diet

When you’re following the ketogenic diet one of the most often asked questions is, “How can I increase my fat intake?”  Well, if you have a good-quality mayonnaise, made from keto-friendly ingredients, that’s a very tasty and healthy way.

But the rumour has it that making mayo is difficult.

No it’s not!

This is the easiest recipe we have ever come across, and here’s my first attempt at a new way of presenting recipes, to make them as easy as possible, even for people for whom cooking is a challenge.

httpv://www.youtube.com/watch?v=K2q9otbAMkE

Nutrition Information

Grams /100 mls Grams / Tablespoon Serving Hellmann’s Grams / 100 mls
Fat 84.84 12.73 79.0
Carbohydrate 0.92 0.14 1.5
Protein 3.77 0.57 1.0

This recipe has 7% more fat than Hellmann’s, only 61% of the carbs of Hellmann’s, and 377% more protein!

Printer Friendly Version

You can download a printer-friendly version of the recipe, complete with nutrition information, by clicking here: Keto Mayo Recipe

Gary Taubes

Peter Attia

Most people with an interest in overcoming obesity will have heard of Gary Taubes, especially if you’re a regular reader of Live Free From Obesity: I mentioned him originally in Why We Get Fat by Gary Taubes, and Vegetarian or Carnivore? You choose!, amongst other blogs.

In fact when I first read Gary’s [simpleazon-link asin="0307474259" locale="us"]Why We Get Fat: And What to Do About It[/simpleazon-link] he immediately became a hero of mine.

Gary is a science journalist, rather than a practising scientist (although, I happen to believe, with a sharper scientific mind than many who are practising scientists).  For a significant part of his career he has majored in writing about bad science–which is what first got him interested in nutrition.  But whereas when he was writing about the bad science of cold fusion he was content to just tell the story, he has become much more deeply involved with nutrition and, last September (2012), with Peter Attia, he set up the Nutrition Science Initiative (NuSI).

I have always found both Gary and Peter quite scary: they have brains much sharper than mine (and I’m no fool), and they also have a level of personal discipline and persistence that I can only envy.  So I was pretty much moved to tears when I watched Peter’s recent TEDMED talk, when he, too was almost moved to tears.  See what you think.

httpv://www.youtube.com/watch?v=U3oI104STzs

For a less emotional, more factual introduction to NuSI and its work, spend three minutes with this video:

httpv://www.youtube.com/watch?v=HmfA9XFw-uU

Peter is also running a blog covering some of the most burning questions that individuals have: what should I eat, should I be concerned about cholesterol, how can I protect myself from the major “diseases of civilisation” on his own website, The Eating Academy.  To begin to study what Peter has to say, start on the Eating Academy’s “Start Here” page.

Peter is at pains to explain scientific concepts in everyday language, but I have to say, his blogs sometimes make me work hard, and I suspect they may leave some of the readers of Live Free From Obesity gasping for air!

Don’t worry, I will make it my task to translate the more difficult posts into still simpler language, so that people with little of no scientific training, but who are eager to understand Why We Get Fat, And What To Do About It, can take the news on board!

[simpleazon-image align="left" asin="0307474259" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/51Ni96jsZzL._SL160_.jpg" width="104"] [simpleazon-image align="left" asin="0307949435" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/51tR7-zIiFL._SL160_.jpg" width="98"] [simpleazon-image align="left" asin="1400033462" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/41ikBliWK8L._SL160_.jpg" width="105"][simpleazon-image align="right" asin="0091924286" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/41zvRZLsE4L._SL160_.jpg" width="97"]

“In my diet plan it says I can eat as much as I want.  How does that work?”

“I’m confused: should I count calories or not?”

“My doctor says that Gary Taubes is wrong: you can’t contradict physics.  I’m fat because I eat too much and don’t exercise enough”

We hear this all the time, and questions like this appear in Facebook groups and diet forums all the time.  Frequently with people saying something like “excuse me for being stupid“.

We will put that last one to bed straight away.  You are not stupid!

Let’s deal with “eat as much as you want“.  First, how much do you want?

Your body has sophisticated control mechanisms to tell you:

  1. You’re hungry: you need fuel (food)
  2. You are full: you’ve had enough

Click this picture: you may get a surprise!

However, unfortunately you have two completely different mechanisms in this control system:

  1. Biochemistry
  2. Psychology and emotions

Frequently our psychology and emotions around food get messed up.  It starts with parental messages to eat up all your dinner or children will starve in Africa and is then manipulated by the HUGE sums of money that advertisers spend to program our brains to make us eat.

Our biochemistry also gets messed up.  When I was a lad growing up in England, Chinese restaurants were  novelty.  There was a piece of “received wisdom” that said that you would feel hungry again half an hour after eating Chinese food. Cecil Adams in “The Straight Dope” even wrote an article about it. (Click those links: they are more fun than this blog post is likely to be!)

The point is that some food makes you feel full up, some food leaves you hungry and there is some food that actually makes you hungry (mostly manufactured food, manufactured by firms with no interest in you being healthy, just in you buying more of their products.

So, leaving on one side the psychology and emotions for a moment, if you STOP eating the stuff that doesn’t make you feel food, and replace it by eating the stuff that does make you feel full, then we can say “eat as much as you like”, reckoning that you will get to feel full quite quickly, that that will be “as much as you like” and you’ll eat less, and lose weight.

But notice what I said there: “you will eat less”.  Let’s move on.

(Oh, by the way, highly processed carbs and sugars are the things liable to make you want to eat more, and fatty and spicy food are likely to make you want to eat less.  ”Diet” versions don’t help.  To understand just a little of what’s going on here, first glance at “Is it true that drinking diet sodas like Diet Coke make you crave carbohydrates?” Ask.com.  You will notice that there is one “yes” vote and one “no” vote, the “no” coming from Snopes, which I usually trust.  But then just glance through this Mercola article: “Aspartame — History of Fraud and Deception“.  It’s down the bottom where he says:

Aspartame is the only biochemical warfare product on grocery shelves

that makes me think I need a lot more research before I’ll give it a try!).

Of course, we haven’t dealt with the psychology yet.

You have probably heard this old joke: “I’m on a seafood diet. I see food and I eat it!

There is even a Facebook page with that name, for food jokes :

Q: Why do bakers work so hard?
A: Because they need the dough.

But maybe the “see food” thing isn’t a joke.  Maybe it’s the truth.  Spend a couple of minutes watching this experiment carried out by stage hypnotist Paul McKenna:

httpv://www.youtube.com/watch?v=AbDFnI_fMd4

You might like to try it for yourself.

And how would it be if someone fed you, rather than you feeding yourself?  My guess is that each mouthful will be smaller and that your “eating speed” will be slower.

I think that we have learned to bypass or over-ride our “satiety” signals, and if we could fix that problem, then we would feel full sooner, and we would eat less.

But notice what I said there: “we would eat less”.

