Monthly Archives: January 2008

Metabolic Syndrome II:The Phalacious Philosophy of Phat

Metabolic Syndrome # 2: Understanding the Fire Within.  “The Philosophy of Phat”

Competency # 20 Culture Lifestyles of the long-lived

Reference:  Good Calories, Bad Calories by Gary Taubes,  Published 2007

“You are overweight.  Ergo, you eat too much.”  Pretty simple, isn’t it?  Except that it’s wrong.  We have lived by this dictum for some 50 years in America and it may not be quite the truth.  Behind the scenes, there are cracks appearing in the wall of this sacred commandment of modern health care.  And for those of us who put on weight without even thinking about it and have to struggle to get it off, we feel as though we are caught in a vice of blame, shame and confusion.  We’re going to explore where the ideas came from and see if there isn’t a better answer.  Eventually, we’re going to get you to better health.  But first, we have to challenge the “Prevailing Phalacious Philosophy of Phat”.  It’s spelt wrong because I think it’s all wrong.

 “You are overweight.  Ergo, you eat too much.”  Pretty simple, isn’t it?  Except that it’s wrong.  We have lived by this dictum for some 50 years in America and it may not be quite the truth.  Behind the scenes, there are cracks appearing in the wall of this sacred commandment of modern health care.  And for those of us who put on weight without even thinking about it and have to struggle to get it off, we feel as though we are caught in a vice of blame, shame and confusion.  We’re going to explore where the ideas came from and see if there isn’t a better answer.  Eventually, we’re going to get you to better health.  But first, we have to challenge the “Prevailing Phalacious Philosophy of Phat”.  It’s spelt wrong because I think it’s all wrong.

Think for just a second.  You can’t escape the logic of, “You’re too fat.  You eat too much.”  Of course I’m too fat.  I can see that.  I have to look at myself in the mirror each morning when I shower.  Thank God it’s steamy in the bathroom and my eyes don’t work.  But do you have cause and effect turned around?  Maybe the confusion is about why I’m fat.  Maybe what you think is cause is actually effect.  Maybe I’m too fat because the food I eat makes me fat.  Ha!  Ever thought of it that way?  Not just a trite excuse, it’s really at the heart of our exploration.  If we keep blaming the victim, and never discovering the real cause, the victim will always be wrong.  Maybe the real culprit is the nature of the food.  Let’s consider that!  I’m not trying to pass blame and get out of my own dilemma, but there are some interesting things to consider I want to put on the table.  But we’ve been preached to about eating a low fat diet now for 35 years.  It’s been a public health disaster.

First, why is that there are dozens of stories from around the planet of people who were healthy on their indigenous diets, who became obese, developed diabetes and heart disease ONLY when they started to eat “Western Diets” that consisted of flour and sugar as the primary source of staple calories?  Why?  The Pima Indians of Arizona are one classic example.  The Inuit, as we referenced last week are another.  The Masai of Kenya eat only milk and blood.  Only.  No vegetables, fruit, flour, cookies.  Some meat.  They have some of the lowest cholesterol levels ever measured.  Were they all just slovenly, lazy indigenous peoples who just ate too much when they got hold of “western food”?  I can’t buy that.  They weren’t overeaters before.   And they had plenty of calories before.  They were not living on the edge of starvation.  So, forget those old chauvinistic myths.  They allow us to not examine the real issue.  What is the science?  What are the questions?

It’s time to stop blaming the individual and think more about the environment we place ourselves in.  What’s causing our epidemic of obesity?  After 30 years of national food guidelines in which we have been advocating low fat diets with many servings a day of carbohydrates, and in which we all gained 15 pounds each, doesn’t it make sense to challenge the assumptions.  Our national food guidelines were based on science, weren’t they? Well, not so fast.  That’s next week’s email.  Cause the answer is NO!

WWW:  What will work for me.  A good scientist has to start being a good philosopher.  What are the real questions?  What’s cause and what’s effect?  This is what raising teens taught me.  They figure out the argument faster than you can if you don’t have your cause and effect right.  We can’t confuse the two.    Maybe you and I are too fat because the food we eat forces us to be fat.   Not cause, but effect.  It may not be the fat we eat that makes us fat.  It may be the nature of carbohydrates and sugars. I want to get down to the cellular level and understand how insulin works on fat cells, how fat gets stored, how carbs turn into fats.  Why am I hungry all the time?  What’s the reason?  If I can figure it out for me, you can come along for the ride.  But my goal is to understand.  Einstein’s definition of insanity was doing the same thing over and over, and wondering why we don’t get a different result.  I’m not looking for an excuse to sit on my couch forever and expect a different result either…

