Tag Archive | Nutrition

Bariatric surgery may be about metabolic health rather than limiting consumption

The Los Angeles Times reports on the results of a new study of the benefits of bariatric surgery”

The study randomly assigned 150 overweight and obese people with Type 2 diabetes to one of three groups. Those in the control group had their diabetes managed with medications and daily blood-glucose monitoring. They also received intensive counseling about diet and exercise, including regular weigh-ins to monitor their progress. After three years, they had lost an average of 9.5 pounds.

The second group in the trial got Roux-en-Y gastric bypasses, in which the stomach is reshaped and relocated to divert most food past much of the lower intestine, where nutrients and calories are largely absorbed. The third group got a procedure called sleeve gastrectomy, which staples some 80% of the stomach closed, creating a banana-shaped tube where once a large pouch existed. Patients who had surgery received intensive medical management and lifestyle counseling as well.

Three years later, those who had the Roux-en-Y bypass had lost an average of nearly 58 pounds, and those who had sleeve gastrectomy lost an average of 47 pounds.

More importantly, Schauer said, the patients in the surgery groups were much more likely to have their diabetes under control — 58% of those who had Roux-en-Y and 33% of those who had sleeve gastrectomy were able to stop taking diabetes medications. Only 5% of patients in the control group achieved the same endpoint after three years, and none were able to discontinue medications completely.

In addition, study volunteers who had gastric bypass whittled their daily number of blood pressure and cholesterol-lowering medications from 2.73 to 0.96, on average. And subjects who had sleeve gastrectomy reduced their average number of cardiovascular medications from 2.18 to 1.35 three years later.

The medication tally for the control group didn’t budge.

Sadly, the report does not discuss the possible mechanism(s) responsible for this result. The theory behind bariatric surgery was that it would work simply by restricting the volume of food that the patient could consume. It turns out that it seems to be driven more by the way it resets metabolic health in general and insulin sensitivity in particular.

Once he was awarded funding, Brady began collecting fat samples from bariatric surgery patients with the help of a research assistant. The samples were collected two weeks before the surgery, and then again two weeks after the surgery.

“We added varying dosages of insulin to the samples to test the sensitivity, to create a dose-response curve,” Brady said. “And what we found that there was a huge increase in both insulin sensitivity and responsiveness just two weeks after the procedure.”

Brady found that these results could be reproduced in each patient undergoing a Roux-en-Y or duodenial switch.

Bariatric surgery seems to ‘reboot’ fat cells so that they do their job properly, absorbing and retaining the lipids,” Brady said. “However, there are likely to be more subtle molecular and metabolic differences between the two procedures. This is something we’re hoping to examine in a larger study.”

It would be great to see the conversation about type 2 diabetes and obesity shift further away from the overeating paradigm to a metabolic health paradigm.

If The Science Was For Sale Why Did The Meat and Dairy Industries Get Rolled?

Marion Nestle had a piece earlier this week on how the American Society for Nutrition (ASN), (the organization that publishes the American Journal of Clinical Nutrition (AJCN) and the Journal of Nutrition) should deal with conflicts of interest, especially in the journals that they publish. Her points are sound and I don’t have much to add except that I’ve never understood how the sugar industry has been able to warp the conventional wisdom via sponsorships of organizations, research and research departments but the meat and dairy industries got rolled on fat and cholesterol.

The evidence against the evils of saturated fat and dietary cholesterol was always thin, and yet these supposedly powerful industries got pummeled by the nutrition community for decades.

The dairy industry I can understand, because they actually benefited from the low-fat milk nonsense. The admonishment to eat low fat dairy functions more like punctuation than actual advice in standard nutritionspeak. You’d think this would drive the dairy industry crazy until you look at the price of milk in the grocery store. A gallon of full fat, 2% and skim are all the same price. They got to sell people crappy reduced fat milk for the same price as the good stuff and sell the fat as butter, cream and half & half without skim milk as a by product. (Health conscious humans trying to watch their weight are willing to pay more for skim milk than hog farmers looking to fatten their hogs [pdf].)

