Monthly Archives: January 2013

There are a number of popular memes I come across on the Internet connected with what we do (or don’t) eat, and how we can lighten up, lose weight, conquer obesity, get healthy, and all the rest. Some make sense to me; others seem like arrant nonsense. Some are arrant nonsense, from people who should know better—for instance, qualified medical people who apparently can’t differentiate between ketosis (good) and keto-acidosis (very bad).

If it wasn’t that I’m working to fit into my new self-image of a kindly and reasonable ordained minister (and to keep the friends I have) I would be tempted to explode and “flame”. But I just passed my 65th birthday so am exchanging that youthful but intemperate passion for the “wisdom” of increasing years.

My number one bête noir is “Diets Don’t Work”. The other is “But can you live that way for the rest of your life?” Let’s take them one at a time.

Do Diets Work?

[simpleazon-image align="right" asin="1582702187" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/514y%2BP4rk4L._SL160_.jpg" width="100"]Of course they do! I regard this as a non-question but I keep hearing people say “Diets Don’t Work” and to me this seems an empty statement.  I addressed it some time ago in a blog post, referring to Jon Gabriel and I thought I had done with the matter.  But I recently had a sweet lady, a vicar’s wife from a rural parish in the heart of England, an intelligent, erudite, educated lady, a lady with seven grand-children, actually SHOUTED at me that DIETS DON’T WORK.

So, before I lose my English gentlemanliness and my ordained-minister composure, and the aforementioned wisdom that came to me as I recently passed the grand-old age of 65, let me take a breath, put my teeth in straight, connect with higher things, and start to take this empty assertion apart.

I suspect that we will have no differences of opinion about the words “do not” so let’s start with the word “diet”.  The word is derived, according to Merriam-Webster:

Middle English diete, from Anglo-French, from Latin diaeta, from Greek diaita, literally, manner of living, from diaitasthai: to lead one’s life

First Known Use: 13th century

Interestingly, I had it in my mind that it came from the Latin “dies” referring to something daily and that it meant “that (food) which we consume on a daily basis”. Either way, we’re in the same ball park. Most modern-day dieticians and nutritionists would have a slightly wider definition.  They would take “diet” to mean the food or nutrition that we consume on a regular basis.  Well, already I hope we can see that the sentence “the nutrition that we consume on a regular basis doesn’t work” needs some further discussion.  I will put on one side, for now, the difference between food and nutrition and come back to it later.

We still have “work” to look at, and now we have introduced “we”.  Let’s start with “work”. What would we mean if we were to assert that a diet did, or did not, work.

I am going to be bold and say that for me any particular diet (that is any particular set of foods eaten on a regular basis) could be said to work if it led me to be fit and healthy, to be disease-free and allowed me to live a long and happy life. If at the same time that set of foods were highly palatable, and relatively easy to obtain without having an overly adverse effect on others or the environment, I would say that that diet could be said to work. On that basis I think that there is some doubt as to whether the nutritional plans followed by many “civilised westerners” are working, at least as well as we might like.

Others might have a different definition of whether a diet is working.

The objective of the systems built by our DNA and driven by our hormones and our psyches over millions of years might be to make sure that we have the necessary energy reserves to survive the hard times that come from time to time and to have enough energy to successfully pass on our genes. In that case I guess for many of us our diets are working… or would be, if only those hard times would come along a little more frequently in the “first world”.

Here’s an interesting aside. If you talk to anyone who was an adult civilian, living in Britain during the Second World War, they would tell you that with all that food rationing, times were hard. But apparently, apart from being bombed, the UK population has never been so healthy1. That diet worked. It worked for those that defined it: their purpose was to keep the population alive and healthy given the restrictions imposed by wartime. Many who were obliged to follow it might have said it didn’t work: it wasn’t that palatable, often left them hungry, was boring, and was hard work.

If you were a character in a murder novel hoping to bump off the fifth earl so that you could inherit, and you were doing it by feeding him dinners laced with arsenic then I’d imagine you’d be hoping for a different outcome from most people’s idea of a successful diet.  If someone had stolen your arsenic and replaced it with self-raising flour then it would be fair to say that that particular diet wasn’t working (for you: I would guess that the fifth earl would be content).

So, I’m quite happy to concede that some diets don’t work, for some people, for some of the time… it all depends on the people involved, the set of foods in question and the desired outcome.