Losing weight is all about eating less.  It’s about doing something that will mean that we are happy to stop eating when we are full.  It is not about forcing ourselves to eat less.  That never, ever works.  And if you think it does, just look around you.  All over the western world for at least the last half century, doctors, nutritionists and diet pundits have been telling overweight people to, “eat less, exercise more”.

Does it look like this advice is working?  I don’t think so.

And then along comes Gary Taubes with his two books, [simpleazon-link asin="1400033462" locale="us"]Good Calories, Bad Calories[/simpleazon-link] ([simpleazon-link asin="0091924286" locale="uk"]The Diet Delusion[/simpleazon-link] in the UK) and [simpleazon-link asin="0307474259" locale="us"]Why We Get Fat: And What to Do About It[/simpleazon-link].  The book (WWGF) changed my life.  Here’s why.

There is a subtle subtext behind “If you eat less and exercise more you will lose weight” which says “you are fat because you are greedy and lazy“.  Gee, thanks doc.

When Gary says that this isn’t the way to go with this all the conventional pundits cry “foul”.  They say it’s all a question of physics.  If you take in more energy than you put out, that excess energy has to go somewhere and it will be stored as fat.  Therefore, take in less energy and/or put out more energy, or both.  It’s all physics and Gary Taubes should be burned at the stake (steak?) for saying otherwise.

But Gary does NOT go against the laws of physics.  Read the above paragraph again, but stop at the word “Therefore”.  There should be a whole book, or maybe a whole library, between “stored as fat.” and “Therefore …”

Here’s an example that Gary uses quite a lot.  Think of  a teenage boy.  There comes a certain age where they seem to grow (tall) overnight.  And they seem to be always in the fridge, except when they are in bed.  But you don’t ever hear a parent say “My Tommy has grown six inches in the last three months, it must be because he’s eating too much and not exercising enough”.  He is eating because he is growing.  He lacks energy because all his energy is going into growing.  And why is he growing?  Well, we know, don’t we.  It’s his hormones.

And it’s our hormones that make us grow fatter, too.  It’s just different hormones.  With Tommy it’s testosterone and somatropin, with me it’s insulin.  With Tommy it’s supposed to happen: if his testosterone and somatropin get out of whack he’ll either not grow, or he’ll be a giant.  My insulin is out of whack: I’m only a giant width-wise.  And it was eating too many refined carbohydrates when I was young and foolish (and middle-aged and foolish) as opposed to now when I am old and foolish, that damaged my insulin system.

But I’m getting off subject, or at least on to a subject that I’ll come back to later.

So, Do I have to Count Calories? Yes or No?

Well, it depends (sorry!)  You will only lose weight if you correct that energy balance: eat less or exercise more (actually, exercising more probably won’t help: it’ll just make you hungry).

What we hope is that by eating less processed junk food, less refined carbs, by eating more “real food” (what your grandparents called “food”), by eating a balanced amount of protein and upping the amount of fats that you eat (etc etc: we’ll deal with precisely what elsewhere), you will naturally want to eat less.

The trick to losing weight while eating as much as you like is to change how much you like.

So if you are following your low-carb diet, or your paleo or primal regime or your ketogenic or auto-immune protocol, and you are not losing weight, then you are eating too much … BUT, the answer is not to just cut down, but to find out why.  If you are significantly obese then it is highly likely that switching to a paleo or ketogenic regime will cause you to lose weight, without having to count calories.  You will just naturally want to eat fewer calories.  You’ll feel full up sooner.

But as you get closer to your goal weight, where the margins for calculation are tighter, you may need to exercise more control.  You may need to count something … not necessarily calories: it may be grams of carbs, or it may be getting the macro-nutrient ratios right.  It may be paying better attention to micro-nutrients.  I have heard it said that if we are missing certain micro nutrients in our diet that we may crave certain foods.  I have also heard it said that modern food is only around half as nutrient dense as food that was commonly available 100 years ago.  So, presumably, we need to eat twice as much (and hence get twice as many calories) just to get the same level of micro nutrients.

Or it may be finding a way to re-wire your brain, so that you find more effective ways of supporting starving African children, other than by eating more than you need yourself.

As so many of my articles conclude, it is highly likely that no-one has an off-the-peg answer to your individual question.  Research is needed.  The question is, will you pay a Harley Street nutritionist £125 per hour to do the research, or will you learn about food, nutrition and your own body, and do your own research?

Go on, give me a hint!

Zoe Salmon

Zoe Salmon

Some while ago the BBC made a programme called “The Big Fat Truth About Low Fat Foods“.   I like this programme because they took an ordinary person (well, as ordinary a you can be, being an ex Blue-Peter presenter and an FHM model) and put her on a low-fat, packaged food diet for four weeks, to see what would happen.  She is “ordinary” in the sense that she doesn’t have any particular health problems, is not a diet and nutrition expert, but generally eats a reasonable diet.

(Having said that, I just discovered that she was a contestant in Celebrity Masterchef!!)

For four weeks, model and former Blue Peter presenter Zoe Salmon ditches the fine dining she’s used to and lives on nothing but pre-packaged, highly-processed foods that are labelled either low or lower in fat. She finds out what’s in these foods and how they affect her moods, nutritional levels and, crucially, her weight. She also meets the low calorie converts who say that eating this way isn’t just a diet, but a way of life.

The programme (I think) does for Weight Watchers what “Supersize Me” did for Macdonalds.  I think the programme is a must to show to anyone who thinks your high-fat diet will kill you, and a must for anyone considering Weight Watchers.  Here’s a trailer:

httpv://www.youtube.com/watch?v=XlLTQHdGzK4

And here’s the who programme (it’s about 50 minutes):

httpv://www.youtube.com/watch?v=jca9O4js2Og

There are those in the diet world who stick firmly to the “Calories In, Calories Out” (CICO) model, citing the “Law of Thermodynamics”.  This is a bit of a problem, and can be easily knocked over as an argument.  Firstly, there is no one “Law of Thermodynamics”.  If someone quotes that at you, ask them if they mean the zero-th, first, second or third law.  That will probably shut them up!  The thing is that we have been advised to eat less and exercise more to lose weight for the last 50-60 years and during that time obesity rates have soared around the world.  Clearly something is wrong.

[simpleazon-image align="left" asin="0307877523" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/51N18MYXSuL._SL160_.jpg" width="139"]There has been much work over the last decade to show that, in human nutrition terms, a calorie is not just a calorie, and I put myself firmly in that camp.  CICO leads to weight-loss advice that says either eat less, exercise more, or both.  This is over-simplistic, and if you want chapter and verse on how to demolish this argument, read Gary Taubes’ books.  ”Why We Get Fat” is the easy book: Good Calories, Bad Calories” (Known as “The Diet Delusion” in the UK) is the “big book” (if exercise is all you need, you could lose weight simply by carrying GCBC around with you!)[simpleazon-image align="right" asin="1400033462" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/41ikBliWK8L._SL160_.jpg" width="105"][simpleazon-image align="right" asin="0091924286" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/41zvRZLsE4L._SL160_.jpg" width="97"]

But while I am a total fan of Gary, and feel that his books have changed my life, the good old calorie can still tell us a few things:  it can show you just how easy it can be to become malnourished when you’re on a diet.