Metabolic Syndrome III: The Mistake that got it all Started

Metabolic Syndrome # 3 The “Pseudo – Science” That Got it all Started

Competency # 20 Lifestyles of the Long-Lived

Reference: Good Calories, Bad Calories by Gary Taubes, 2007

Here is how it all got started.   The names are Ancel Keys and Jeremiah Stamler.  Keys was the alpha male of nutrition science after World War II.  He ran the Laboratory of Physiology in the University of Minnesota.  His name was the “K” in K-ration from World War II.  He was well known.  Stamler was a cardiologist in Chicago who liked to use the imagery of artery clogging fats.  Just like the plumbing in your kitchen sink, the imagery of arteries that plug up with cholesterol was one that the public could relate to, even before the means by which that “clogging” was understood.  You can imagine, you eat butter and it flows from your mouth right to your arteries.  Sounds ridiculous now, but we all have used that imagery.  Prior to WWII, the best research on nutrition was being done in Germany and Austria.  Their work wasn’t published much in English, and their research institutions were all destroyed in the war.   WWII was such a huge disruption in everything that lots of folks in America, who had been doing nutrition research, had run out of steam and retired.  Stamler and Keys came onto a clean slate after WWII.  The Europeans were exhausted and the Americans were starting from scratch.

Keys first research involved feeding men a diet laden with cholesterol, and found no effect on their blood cholesterol levels.   So he poo-pooed the cholesterol, heart disease connection.  Then he had a conversion experience.  He went to a conference in Rome on nutrition and disease.  An Italian physiologist from Naples said that heart disease wasn’t a problem in Naples.  Keys bustled off to Naples with his wife, a lab technician skilled in measuring total cholesterol.  He interviewed poor folks, who were skinny and didn’t have heart disease.  His wife measured their cholesterol.  Then he visited the Rotary Club of Naples and found that the rich folks had pasta and rich meat and cheese sauce.  Their cholesterol was higher.  Their rate of heart disease was higher.  They were fatter.  And the disease of high cholesterol was born.  Keys believed.  It must be true.  They ate more meat and cheese and had more heart disease.   Ergo.  Presto.  Cholesterol must cause heart disease.  He came back to the USA and began advocating that folks should reduce their intake of fat by a third.  The low fat diet to fight heart disease was started. Bad conclusions were born!  And Keys attacked and ridiculed anyone who disagreed.

Keys began to assemble “evidence” to bolster his argument.  He examined Japanese living in Japan and in America.  In America Japanese immigrants became overweight and got coronary artery disease.  It must be the cholesterol.   Keys looked at the rate of coronary artery disease in European countries during WWII and how it dramatically declined.  He connected the dots that folks ate less fat during WWII and that’s WHY they had less heart disease.  He didn’t consider that they had many few calories too, and lost weight, and starved……  Keys continued to study heart disease in nations.  He looked at “7 nations” whose data supported high cholesterol and heart attack.  No one noticed that he didn’t mention the other 15 that didn’t and yet had similar populations and diets.  But the “Seven Nation” study has been quoted for 40 years as PROOF positive.   And all he was going on was associations, in the countries that supported his idea.  He was confusing cause and effect, and picking his sources.  He was trying to take the process of epidemiology, a scientific process that worked well with infectious diseases, and applying the same logical inferences to nutrition.  Infections have one bug to blame, one cause, one effect.  Nutrition is more complex.  Increased fat may go along with increased calories, increased processing, more sugar, less fiber, less Vitamin D and on and on.  None of those were in the mix in 1950.  The “science” of epidemiology of nutrition research requires a randomized controlled trial to complete the observations found in associations.  And an RCT has yet to be done.  Bad philosophy, bad logic, bad science.  But, we’ve lived with it for 40 years.  And it’s wrong, or at least not proven.

WWW:  What will work for me?  This is like a detective novel.  I grew up in medicine knowing the names of Stamler and Keys.  We took their studies without comment and just memorized their conclusions. “ You should advocate a low fat diet.”  Along with that came NATIONAL GUIDELINES that said to eat more carbs.  I jumped right in and felt like I was doing a good thing with a second serving of rice.  So did all of us, from the looks of things.  It all seemed too complicated and huge a topic.  Next week we will look at how George McGovern carved “low fat” in stone.   I love detective mysteries.  I just don’t want to be the guy found lying on the floor of the library with a lead pipe in my hand, clutching my fat chest because some lousy CSI didn’t get their facts straight.