During the 1960s there was an apparent surge in deaths from cardio-vascular disease in American men. This was an odd anomaly caused by two artifacts.  One was that previously there had been a life-expectancy of adult males of around 49 years due to a high-incidence of infectious diseases. Then we invented antibiotics; life expectancy rose and people died of different things: degenerative diseases as opposed to infectious diseases.  The other artifact was even sillier.  There is in the medical world almost a fashion as to what is written on the death certificate. At one time a doctor might have written “natural causes” where now they might write “heart failure”.  Both Susan’s mother and my mother have “heart failure” as the cause of death on their death certificates. Neither woman had a history of heart problems. Neither woman had an autopsy.  Susan’s mom wasn’t even attended by a physician when she died.  Basically the statistics say that these women died because their hearts stopped beating.  Well, yes, but those statistics don’t tell us anything useful. They told us even less back in the 1960s.

But back then nobody noticed this and one scientist who had a bee in his bonnet about dietary fat managed to get his hypothesis to hold sway, and over the last 50-60 years we have been persuaded to leave fat out of the set of things we consume on a regular basis. This makes that set of food stuffs less nutritious and less palatable.  The palatability issue was addressed when food manufacturers noticed a (for them) heaven-sent opportunity. America has a huge amount of land ideally suited to growing corn: sweet corn. From sweet corn you can easily derive high-fructose corn syrup (HFCS) and, provided you have a sweet tooth (and a sweet tooth is fairly easy to develop in a population, by gradually increasing the quantities of HFCS in the foods you manufacture, and judicious use of TV advertising) HFCS makes all that bland, fat-free food taste good (well, better!)

Then governments around the world got more and more worried about the failing health of their populations and the increasing cost of health care and they advocated nutritional regimes (dare we call these “diets”?) that made matters worse. They put increasing store on avoiding dietary fat, got the message about cholesterol back to front and upside down, and recommended the very things that were making us sick: cereal grains, sugars, and fructose.

These nutritional regimes resulted in an overwhelming rise in obesity, type 2 diabetes, metabolic syndrome and, ironically, cardio-vascular disease; the very thing that they were trying to address in the first place. They were also responsible for a surge in Alzheimer’s Syndrome in the elderly (and, increasingly, not so elderly) to the point that some people are now calling Alzheimer’s Type III diabetes.

So, all right, the diets suggested by most modern, western health authorities don’t work that well. We all know they don’t work—that well. I am writing this sitting in an Internet cafe right opposite the checkout line in a supermarket in Florida. I am not medically qualified. I am not a qualified nutritionist or health adviser. But I don’t need to be to see that the majority of people going through these checkouts are not peak physical human specimens. And I’m not being arrogant saying this: neither am I! My purpose here is not to preach from the pulpit, despite my newly-arrived white collar (I’m not wearing it because the shirt doesn’t fit—yet!). My purpose is to raise the banner and see if we can’t educate ourselves and take our nutrition and health back into our own hands. And to do that we are going to need food, but food that fits into a different nutritional regime than the one(s) that brought us here.

We are going to need diets that do work.

When I read “Diets Don’t Work” I suspect that what is being referred to are those hastily thrown together dietary plans that are published in women’s (and men’s) magazines, with increased magazine circulation more in mind than increased health for the readers. But is it true that universally these diets don’t work? I don’t think so. I suspect that all of these diets have worked, according to some set of criteria or another, for some people, for some of the time.

[simpleazon-image align="right" asin="B00AWQWYVK" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/516RY%2BHkMDL._SL160_.jpg" width="100"]Before I move on to the second “nutritional meme” I just need to spend a moment with a thread I just saw on a lifestyle forum where someone had posted a question about ketogenic diets and someone else (let’s call him “John”) had posted a response:

@john: I find that these diets don’t work because people don’t stick to them.

Well, there is a sentence that could keep people from a host of different disciplines occupied for many a happy hour. But I will just stick with reflecting about the use of “I” as in “I find…” and “people”. Later on this book we will begin to look at how we can support each other and how we can build a supportive environment. One small aspect of that is “owning”. So, with our Neuro-Linguistic Programming (NLP) hat on, we might ask @john if he can own that for himself.

“Who are these people, John”, we might ask, “who can’t stick to the diet?” We might wonder what motivated him to write that.

Now let me get on to the second “nutritional meme” that’s irritating me.

Can you live this way for the rest of your life?

No. So?

This challenge is thrown out as a criticism against various nutritional regimes.  ”This isn’t a regime”, says the pundit, “that you can follow for the rest of your life, ergo, it’s of no value at all”.  I don’t agree.

Let’s imagine that, cycling home from Winn Dixie (which is where I am right now, drinking their free coffee and using their free Wi-Fi) I get knocked off my bike, break my leg, and wind up in the Emergency Room at the local hospital. The doctors take an x-ray of my leg, proclaim that I have a fracture and propose to re-position the bones and then plaster my leg and issue me with crutches and some analgesics and instructions to take it easy while the bones knit together.