For instance, the “average” person needs around 2000 calories a day to maintain normal life.  This, of course, varies a lot.  According to the math I would need 3050 calories a day to maintain my current size, and my wife would need 1755 (she’s younger, much smaller, and more active than me).  You can see that it’s quite a range.

We know that body fat is a highly-effective energy storage medium: one pound (.45kg) of fat contains 3500 calories.  So if we just go with the basic idea of “eat less”, if we want to lose 1lb a week we need to consume 3500 calories less per week, or 3500/7=500 calories less per day.  For Susan that would mean reducing her daily calorie intake by 28%, for me I’d need to reduce by 16%.

That’s all very well, but our food is not just an energy supply.  In addition we need micro-nutrients and, although as their names implies we don’t need much of them, when we don’t have enough the results can be horrendous.  For instance, a severe deficiency of vitamin C causes a disease called scurvy, where your teeth fall out, you get suppurating sores and you get severely depressed (well, you would, wouldn’t you?)

Beri Beri victim

Pellagra sufferer

Beri beri, a disease caused by a lack of thiamin (vitamin B1) caused extreme lethargy and even death.  And pellagra, caused by a deficiency of vitamin B3 (niacin) affected more than three million people in the American south, killing 100,000 of them in the early part of the 20th century.

I got quite a shock, researching this.

I am from the UK but my wife is American and her father was a southerner.  When she grew up she was accustomed to eating grits (from the same stem as English “groats”) and still enjoys grits when we go out to breakfast if we are in the Southern states.  I have always laughed: to me grits looks like wallpaper paste, tastes not much better, and I imagined it to be completely devoid of nutrition, because grits is made from corn kernels, dried and soaked in lime (that’s the chemical, not the juice of the fruit!)  But apparently, the key nutrient in corn (maize), niacin, is biologically unavailable (it’s locked up).  However, if you treat the maize with lime it makes the niacin nutritionally available.  Traditionally, new world cultivators of maize knew this (how?!) since 1500BC and didn’t suffer from pellagra, but when maize started being shipped around the world, people who adopted it without knowing about this process of  nixtamalization developed diseases of malnutrition.

Now you may think that these were all diseases of the past, and that we no longer need to worry, but here’s the interesting (and worrying) thing … these are diseases of extreme malnutrition, but malnutrition happens on a sliding scale.  If you are bit short of micro-nutrients you might not suffer from anything as bad as pellagra, beri beri or scurvy, but your health will be negatively affected.

Various governments publish “Recommended Daily Allowances” (known by various names depending on the government and the day of the week) for various nutrients.  But these amounts are the amount that, if everyone in the population had that much, around 50% of them wouldn’t get ill.  How much you need, not just to avoid malnutrition, but to be in optimum health, is probably much more than the RDA, or whatever your country calls it.

So, if you are aiming to lose one pound a week on your diet, and you do it by reducing what you eat by between 15% and 30%, you’re reducing your micro-nutrients by that amount, too.

Scary, isn’t it?

Before dieting you were probably malnourished to some degree; now you’re dieting it’s got worse.  We have all heard of pregnant women getting cravings–that’s because the baby is using up the mother’s micro-nutrients.  The craving is the body’s drive to get the mother to correct the deficiency.

Irradiated food symbol

But, if we’re eating a “normal” diet, are we getting all the nutrition we need?  No.  In the Standard American Diet (SAD), which (obviously, by definition) most Americans, and large numbers of people in the rest of the world eat, our food is deficient in these micro nutrients, for a variety of reasons:

  • The soil is worn out: we keep cropping, but don’t replace what we take out
  • The time from field to fork gets longer: vitamins start to decay once a plant is picked.  In America the average distance travelled from field to fork is around 1500 miles.  And if you think it’s better in Europe, just remember that most of your “fresh” vegetables and salad stuff comes from southern Spain.  A tomato grown in a greenhouse in Malaga will have done over 1500 miles by the time it gets to a supermarket in Birmingham.
  • Vegetables, nowadays, are picked before they are ripe, so that they will last longer on supermarket shelves.
  • Food is irradiated, destroying its DNA.
  • A lot of food is so processed that it has few, if any, micro-nutrients: what we call “junk food”.

So, we are already eating a diet that is low on nutrition, and then we eat 15-30% less of it.  Less of a bad diet is a worse diet, not better.  No wonder we have cravings and get hungry.

What are we to do?

[simpleazon-image align="left" asin="098430472X" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/418yh6o7hML._SL160_.jpg" width="106"][simpleazon-image align="right" asin="0984755179" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/51AXQpauaLL._SL160_.jpg" width="115"]Well, I already knew a lot of this information about nutrition, but it wasn’t at the top of my consciousness until I read Naked Calories and Rich Food, Poor Food by Jason and Mira Calton. Time for a declaration of interest.  Currently I have no commercial relationship with the Caltons at all.  But I am so impressed with the books, and with their supplement, that I am hopeful that I may be able to import it into the UK.  I’ll alter this sentence if and when that happens!

By now you will understand the title of this post.  If most of the food we eat is just “naked calories”, how can we make sure that our calories are well-dressed?  The art and science of making sure that you have enough micro-nutrients is complex (one of the things I like about the Calton’s supplements is that they have made it very easy), but there are some things that we can do straight away.

Looking at the list of problems above, you can see that eating your five a day will help, especially if they come from a local, organic farm.  When we live in Florida we buy as much as we can from Lake Meadow Naturals (about 10 miles from where we live) and in the UK we use Sunnyfields Farm and Beechcroft Farm, both, I was surprised to find, exactly 9 miles away from where we live, but in opposite directions!

Next, don’t keep stuff too long.  Buying it fresh, organic and local is all very well, but if it sits in the veg drawer in the fridge until it’s floppy and unpleasant, you might have done better to buy canned or frozen!

Lastly, for now, aim for the most nutrient-dense foods that you can find.  I will be helping with that by posting about various foods.  For now, check out my recent blog post “Which Avocados are best for Paleo/Primal?

And educate yourself.  For starters, read the Calton’s books, and click the various links on this page.  And watch out for the next posts in this series.

I recently published a post called “How Do We Know What We Know“?  I think it’s important that we think about how we come by the knowledge that we use to manage our lives.

Some people believe what they are told; “I read it in the newspapers”, “I saw it on TV”, “It must be true”.

Some people believe what they are told by authorities: their doctor, religious leader, etc.  Some people work off of a gut feeling, and some trust scientists.

But what is science?

What it isn’t is a bunch of (mostly) men in white coats with clip boards peering into microscopes and test tubes.

Science is a process of coming to know: of justifying a belief.

Beside me as I write I have what Brits call a torch and Americans call a flashlight. It doesn’t work and I want to know why.  My guess is that the battery is flat, so I take out the old battery, shove in a new one from my drawer, and the torch lights up.  That, in a nutshell, is the whole scientific process.

