved and available for January 1, 2011.The blackout will occur on November 18th (online quoting), and the last day to submit applications for December 1, 2010 start dates will be November 22nd. Any applications

Congratulations Rick Bronstein!

Rick Bronstein, a fellow agent and friend, ran for the office of CA Insurance Commissioner in the 2010 election. Rick placed third in the race and garnered almost 300,000 votes. Not to shabby for a 3rd party candidate with no corporate backing nor war chest.Congratulations, Rick. You certainly made them take notice. Now, get back to work LOL!

Anthem Blue Cross CA Update

Just wanted to update on my suspending sales with Anthem Blue Cross CA.I have spoken with Anthem concerning my issues with their processes and am supposed to be receiving some correspondence from "on high" regarding my issues and concerns. As of today I have not yet received anything from Anthem in this regard. I understand the correspondence has to be cleared by the legal department due to

5 Scary Cancer Questions, Answered

Q: I can’t always find—or afford—organic produce. How harmful are the pesticides in nonorganic foods?

A: People who consistently eat a diet high in fruit and vegetables have lower cancer risk—whether the produce is organic or not, according to David Katz, M.D., director of the Yale Prevention Research Center in New Haven, Connecticut. That said, Dr. Katz does think it makes sense to keep pesticide exposure to a minimum, because experts aren’t sure how—if at all—it affects cancer risk. About 3 percent of domestic products and 4 percent of imported products had pesticide levels of concern, according to a 2007 FDA report. Some items such as apples, bell peppers and spinach contain higher levels of pesticides than others, possibly because they have more permeable skin or more is taken in through their root systems, so use our shopping list the next time you hit the grocery store for guidance on when it’s best to opt for organic.

Q: I’ve read that sunscreen can actually cause cancer—is that true?

A: Sunscreen is still a must. Period. But controversy flared after a report by the Environmental Working Group claimed that 41 percent of sunscreens contain a form of vitamin A (retinyl palmitate) that may speed the development of skin tumors and lesions when exposed to...sunlight! The American Academy of Dermatology criticized the analysis because the data was from research conducted on mice, and it’s unclear if it’s applicable to humans. Not all sunscreens contain the chemical in question, so if you’re concerned, opt for those made with zinc oxide, titanium dioxide or Mexoryl. Bonus: These ingredients are less likely to break down than others, so the protection lasts longer.

Q: I drink bottled water all the time, but I keep hearing that some bottles contain dangerous chemicals. Should I be worried?

A: In this case, it’s valid to be concerned. BPA, a chemical often found in plastic water and baby bottles and metal cans—even cash register receipts—has been linked to increased risk for breast cancer and heart disease. “BPA acts as a weak estrogen, which can spur the growth of cancerous cells,” says Hugh Taylor, M.D., professor of obstetrics, gynecology and reproductive sciences at Yale University Medical Center. Whenever possible, give plastic water bottles a pass and sip from glass or steel containers instead (I often choose a metal commuter cup); use baby bottles that are labeled BPA-free (fortunately these are widely available); and avoid plastics with the code 7 on the bottom—those are more likely to contain BPA. Also, opt for fresh or frozen foods instead of canned ones (most cans are lined with BPA-epoxy liner), and wash your hands after handling receipts.

Q: Is it true that three bad sunburns guarantees you’ll get skin cancer?

A: Not exactly, but your risk for skin cancer, including melanoma, dramatically increases if you have had five or more severe sunburns that blister. “The more sun exposure you get, the more DNA damage to your skin, which can lead to cancerous changes,” explains Kevin Pinski, M.D., associate professor of dermatology at Northwestern University Medical School. It’s not only burning that puts you at risk. Cumulative exposure ( repeated sunbathing without burning) is linked to basal cell and squamous cell carcinomas. You can’t reverse all your past exposure, but you can prevent future damage: Wear protective clothing (like long sleeves) and get your tan from a tube, not a tanning bed! Remember: The only safe tan is a fake tan.

Q: Cancer rates seem to be skyrocketing—what’s going on?

A: Despite scary headlines, rates of many cancers are going down in this country, Michael Thun, M.D., an epidemiologist at the American Cancer Society in Atlanta, assured us. Breast cancer incidence rates have dropped 11 percent since 1999; experts say that’s because women stopped using hormone-replacement therapy after studies linked it to cancer. Fewer women have had colon cancer over the past two decades thanks to better screening. And ovarian and uterine cancersare less common because women are taking birth control pills for longer periods of time. (The Pill prevents ovulation, which is thought to trigger cell damage and raise the risk for tumors.) More encouraging news: If you do get cancer, you’re more likely to beat it. Breast cancer death rates are down 30 percent, thanks to earlier detection and better treatments. And five-year survival rates for all cancers are up almost 20 percent. With research and advocacy, we can lower those numbers more every day.

Gulf Seafood Is Safe, Officials Say

Extensive testing of Gulf of Mexico seafood by federal scientists has found just minute traces of the dispersant Corexit, which was used to break up oil from the BP spill, officials say. About 1.8 million gallons of dispersant were applied to the waters’ surface and at the wellhead, almost a mile undersea.Of 1,735 tissue samples analyzed, only 13 showed trace amounts of dispersant residue, in

Healthy Weight Loss Help and Tips