“Oh no, doctor”, I cry, “I can’t possibly live that way for the rest of my life!”

The doctor looks at me and wonders whether he shouldn’t call for the on-duty psych consultant.

“Of course not”, he says patiently. “You have broken your leg: the plaster cast will hold it in position while the bones heal themselves, helping them to heal cleanly, and when that happens we will remove the plaster cast”.

Whew! I am relieved. I thought I would be in a plaster cast for the rest of my life, and didn’t want to live that way.

So, for the next few weeks while the bones heal, I consider what I could have done, that fateful day, to have avoided being knocked off my bike. Remembering that I was in the USA and not the UK and cycling on the correct side of the road might have helped. Stopping before making a blind left turn might have helped. Indicating my intentions with hand signals might have helped.

A few weeks later I go back to the ER and have an X-ray: my leg is healing fine and they take off the plaster cast. The weeks of inactivity have left me feeling very weak. I have difficulty even walking.

“Doctor! I can’t live the rest of my life this way”.

The doctor sighs and patiently explains that I will have some sessions with the physiotherapist (“physical terrorist” as Mom used to say) and she (I hope it’s a she) will teach me some exercises that will re-condition my muscles to get me into a good shape for living the rest of my life. And I continue to reflect on my new, accident-free cycling style.

Does this seem like an extreme example to you? Well, I guess it all depends on why you want to lose weight, what else is going on with your body, how much weight you need to lose, and so on.

If you went a little wild over the holiday season and put on a few pounds so that now your favourite pants are a little more snug round the middle than you’d like, then a gentle adjustment to your lifestyle will do the trick. Probably losing 1-2 lbs a week is going to be fine: you’ll be back in shape before January is out and you’ll be on a regime that works for the rest of your life (except, perhaps, the winter holiday season!)

But that’s not the situation that I, and literally millions of people like me, am in. For whatever reason, parts of my system are as broken as my leg in the above example, and it’s fatuous for me to cry to the doctor that I can’t live like he proposes for the rest of my life.

If I don’t let the doctor reset my leg and put it in plaster my leg would get worse and worse and, quite likely, I would be crippled for the rest of my life. Maybe my life would have been shortened: gangrene setting in and so on. Could I live the rest of my life that way? Yes, obviously. But the rest of my life may be shortened and I certainly would be a less-than-happy bunny.

Well, it’s not my leg that’s broken; it’s a part of my endocrine system. The bits that are connected with the hormone insulin aren’t working properly. As a result I’m not just a few pounds over the top, I’m 65% too heavy. I have type II diabetes, high blood pressure and I can already feel the damage that high blood sugar is doing to my legs and feet. I could find a nutritional regime that I could follow for the rest of my life. It might, eventually, lead to my type II diabetes going away. If it followed the well-known “safe rate of weight loss” (1lb per week) it would take me the best part of three years to get down to my goal weight.

Whichever way you look at it, this isn’t a gentle lifestyle issue! I need to get healthy. I need a reset, I need to be “put in plaster” until my body re-builds itself, then I need a re-hab period (what we would call convalescence in the UK) until I have built up my strength around my newly healthy body. Then, and only then, I need a regime that will work for the rest of my life to stop this happening again.

Let’s go back to the broken leg scenario. Once my leg is healed, once the physio has signed me off, I might go walking to build up my strength. I might even start running from time to time. I might go and take some cycling road-safety lessons, and all of these constitute a new approach that is viable for the rest of my life. But none of it is appropriate while the fractured ends of the bones are still rubbing together. If I try walking, running, cycling before the bones have healed I will just set myself back and back and my leg may never heal.

So we are probably looking at a number of phases. Let’s look at the Emergency Medicine scenario. An accident happens. Those first on the scene, probably the paramedics, are initially concerned to make sure that things don’t get worse. Is the traffic being diverted? Are we safe from fire or electricity? Airways, breathing, circulation: the ABC of first aid. Staunch bleeding, stabilise the body with back board, neck brace. When the patient is stabilised we can take them to the hospital and the doctors can begin the therapeutic stage: having made sure that things aren’t going to get worse, we can look at how to help the patient begin to get better. The third stage is rehabilitation or convalescence: getting used to being healthy again. The fourth stage is to take advanced driving lessons.