The Disease Called Winter

The Disease Called Winter: Risk of Heart Disease and Vitamin D

Competency # 15  Vitamin D

Reference: Circulation 2008: 111 Wang et al from Mass General and Framingham Study

Winter is dark and cold.  We bravely face it here in Wisconsin, making the best we can do with the state we are in.  But deep down inside, our souls just yearn for a nice warm, sunny day.  Intuitively, we have this vague feeling that winter just isn’t good for us.  What we do know scientifically is that from about Oct 15th to April 1st, the angle of the sun is so low in Wisconsin, that your skin cannot make Vitamin D, no matter how hard you try.  In late December, the angle is about 24 degrees.  For six months we coast on our reserves from summer, with a tiny addition from the milk we drink and the multivitamin we take.  Nothing dramatic, but year after year we do it again and again …

Now the proof is here.  This study about heart attack risk and vitamin D is a landmark study.  From the Framingham cohort of patients, now followed for over 50 years, 1739 patients without heart disease were followed and separated into groups by their natural levels of Vit D.  Those folks with Vit D below 15 ng (28% of the sample group) had a 62% “hazard ratio” (AKA greater risk) and those folks with Vit D below 15 ng AND high blood pressure had a 2.12 “hazard ratio”.   This is stunning.  It adds to the growing body of evidence that the human species was not designed to live outside of sunshine.  Vitamin D is important to every cell in our bodies.  It essentially works as a hormone, not a vitamin, to tell our cells to grow up into their intended function.  That happens to blood vessel cells just like any other.  When they are well, they don’t get fatty plaques and respond well to blood pressure challenges, just like they were designed to do.

The scientific language says it this way:  “1,25 dihydroxyvitamin D directly suppresses renin gene expression, regulates the growth and proliferation of vascular smooth muscle cells and cardiomyocytes, and inhibits cytokine release from lymphocytes.”   What Dr. Wang and his colleagues at Harvard found in the Framingham cohort of patients is observational data (not a randomized controlled trial but a prospective observational trial).  This makes vitamin D deficiency to be almost as powerful a risk factor as high cholesterol, smoking and high blood pressure.  The study wasn’t large enough to detect if medium deficiency was also dangerous.  15 ng is what 28% of the population has, and very likely what many of us in Wisconsin have in mid-winter.

That suggests that each winter each of us goes through a 5-6 month stress test during which time our bodies have inadequate amounts of Vit D for optimal health.  We don’t have any disease state from it that can be detected in one winter.  Instead, each year, winter after winter, our blood vessels are in a state of stress, just like all the other cells in our bodies that need Vit D to reach optimal health (so far 1,400 different types).  Then we recover for the summer.   And after 30-40 years, we are in a condition where the other risk factors for heart disease take over: like high cholesterol, high blood pressure etc.  And we ask,  “What went wrong?  What could I have done?’

This is plausible!  The cellular mechanisms are understood and make sense.  The cell types that make up our arteries and heart have vitamin D receptors.  Vitamin D has been shown to reduce blood pressure, all by its self, and is therefore known to be active in our vascular system.  What we need now is a prospective, randomized controlled trial to test whether an intervention will work at reducing the risk.  That will take lots of time.  Is it risky to take Vitamin D in the meantime?

Is winter a disease all by itself?  It certainly is a physiologic stress test, one that optimal health would argue we can do something about.    Now we’ve got the details.

WWW: What Will Work for Me?  We were designed to live in sunshine.  A five-month period of time deprived of sunlight is not to our best advantage.  I measured my own blood level of Vit D on 2,000 U a day and found it to be 25 ng. in early December.   That’s after living in Wisconsin for four months without a vacation to any place sunny and being essentially indoors. That’s with a supplement.  Not a rock bottom number but lower than I want.   I want at least 30, so I raised my supplement dose to 5,000 U a day.    After a month, my level came back at 35.4 ng., not toxic.  The upper limit of normal is 52 ng/ml.   If there is anyone out there that you know that isn’t taking Vit D during the winter, especially if they have high blood pressure, talk to them.  Encourage them to see their doctor and ask about a Vitamin D blood level.   I’m sure this will become part of our standard risk assessment for heart disease and just plain general health.  So, get out there and schedule your trip to Disney World, Fort Myers Beach, Cancun, or 10 minutes in the tanning booth three times over the next two weeks.  Short of that, a cheap Vitamin D pill and a beautiful poster will have to do until April.  Then, like Grandma said, “Go play outdoors.”  Your heart will benefit and thank you.