In science we start with a problem (torch doesn’t work); we form an hypothesis as to what the cause of the problem is (formally, according to Wikipedia, an hypothesis is a “proposed explanation for a phenomenon”.  Or a guess as to what is causing the problem).  We then design an experiment to test the hypothesis (hypothesis is that the battery is flat; experiment is to replace old battery with a new one.  If the torch then works we will declare that our hypothesis was the correct one).

There are a few problems with this experiment.  What if the problem wasn’t a flat battery, but a loose connection, and that taking one battery out and putting another back (or even the same one back) restored the connection?  Then we would have a “false positive”.  And we’d probably chuck away a perfectly good battery (and the torch would probably fail again next time it was shaken, and we might decide it was going through batteries too fast and chuck the torch out as well as the batteries.)

So to make the scientific process a bit more likely to produce good and useful knowledge, we come up with a whole set of hypotheses, and try to design experiments to test all of them.  For instance, hypotheses for our non-functioning torch might be:

  1. Flat battery
  2. Dead bulb
  3. Loose connection
  4. Alien invaders have stopped electricity working on earth.
  5. etc.

If we have an electric meter or tester we can use it to measure a brand new battery, straight out of its packet.  If that works then we know that the tester is working, and we can also rule out hypothesis number 4.  We can then use the tester on the battery.  We may need to test the battery and the bulb, and the connections, because the problem might be 1, 2, or 3, or any combination of the three variables (or four variables if we haven’t yet ruled out the alien invasion).

I’m sure that I am labouring the point, and that you get it by now.  But you may also be getting a sense that, to an outsider, science looks glamorous while actually it involves a lot of care and pains-taking step-by-step rigour.

In the science of nutrition, as in all other science, when we do experiments we need to “control” for all the variables.  If we think that eating chocolate is what is making someone fat we could take two groups of people, feed one group chocolate and the other not, and measure them.  But to be absolutely sure the problem is the chocolate, the two groups must eat exactly the same apart from the chocolate.  And exercise the same, and sleep the same, and drink the same, and live at the same altitude (I’ve just got back from a week in the rocky mountains: you’d be amazed at the difference it can have on you; even how often you need to wee!)

So, anyway, that’s what science is: it’s just a way of thinking about solving problems, of producing knowledge.

But here’s an interesting thing: it’s the science of finding things that will make people well.  On the face of it, if you developed a pill that stopped people getting smelly feet you might think you’d get a large group of people who have smelly feet, divide them into two groups, give one group the pill, the other group no pill, and see how smelly the feet were of the two groups.

But that’s not what pill researchers do.

They make a second pill that looks exactly the same as the first pill, but which does absolutely nothing.  It’s probably just made of chalk.  And no one knows which pill is which (except the people designing the research).  In particular, neither the folks taking the pills know which is which, nor do the folks handing out the pills.  This is called a “double-blind” trial and it is to prevent the outcome being influenced by the placebo effect and researcher bias.  The placebo effect is when people who are given the “sham” pill, but who believe it to be real, get better anyway.

Very many scientists tend to dismiss all sorts of things that are outside their paradigm as “just the placebo effect”.  But hang on … are you telling us that just because people believe they are getting treated, they actually get better?

Yup.

There’s even placebo surgery.  People with a knee problem were anesthetized, the surgeon made an incision, then just sewed it up without doing anything, and people got better!

So what do they mean by “just” the placebo effect?  This is amazing!  While many scientists sniff at the placebo effect, they clearly recognise that it exists, or they wouldn’t have designed the blind trial.

But just a minute here.  That’s why they designed the blind trial.  But what about the double blind trial?

Well, that’s because they also recognise that what the experimenter believes can also effect the outcome of the trial.  Hmm.  Weirder and weirder, don’t you think?  Obviously, of course, you can’t have double-blind knee surgery, but still …

So, we have our sweet-feet pill, and we design a double blind trial.  You’d think, if the pill worked, one group would have sweet feet and the other group smelly feet.  No: doesn’t work like that.  What we are looking for is for a “statistically significant” number of the sweet-feet group to see some improvement.  You never, ever get 100% cured with the real pill and 100% not cured with the placebo.

Never.

Here’s a fun one; some researchers wanted to test out the claims of some herbalists that the herb ginkgo biloba can help with sexual problems.  They found that it didn’t.  But they didn’t find that no-one got better, they found that equal numbers of people got better in both groups!

The aim of this study was to examine the effect of Ginkgo biloba on antidepressant-induced sexual dysfunction. The Ginkgo biloba (n=19) and the placebo groups (n=18) were divided; each to be administered with Ginkgo biloba and placebo respectively for 2 months by means of a randomized placebo-controlled, double-blind study. The results of this 2 month trial were: (1) there was no statistical significant difference from the placebo at weeks 2, 4 and 8 after medication; (2) in comparison with baseline, both the Ginkgo biloba group and the placebo group showed improvement in some part of the sexual function, which is suggestive of the importance of the placebo effect in assessing sexual function.

A placebo-controlled, double-blind trial of Ginkgo biloba for antidepressant-induced sexual dysfunction

Last point before I get to why I am telling you all of this.

Some people suddenly realised that, because all drug trials are done using double-blind trials with placebos, there was an awful lot of clinical trial data about placebos.  If you analyse it, you see that some people are “placebo responders”: pretty much they will get better whatever you give them, whether it’s the drug or a chalk pill.  And then there are the placebo non-responders.  They won’t get well whatever you give them.  I bet you are already thinking of a few grumpy people that you know for whom nothing ever works.  And a few Pollyanna types for whom everything is always wonderful.  If you’re a placebo-non-responder you probably spend your life wanting to slap some sense into the Pollyannas of this world.

If you find this stuff fascinating and want to know, this may be the place to start: What Is the Placebo Effect? By Kendra Cherry, About.com Guide.

Diets

Well, it’s taken me long enough to get to the point, but here it is.  I would be willing to bet that, for every diet, nutrition plan, weight-loss pill that’s ever been invented, however crazy, there is at least one person for whom it was a miracle cure and changed their life.

And for every serious, perfectly researched, based-on-pure-science-and-nutrition, life-style change that’s ever been invented, there are a whole host of people who got fat and sick and died a horrible death using it (well no, probably not that bad, but you get my point).

All of this is because, in my next post, I am going to try to create a map of the dieting, weight-loss, lifestyle territory, and I want you to understand that, while I may sneer at some things, and exalt others, I just know that there are people for whom the silver-bullet capsules filled with floor sweepings worked like a dream, and I’m sure that there are people who have eaten a Big Mac, fries and a full-fat Coke with extra sugar every day of their lives and went on to win Olympic Gold in the Ultra-Marathon.

But I’m also willing to bet that neither of those people are you!