But it’s seems weird that if the science was for sale, why didn’t the meat and egg people buy it? It should have come cheap as the evidence was mostly on their side when it came to fat and cholesterol.

Notes
Conflicts of interest in nutrition societies: American Society of Nutrition
Marion Nestle | Food Politics | November 20, 2013
Big Sugar’s Sweet Little Lies
Gary Taubes and Cristen Kearns Couzens | Mother Jones | November 2012
A Big Fat Debate
Kristen Wartman | Civil Eats | March 4, 2011
What’s Cholesterol Got to Do With It?
Gary Taubes | The New York Times | January 27, 2008
New Review Paper by Yours Truly: High-Fat Dairy, Obesity, Metabolic Health and Cardiovascular Disease
Stephan Guyenet | Whole Health Source | July 22, 2012
How to Fatten Hogs for Market [pdf]
Oregon State Agricultural College | 1930

Daily Essentials | Thursday | 3 October 2013

1. SHUTDOWN LEAVES PROGRAM FEEDING WOMEN AND INFANTS IN THE LURCH
Eliza Barclay and Allison Aubrey | NPR

Among those affected by the chaos of the government shutdown are 9 million low-income women and children who may be worrying where next week’s meal is going to come from.

They rely on the government for food assistance through the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC.

And according to Douglas Greenaway, president and CEO of the , some of the state programs that serve these women and children may run out of money by next week, while others may have enough funds to offer the food benefits through the end of the month. But across the country, he says, anxiety is rising as both program administrators and participants wonder how long they’ll be in limbo.

2. WHERE DO HUNGER AND COGNITION INTERSECT
Zarja Muršič | The Scicurious Brain | Scientific American

Just how important is leptin? Studies of genetically modified strains of mice with deficiency in production of leptin, and so without the ability to reduce food intake, are prone to obesity and diabetes (8). These mice have a genetic defect in fat cells, which prevents them from secreting leptin, and without leptin, they don’t have the signal to stop, so they keep eating, and get very obese.

So, maybe you are halfway through your omelet, or that big bowl of oatmeal, and your body begins to produce leptin, signaling you have had enough. This may be the whole story of your Sunday breakfast, but the leptin has not yet finished its work. Maybe you didn’t make that omelet yourself, but bought it at a little breakfast place down the road. If you remember where that breakfast place is, you might be able to go back. And leptin plays a role here as well. Our bodies are quite efficient and will turn one hormone to many uses. In case of leptin – if the hormone can do one thing, it can be adapted to do another as well, and in this case, leptin plays a role in cognition.

3. WHAT ARE WE TO MAKE OF CHIPOTLE’S NEW AD?
Paul Raeburn | MIT Tracker

The root of much of the criticism, it seems to me, is that people are shocked, shocked that Chipotle would advocate sustainable farming, family farms, and greenmarkets when it is nothing more than a big corporation selling burritos by any means necessary!

If Chipotle is sincere in trying to use its leverage to promote better agricultural practices, there is no greenwashing here; it is pursuing the course promoted in the video. If it is lying about that, then it is not only guilty of deception, but possibly crimes.

But let’s not be shocked by Chipotle’s eagerness to sell its burritos. It’s a public corporation listed on the New York Stock Exchange, and it’s trading around 419 as I write this, close to its 52-week high. It has a market cap of almost $13 billion and a P/E of just over 44.

If Chipotle is pushing sustainable agriculture over less desirable practices, let’s take it. Would we feel warmer about the burrito-industrial complex if Chipotle promoted ruthless slaughter?

4. POSTSCRIPT: MARCELLA HAZAN CHANGED MY LIFE
David Sipress | The New Yorker

On Sunday, the great Italian chef and cookbook author Marcella Hazan died, at the age of eighty-nine. Marcella changed my life. Twenty years ago, my wife and I went to Italy for our honeymoon and I discovered the wonders of Italian food. I returned from the trip determined that, for the rest of my life, I would eat only the way I had during those three weeks of culinary bliss. There was one huge problem—I was a terrible cook. The little cooking I did usually involved frying in Wesson oil and saucing with Paul Newman salad dressing. Fresh ingredients were not in the picture; having grown up in New York in the fifties, I had pretty much accepted my mother’s theory that any food item not wrapped in plastic was probably covered with germs.