The same is true with nutrition and nutritional ill health. If you are eating toxic food the intervention of first cause is to stop. Once you are reasonably stable we can look at therapeutic interventions: there are nutritional plans that have therapeutic effect: they can help the body heal itself from all sorts of conditions. Various forms of the ketogenic diet, for instance, have been showed to help epileptics keep free of seizures, clear cancer, and allow diabetics (even type one diabetics, to my amazement) heal themselves. And ketogenic diets, by their very nature, help obese people to burn that fat: ketogenic diets are fat-burning diets. It is possible (I know, I’ve done it) to lose weight at the rate of 1lb per day rather than 1lb per week. It’s not do-able through just reducing what you eat, and it certainly isn’t a regime anyone could (or would want to) follow for the rest of their lives. But I started that regime on a Thursday morning and, on urgent medical advice stopped my diabetes medication on Sunday morning and didn’t require it again. I was on a therapeutic diet, rather than a long-term, sustainable regime. There is a place for both.

The Jaminets (“[simpleazon-image align="right" asin="145169914X" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/51AHwQW%2BtCL._SL160_.jpg" width="106"]”: I know I’ve mentioned them elsewhere) make an interesting point that helps differentiate between food and nutrition. Pretty much all mammals need the same (or very similar) nutrition. That’s the same whether you are a polar bear or an elephant, a lion or a cow, a human or a lowland gorilla.

But they all need very different food. A cow couldn’t become a carnivore (look what happened when feed manufacturers tried to make that happen: BSE!) A lion can’t become a vegetarian. Why? Because each of us has a different digestive system, designed to produce the nutrition that we need from the food that we (naturally) eat. A cow, for instance, has four chambers to its stomach and regurgitates its food so that it can re-digest it. Horses, who also eat grass, only have one stomach, but a very long digestive tract. There are foods that are natural to each type of animal: foods that its digestive system has evolved to process to provide optimum nutrition.

The problem is that most of us who live in western civilisation don’t eat what is natural. Most of us can, I suspect (I certainly can) reflect on what my parents and grandparents ate, and see how different it is from what we (I!) eat today. I couldn’t be in a better place to see this: I am sitting in an internet cafe in a major American supermarket and I am directly across from the checkouts. There are only 12 checkout lines and I can easily see at least a dozen medically obese people—and I can also see what they have in their shopping carts! Mostly packets of things my grandmother would never have seen. But this is only a perspective of 50-100 years. Human kind has been around for millions of years (probably around two million years) and has only been living an agricultural existence for around 10,000 years. That’s about 0.5% of the total. That’s not enough time to evolve to cope with the “new” agricultural diet. And it’s only been 50 years at most that we’ve had an industrial diet (manufactured food). That’s 0.0025% of the time we’ve been around. That really isn’t enough time to evolve to cope with our new diet.

So, do diets work? Well, the “Standard American Diet” certainly doesn’t seem to work as well as it could, or should. In which case, we need to replace it.

How can we decide how to change our diet?

Most of those “diets” suggested in magazines, the ones that my vicar’s wife and @john and Jon Gabriel say don’t work, are prescriptions for reducing the quantity of what we eat. Sometimes it’s the overall quantity of what we eat (calorie counting), sometimes it’s reducing some component of what we eat (such as a low-fat diet).

Do these work? Well, it’s a truism to say that for some people they don’t work. People try them and they don’t lose the weight. Sometimes that’s because the diet is not well designed, or it’s difficult to stick to (my guess is that’s the sort of diet john encountered). Sometimes it’s a matter of management of expectations. I sometimes comment on a blog about ketogenic diets and have come across people who want to switch to the ketogenic diet because they tried xxx diet for 5 days and nothing much has happened.

Very often these diet plans are based on a false assumption, or on a set of false assumptions. Often the objective is to lose weight; sometimes that is achieved. If you overdid it over the holiday season and normally you eat healthily then simply cutting down on what you eat for a short while will probably bring you to your objective. Actually, simply returning to your normal healthy diet will probably bring you to your objective, but cutting down a bit might achieve your goals more quickly. Very few nutritionists would put their name to a recommendation to do this (they would prefer that you just return to your normal healthy regime), but they won’t ring alarm bells and have you sectioned, either.

But, as someone I read recently (it was probably Paul Jaminet) said:

Eating less of a bad diet is simply a worse diet.

If you are currently eating foods that don’t support a healthy body and a healthy mind, just eating less of them won’t really help. And reading one diet book and sticking to its recommendations slavishly won’t help, either. You have to know your own body and take responsibility for its health.

You have to find the diet that does work, for you. And that might be just one nutritional plan that will work for the rest of your life, or it may be a set of diets, each designed to take you through a therapeutic process until you are well enough to move on to your lifetime plan.

The question is, how do you find that diet or diets? I will deal with that in a future post.

 

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