This is a bit of a long post, but it’s important!  It’s part of a series where I hope to help you to find out how to make decisions about life!  Big aim!  In this post we will discuss knowledge, epistemology, paradigms, statistics, and how journalists, marketeers and others try to pull the wool over our eyes.  Here we go …

When I began this post it was a chapter for my book; the chapter was called “Back to School”.  But I was worried about the chapter title: I hated school and if I saw a chapter called “Back to School” in a book it might have put me off. I suppose if you’re still reading then it hasn’t put you off!

I hope not, because this information is important (and I’ll do my best to make it unlike my experience of school). But here’s the problem: there is an awful lot of information out there about diet and nutrition. Some of it is useful, some of it is downright wrong. Some is misleading. Some is relevant to some of the people, some of the time and not relevant to others. How on earth are you going to be able to make up your mind what to do? How are we going to find out the knowledge we need, and differentiate it from knowledge that’s unhelpful?

To make matters worse I believe that there are a lot of people that we might think we can trust to have the knowledge we need: dietitians  doctors and the like. It turns out that many of them don’t really know either! My evidence for that is simply that if you start reading you will find that there are doctors out there who violently disagree with one another. They can’t all be right, so some of them must be wrong! But each believes that they know what they are talking about. In order to be able to begin to unravel this mess, we need to spend a little time thinking about how we know what we know (and, hence, how other people, like the doctors and nutritionists, know what they know).

What I am aiming to do in this post is to give you the knowledge that you need to be able to make up your own mind about what seems right for you and how you might judge who to believe and who not to believe.

This subject (how do you “know what you know”) is called epistemology (eh-piss-tem-ology) and is a key part of philosophy.  It may all seem terribly esoteric and too complicated to worry about.  But have you ever been in the position of being absolutely convinced that you were right about something, and then discovering that you were wrong?

The philosophers talk about knowledge being “justified belief”, and it is this question of “justification” that is the key.  You thought that you were justified in believing something, but it turned out that you weren’t.  If I were to tell you that I am a “young earth creationist” and I believe in the absolute truth of every word in the Bible, then, depending on your beliefs, you’ll either believe everything I say, or write me off as a nutter and disbelieve everything I say.  On the other hand, if I tell you that I have a PhD in applied physics and that I am a convinced atheist, then a different set of people will believe me or reject what I have to say.

This is because different people have different ways of justifying their beliefs; of having faith in what they know.  What I want to do here is to show some of the tricks of the trade, so that you are better able to work out whether the knowledge that people offer you is a justifiable belief, or not.

Just so you know, I am not an atheist, nor even an agnostic.  I have both philosophical and scientific training.  I am not a “young earth creationist”, and I believe that you can find nutters with unjustifiable beliefs in just about every school of thought out there!  I try to avoid calling them out in public: it won’t change their minds and it just makes enemies.

While we’re on the subject of jargon, I want to introduce another word that may be new, “paradigm” (para-dime).  The word has been around for centuries but was used in the last century by Thomas Kuhn to talk about what he called “scientific revolutions”.  A paradigm is a whole set of beliefs that all seem to support one another, until you get a “prevailing world view” that seems, to almost everyone” to be “true”.  One example was the paradigm about the earth as the center of the universe, with the sun going round it.  When Galileo called that idea into question it almost got him killed.

It is in the nature of “scientific paradigms” that we have a whole set of beliefs that all seem to hang together, except, maybe, for one or two minor, irritating bits of data that don’t fit.  Most people say that the observations that produced those irritating bits of data were just wrong.  But eventually more and more bits of irritating data turn up, until someone has a sudden insight, and a whole new idea (or paradigm) is born.  If you had a scientific education that included a bit of science history, you may have come across the “phlogiston” theory, or the theory of the “ether“.  One with which we struggle now, that is relevant to our concerns, is the theory that dietary fat is bad for you and that we should all be eating “healthy carbs”.  To many people this isn’t a “belief”, or a theory or a paradigm, it is the TRUTH!

The irritating bit of data is that, despite pushing this advice for 50 years, we are all getting more and more obese, there is an increase in diseases of inflammation, and auto-immune disease are also increasing at an alarming rate.

Liz Lipski, PhD, CCN, CHN

This “inconvenient data” is dismissed in various ways by those committed to the old paradigm, as are the “unscientific people” who are looking for alternative theories that embrace and acknowledge these facts.  I think I may be revealing my personal biases here.  And although no-one has been burned at the stake for saying that dietary fat isn’t bad for you, there have been incredibly intelligent, knowledgeable and high-qualified people who have been pilloried by the establishment for being heretics.  One example is Liz Lipski, PhD, CCN, CHN, a highly-qualified nutritionist in North Carolina, USA, who has been denied the right to practice, despite having 30 year’s experience in the field.  Passions are raised!  Check out her story on the web page set up to try to defend her.  By the way, back in primitive times people could be killed for their beliefs, or, slightly less extreme, they could be exiled.  Of course, that wouldn’t happen today, would it?  Well, Liz Lipski used to live and work on North Carolina.  Now she’s based in Maryland.  I wonder if the reactionaries will follow her there?

Arthur Fry, inventor of the Post-it note, with one on his forehead with a picture of a light bulb. Wikipedia Collective Commons

Over 30 years ago I learned something called “co-counselling” (it’s what’s behind “Together We Can”). I can still remember the first Saturday morning that I sat in a co-counselling seminar in someone’s living room in a house in Esher, Surrey. One of the seminar leaders said, “In co-counselling it’s the client who is in charge”: I had one of those bolts of insight: a “road to Damascus experience” (or a “light-bulb” moment, or an epiphany). I suddenly realized that, up to then, if I had gone to see a doctor, or a counsellor, or any other person whose profession it was to help me in some way, my attitude was slightly aggressive and along the lines of “well, you’re the professional; fix me”. You see it in medical dramas on the TV. The poor long-suffering doctor, being very polite, says to the patient, “what seems to be the problem?” and the pugnacious patient responds, “well, you’re the doctor; aren’t you supposed to know that?” and we, the TV audience, wonder how the doctor manages not to slap the patient round the head. I realised that, in the past, I had been lucky not to have been slapped by my doctor!

Ever since my light-bulb moment in that seminar I have changed. Now, when I go to the doctor my attitude is: you’re the doctor and you have studied illness and health and you know a lot, but maybe not everything. I’m a reasonably intelligent person, and I know a lot about me. Here are my symptoms or worries; I’d appreciate hearing your opinion. And having heard that opinion I may, or may not, decide to take the offered advice or the offered medication.

From time to time I get gout. My favourite ever doctor, Dr Halfpenny, counselled me to take allopurinol, the most popular drug for gout. My uncle was one of the first people ever to be put on allopurinol and he swore by it. But it’s something you take every day, and I didn’t want that.  I discovered I had gout many years ago when I slipped in the foot bath at a public swimming pool and stubbed my toe very painfully. The hospital thought I’d fractured it and put me in plaster (from the ball of my foot to my knee, when the pain was in my big toe!) By the following week my whole leg was inflamed and I went back to the hospital. A doctor looked at it and said, “I know what that is: it’s gout!” and I said thank you and left the hospital before anything else could be said.