What I needed was a teacher. And I found mine in Marcella’s “The Essentials of Classic Italian Cooking.” All I had to do was follow her instructions to the letter, and success was pretty much guaranteed. If you’ve ever seen Marcella on television, you know that she was a short, compact lady, a tough biscotti with a raspy voice who didn’t suffer fools gladly and had a surprising preference for Jack Daniels over a glass of wine. But in her books her voice is always warm and encouraging. This, and the fact that her recipes are consistently clear and straightforward, enabled me to overcome a lifetime of insecurity in the kitchen. She just made it all seem so easy.

5. COFFEE EXPERIMENTS
Seth Brown | Dr. Bunsen

For analyzing beer and whisky flavor preferences, I turned to several comprehensive datasets. For coffee, I couldn’t find an equivalent resource, so I generated my own data. My experimental design was simple.3 I’d give guests two cups of coffee prepared in exactly the same way except for one important difference. I’d then ask guests to choose their favorite of the two cups without them knowing which cup was which. Then, I’d record the results.

To avoid Groupthink, I gave one of the two cups, blinded and at random to each subject. I also wouldn’t inform the subjects what the independent variable was until after the experiment was completed. These steps helped avoid introducing bias into the experiment which may have distorted the results.

In total, 3 rounds of randomized experiments were conducted. Two of the three rounds were actual experiments, while the other round served as a control. As a control, house guests were given two cups of the exact same coffee and asked to choose their favorite. The control served as a baseline to calibrate the experiment. In all control experiments, subjects’ preferences between the two cups of coffee were consistent with a random coin flip.

6. LET’S RETIRE THESE DAMAGING NUTRITION MYTHS, PLEASE
Andy Bellati | Huffington Post

1) “There is no such thing as junk food/there are no bad foods.”
In very specific contexts (i.e., eating disorder recovery), I understand where this stems from — strip away judgmental labels on food and bring it to its most basic function: nourishment. However, I’m increasingly seeing this message doled out by mainstream nutrition experts as a “takeaway” for the general public. . .

2) “Moderation!”
To my ears, “Everything in moderation!” is the equivalent of 600 fingernails on a chalkboard, plus the never-ending drip of a leaky faucet. “Moderation” is a meaningless term. Ask 20 different people what it means and you’ll get 20 different responses.

“But that’s the beauty of it — each person can define it themselves!” some say. That doesn’t sound like beauty to me. It sounds like chaos.

“Everything in moderation,” is another way of unnecessarily and inaccurately equalizing all foods. It operates on the inane and utterly insane notion that peaches, Pop-Tarts, muffins, soda, lentils and tomatoes should all be approached the same way. . .

3) “Healthy eater = red flag.”
When I was in school, I recall many of my nutrition textbooks pointing out that vegetarians, vegans and “those who avoid certain food groups” must be warned that if they do not plan their diets adequately, all sorts of nutritional ills could befall them. Meanwhile, the average American on the omnivorous “Standard American Diet” falls short of the recommended intake of fiber and several minerals, including magnesium. Of course, this is not because omnivorous diets are inherently unhealthy, but because the majority of Americans eat highly processed foods with little nutritional value. . .

4) “You have to be realistic.”
This is often brought up by some nutrition professionals to justify their recommendations about making healthful choices at fast-food restaurants (“Just get the small size”). I’ll admit it — I used to think this way when I first started studying nutrition, before I counseled clients. I now see that the most satisfied individuals I have worked with are those who stepped outside their comfort zone. They aren’t interested in learning how they can still go to the drive-through three times a week and making “lower-calorie choices.” They want to truly learn about healthful eating. . .