[simpleazon-image align="right" asin="B000GFHP02" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/41mclx7JJuL._SL160_.jpg" width="160"]When I got home I spent ages reading books and articles on the internet and found that there were a number of recommendations for eating cherries to cure gout. It seemed weird, but worth a try. All I can say is that it works (for me, and for many others). That was maybe 20 years ago: since then there has been a lot more recognition that cherries work for gout, and Montmorency (tart) cherries best of all. You can even get cherry capsules from health stores. If you ever get gout, try it. For me it works like a miracle. My worst ever attack was in January 2010. It was so bad I was contemplating asking for a wheelchair (we were in Fort Lauderdale, about to board a cruise liner). Susan hiked off into the local shopping mall and came back with cherry juice, fresh cherries, and cherry powder capsules. Two days later I was Nordic Walking up the highest hill on Sint Maarten with not a twinge of pain.

I said that, in this chapter, I want to give you the information you need to make up your own mind about the diet you will follow. That’s not just information about “this food does this and that food does that”. The most important information that I can pass on is about how to judge information that you are offered (including mine!) You will find diet and nutritional information everywhere. How can you judge which may have something important to say, and which not is the question here.

For an example of the “who do you believe” stuff on the internet, here’s an example of a hyper-intelligent person saying that the “cherries cure gout” thing is just gullible fools being taken in by snake-oil salesmen.

The blog post is called “Thinking is Dangerous“.  His thesis is that there has been little serious scientific research done on the effect of eating cherries on helping with gout.  True.  However, there are countless people out there who have tried it and who swear by it.  They, of course, being “unthinking non-scientists” don’t count.  But for most people, eating a bowl of cherries isn’t going to do any harm, and if it relieves the pain of gout (which is really bad) then it has to be worth a try. He sums up:

You can see for yourself that the evidence is weak to non-existent. Of course, that doesn’t mean the evidence won’t be there in the future, the point is they don’t need it. They have people willing to be duped in to believing it works (placebo-effect alone), with the press as their willing conduits – it seems churlish not to put yet another fawning, uncritical Daily Mail link in time-honoured fashion, so here it is, from Sept 2008.

Oh, by the way, this blogger publishes neither his name nor his picture.

All we know about him is that he says that he’s from the UK and works in manufacturing.  He believes that who he is, is irrelevant to whether the knowledge (or opinions) he shares are relevant.  That’s up to you to judge.

So. I maintain that eating cherries is good for curing gout on the basis that it has worked for me over many years and I have heard the same from many other people.  Is that serious scientific research?  No.  So if your only basis for a justified belief is serious scientific research, you won’t accept that from me.  On the other hand, you might decide to check out this assertion by looking it up on the Internet. If you Google “cherries gout arthritis” you will find that the US Food and Drug Administration (FDA) are threatening manufacturers and cherry growers with legal action unless they stop “making unsubstantiated claims that cherries and other fruits can help with arthritis”. On the other hand, the US Department of Agriculture (USDA) has run research that shows that sweet Bing cherries can help arthritis and gout (gout is a form of arthritis) . I am delighted by the USDA research because it confirms my experience (you could say that it confirms my prejudices) when I was very irritated by the FDA.  At the bottom of that USDA internet article it does say:

The grower-sponsored California Cherry Advisory Board helped fund the research.

My reaction is “well, good for them; helping to find simple solutions for people suffering from painful conditions”. On the other hand, if the Tobacco Growers Association sponsored research that showed that smoking 10 cigarettes a day lowered the risk of getting gout I would be spitting fire and pouring scorn on the research. So now you know even more of my biases!

But I digress. How can you find advice about diet that works for you? Firstly I want to teach you about some tricks that advertisers and newspapers do … and even people who want to push their particular diet plan. I came across it this morning when I took the top off a tub of miso soup paste and inside there was a circle of paper that says, “Miso Soup Consumption linked with up to 50% Reduced Risk of Breast Cancer*”. In very small print round the bottom of the circle of paper it says, “*As reported in the journal of the National Cancer Institute, Vol. 95, Issue 12”.

The first thing you need to notice here is the word “linked”. This is a “warning word” and it warns you that this was an “epidemiological study”. Sorry about the long word: “epi-deemy-o-logical” is how you pronounce it and it means (from the Greek) “outside the skin”. In other words this research didn’t look at what was going on inside the women who did (or didn’t) consume miso soup. It was merely (note my use of an emotive word there, “merely”) a statistical exercise. They counted women who drank miso soup (and those who didn’t) and they counted the women who got breast cancer and those that didn’t, and they did statistics on the numbers to see if they could find a connection. They didn’t look at the chemistry of miso soup or the biochemistry of breast cancer; it was all numbers “outside the body”.

Let me give you an example. Let’s suppose that we find two women. One of them absolutely loves miso soup, believes it’s good for her, and drinks a bowl almost every day. The other woman hates it, neither knows nor cares whether it has any health-giving properties and wouldn’t touch the stuff if you paid her. We follow these women through their lives and eventually the woman who hates miso soup gets breast cancer and, sadly, dies. The other woman lives to be 103 and on her 103rd birthday when all the journalists are interviewing her and asking her how she got to be so old she says that she puts it all down to drinking miso soup. The miso soup manufacturers are over the moon with excitement and put her picture on all their packets and sales of miso soup soar.

What isn’t mentioned in this story is that the woman who died has a family history of breast cancer: her mother and sister both died of it and she worked in a nuclear power station handling nuclear fuel rods. The woman who lived to be 103 lives on a remote island in the Pacific where the air is clean, the water pure and most people live to be 120 without drinking miso soup. Now we see that drinking or not drinking miso soup may have nothing whatever to do with the one woman dying young and the other living to be a grand old age.

Now, let me go look up that study. You can see the summary for yourself . Basically the study looked at nearly 22,000 Japanese women aged 40-59. They got them to fill out “self-administered” questionnaires (that means the women took the piece of paper home and filled it out themselves: not the most reliable way of getting data) and the researchers looked for a statistical relationship between women who said they drank miso soup and women who got breast cancer and the researchers found an “inverse relationship” (meaning the soup drinkers were less likely to get breast cancer). So far so good. Anyone for a bowl of soup?

Next we need to look at that “50%”. Looks impressive, doesn’t it? But what was the risk of getting breast cancer anyway? If, as a Japanese woman between the ages of 40-59, there is a 90% risk of getting cancer and you can cut that down to 45% by drinking miso soup, then it looks like a no-brainer, doesn’t it? Swig it down! But what if the risk of getting breast cancer was only 1%? Reducing your risk from 1% to half a per cent doesn’t sound like much, does it? And when you read the paper further it says that the effect is greater in post-menopausal women. Now you have to judge where you are (I guess you’ll know whether you are post-menopausal or not!) The paper does say that they corrected for various things:

Results: Consumption of miso soup and isoflavones, but not of soyfoods, was inversely associated with the risk of breast cancer. The associations did not change substantially after adjustment for potential confounders, including reproductive history, family history, smoking, and other dietary factors.

(Oh, by the way, of the 21,852 women that they studied between 1990 and 1999, 179 got breast cancer, which works out at about 0.8%. So maybe that label should say “drinking miso soup could reduce your absolute risk of getting breast cancer from 0.8% to 0.4% if you’re a Japanese, post-menopausal woman between the ages of 40-59”. But that’s not so snappy, is it?)  Please note: I am not decrying miso soup.  I am not saying that the manufacturers are lying.  But when you delve into the research a little, you discover that it isn’t quite as exciting as you may have imagined.  And if breast cancer is a concern, there may be other, more effective things you can do to mitigate your risk.

There are a few other bits and pieces I want to mention here. Firstly, the word “confounders”. An epidemiological study looks for “correlations” but it does not indicate causality. Just because the women drinking the soup didn’t get so much cancer doesn’t mean that it was the soup that saved them.  For instance, let’s say that it is widely believed in Japan that miso soup is good for you (I don’t know whether that’s true, but stay with me here). Then we might guess that the women who drink miso soup are the sort of women who take good care of themselves and are careful about what they eat. That might be the real reason for the reduction in cancer risk. Maybe (again, I don’t know) miso soup is very expensive. Maybe only rich people who generally eat better-quality food are the ones who drink miso soup. Maybe miso soup is much easier to get hold of in quiet, rural communities. All these possibilities that I am raising are what are called “confounders”. Because the very nature of this sort of research is that the researchers are looking for correlations such as “people who drink miso soup get less cancer”. But we must not get fooled that we have found causation: we haven’t discovered that people get less cancer because they eat miso soup.

But this is what the advertisers and newspapers do. They bamboozle us into thinking that correlation is causation. It isn’t. The researchers above say that they have adjusted their results to take into consideration such confounders as “reproductive history, family history, smoking, and other dietary factors”. Good. But what about just plain coincidence? After all, a reduction from 0.8% to 0.4% isn’t exactly massive, is it?

So, what would I do if I was a woman and concerned for my health? On the basis of what I have learned here I think I might drink the odd bowl of miso soup. How many I might drink I don’t know—the research doesn’t mention that!  It would probably depend on how much I enjoyed it.  (Actually, the nutritional guidelines I currently follow are a bit anti-soy, so I would probably go and do some more research f my own.)

Stanley Young: Assistant Director for Bioinformatics, NISS

If this stuff fascinates you, I have found a wonderful (but pretty difficult unless you’re a university-level statistician) presentation that compares the paradigms of epidemiologists (who use a lots of statistics) and of statisticians (who also use a lot of statistics, but don’t always approve of the way non-statisticians use them).  It is called “Everything is Dangerous: A Controversy” and says:

The basic thesis is quite simple. Epidemiologists have as their statistical analysis/scientific method paradigm not to correct for any multiple testing. Also, as part of their scientific paradigm they ask multiple, often hundreds to thousands, of questions of the same data set. Their position is that it is better to miss nothing real than to control the number of false claims they make. The Statisticians’ paradigm is to control the probability of making a false claim. We have a clash of paradigms.

This paper is by S Stanley Young of the National Institute of Statistical Sciences.  He is the Assistant Director of Bioinformatics.  You can read everything (relevant) about him on his webpage.  No hiding for Dr Young: go read his CV; certainly impresses the heck out of me!

We have looked at one sort of research: epidemiological research. What other sorts are there? Epidemiological research is “outside the body”. If you go and read that article about cherries, those researchers were looking inside. They took blood samples. They knew the sort of chemicals in the blood stream that cause, or are indicators of, gout. They then fed the women in the study cherries and took more blood samples. Here we are seeing more directly that the cherries appear to be reducing the chemicals in the blood that cause gout. However, here’s a big difference between an epidemiological study and a study of this kind. The miso soup researchers monitored nearly 22,000 women for 10 years. The cherry researchers worked with 10 women for a week.

Nutrition research on human beings is really difficult. Just to go back to the miso soup research: the researchers got their data by asking the women to fill out self-administered questionnaires. We have no idea how accurate the women were, or whether they lied. There is a tendency for people to report what they think you want to hear.

A major problem in self reported dietary studies is people who under-report their true habitual food intake, or change their diet, during the period of the survey.
The problem of accuracy in dietary surveys. Analysis of the over 65 UK National Diet and Nutrition Survey, Adrian Cook, Jane Pryer, Prakash Shetty, J Epidemiol Community Health 2000;54:611-616 doi:10.1136/jech.54.8.611

Maybe the women over-reported. Maybe they just lied. Who knows? And the research was done over 10 years. Maybe some of the women had been drinking miso soup all their lives and others took it up once they were in the study. Maybe they’d never thought about it before, but the study may have made them think about it. Maybe the long-term drinkers drank a bowl a week, but the newcomers decided to drink a bowl a day to catch up. And what about cultural differences? Are Japanese women more or less likely to follow instructions than, say, American men (I’m sure that we all have opinions about this: but has anyone done the scientific research?!)

To do really hard scientific research on nutrition you need a population that you can really control and where you can measure just about everything. You probably need them in cages where can you measure to the nearest gram exactly what they eat and where you can operate on them to see what’s going on under the skin. And in any even remotely decent society that isn’t going to be possible with humans. Which leaves us wondering how relevant it is that rats fed on this or that diet, contracting, or not, this or that disease, has any relevance to us.

There is some famous research, about which really violent arguments rage on the internet, where rats were infected with a toxin often found in food that is “off”: aflatoxin. These rats were then divided into two groups and one was fed a diet that had 20% of an animal-derived protein called casein and the other group was fed a 5% casein diet. The 20% group got more cancer than the 5% group. The researchers are dedicated vegetarians and they say, “Look, a diet with higher levels of animal protein causes cancer”. The meat-eating researchers looked deeper into the results and said, “yes, the 20% rats got more cancer. That’s because the 5% rats died of a protein deficiency before they had the chance to get cancer”.  (If you like watching fights, you’ll love this: it’s an almost religious war!)

And then there’s bias. This may come as a shock, but scientists are human beings. They have axes to grind, they have masters to please. In order to do research a scientist needs money: he has to pay his own and his family’s food bills, pay the rent, put fuel in the car. Someone needs to pay for the research. If Bill and Melinda Gates, determined to do good in the world, put up the money from their foundation to pay for the miso soup research that’s one thing. But, be honest, if it turns out that the miso soup research was paid for by a consortium made up of soy producers and food manufacturers, do you think you would trust it quite as much? Probably not. Consider the cherry research paid for by the cherry growers: does that change your faith in the results?  I’m probably not making you feel good now, am I? Who are we to trust?

All is not lost: there are ways around this, and that is to do your own research, using a study group of one (or more, if you cook for the family or friends!) In its extreme form this is called bio-hacking. Extreme bio-hackers do their own DNA sequencing at home and wire themselves up to all sorts of machinery. At my end of the scale it’s called “suck it and see” and involves choosing the advice that seems reasonable to me and trying it out, taking what measurements I can (like weighing yourself, taking your own blood pressure and, if you’re diabetic or pre-diabetic, monitoring your own blood glucose levels. With all these things it’s probably an excellent idea to discuss them with your doctor before you start.)

But how do we find some advice that we want to “suck and see”–some knowledge that we want to test?

It used to be that I never read books on nutrition because they were so confusing. Everyone seemed to contradict everyone else and with many of them I couldn’t see where the advice was coming from.

For instance, many years ago someone recommended the food-combining diet to me. I thought that it should have been called the food separating diet because, it seemed to me, it was mostly about not eating this sort of food with that sort of food. Mostly it was about not eating carbohydrates in the same meal as proteins. That meant you could have a fried egg for breakfast, but you couldn’t have toast at the same time. And that would mean the yolk would run all over the plate.  I needed the toast as a “raft” to convey the egg from plate to mouth (took me some time to switch to eating scrambled eggs!) And what about beans such as baked beans or lima beans? They are both protein and carbohydrate at the same time. Should I have beans as a carbohydrate meal or a protein meal? The books seemed to say I could decide for myself, which to me was tantamount to saying that this diet was whatever I wanted it to be. Despite the fact that it was recommended by people I liked and trusted, it didn’t make sense to me; I couldn’t understand what it was based on.

Then one day I was having dinner with a group of people I hadn’t met before and made this point about the beans. One of them said, “Aha!” Beans proved the point of the food-combining diet, for we all know that beans are pretty indigestible. They give us gas and make us worried in polite company. That, said my new friend, is precisely because they are both carbohydrate and protein. Hmm. That made sense to me. Not enough sense, I have to admit, to make me switch to a food-combining diet, but it made me think.

Mind you, on that basis egg on toast should make you fart, and I’m not aware that it does!

So here’s what I recommend that you do. Well, no: here’s what I do!

[simpleazon-image align="right" asin="0307474259" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/51Ni96jsZzL._SL160_.jpg" width="104"]Someone recommended that I read a book: “Why We Get Fat and What To Do About It” by Gary Taubes.  Long ago I stopped accepting recommendations to read this or that diet book, simply because they were all so contradictory, and I had no basis for deciding between them. For some reason this one caught my attention. It was available on Kindle, it was cheap, and, on a whim I bought it and actually read it!

[simpleazon-image align="left" asin="0394584562" locale="us" height="75" src="http://ecx.images-amazon.com/images/I/41TgOIPB5YL._SL75_.jpg" width="49"]Reading it was another “road to Damascus” experience and completely changed my life and my thinking (I blogged about it elsewhere). Gary Taubes isn’t a doctor and he isn’t a nutritionist. He’s an investigative journalist especially interested in (bad) science. Having written a book about the infamous “cold fusion” physics research, someone suggested to him that if he was interested in bad science he should look at the science of nutrition.  (By the way, if you want an example of “paradigm wars” click that Amazon link for the cold fusion book, and read the customer reviews, comparing the 5-star reviews and the 1-star reviews.  There are some folks there with a near-religious attachment to the idea of cold fusion, and they are seriously angry with Gary.  But, you will notice, his book doesn’t persuade them.  Probably nothing will.)

Gary spent a long time looking at the research and wrote a huge tome called “Good Calories, Bad Calories[simpleazon-image align="left" asin="1400033462" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/41ikBliWK8L._SL160_.jpg" width="105"]” (in the UK it is called “[simpleazon-link asin="0091924286" locale="us"]The Diet Delusion[/simpleazon-link]”). It is 500 pages long and has 75 pages of references. Its Amazon.com ranking is truly amazing for a heavy-duty text book (as of March 22, 2013: it will have changed by the time you look at it):

Amazon Best Sellers Rank: #1,664 in Books (See Top 100 in Books)
#1 in Books > Medical Books > Medicine > Internal Medicine > Occupational
#7 in Books > Cookbooks, Food & Wine > Special Diet > Low Fat
#11 in Books > Health, Fitness & Dieting > Diets & Weight Loss > Low Carb

Having written that magnum opus a lot of people asked for an easier version that they could hand to their partner, doctor, patients, et cetera and Gary wrote “[simpleazon-link asin="0307474259" locale="us"]Why We Get Fat: And What to Do About It[/simpleazon-link]”. It ranks even higher:

Amazon Best Sellers Rank: #636 in Books (See Top 100 in Books)
#2 in Books > Health, Fitness & Dieting > Diets & Weight Loss > Food Counters
#3 in Books > Health, Fitness & Dieting > Diets & Weight Loss > Low Carb
#5 in Books > Cookbooks, Food & Wine > Special Diet > Low Carbohydrate

Clearly he is connecting with a lot of people. “Why We Get Fat” is available on the Kindle for $6.86 or £4.27. (And if you don’t have a Kindle you can download “Kindle for the PC” or “Kindle for the Mac” for free and read Kindle stuff on your computer). It won’t break the bank!

Now here’s what I got from Gary’s book: it made sense to me and it showed where a lot of the “received wisdom” in the diet world doesn’t make sense. For instance, for most overweight people if you go to the doctor and say, “doc, I’m worried about my weight, what should I do?” most doctors (and nutritionists and “health experts” and diet gurus and general know-it-alls) will say “eat less, exercise more”.

This has been the advice for the last 60-70 years.

Look around you. This advice isn’t working.

If you ask the “eat less, exercise more” crowd why the advice isn’t working they will say that it’s because all of us fatties are lazy and greedy and we don’t do as we’re told. As if that would explain how come babies are being born obese nowadays: born lazy and greedy!  (Note the inconvenient data that doesn’t fit the current paradigm about the causes of obesity.)

And if you were to go to a health expert and say, “I’ve been invited out to dinner by a very important business client. They are excellent cooks and will serve up a big dinner. I don’t want to look rude; what can I do to make sure I have a good appetite that day?” They will tell you to skip breakfast and lunch and go for a long walk. In other words “eat less, exercise more” is the recipe for getting a good appetite. And that’s what they recommend to “people of size” who want to lose weight. Hmm.

Now think for a moment about teenage boys. They lay around in bed for most of the day and when they do manage to haul themselves upright they come down stairs and empty the fridge. And they grow; almost overnight it seems. But we don’t say “my son has grown six inches taller in the last year because he is greedy and lazy”. He grows because his hormones are telling his body to grow. It takes a lot of energy to grow, which means he needs to take on a lot of energy and he frequently doesn’t have much to spare for doing chores (although amazingly he does have energy for chasing girls: obviously it’s a different sort of energy).

So, maybe, just maybe, there is a different explanation (different paradigm) as to why we obese people get to be this way. Taubes says that our hormones (a different set of hormones than the teenager’s hormones that tell him to grow up) are telling us to grow out. We aren’t fat because we eat too much; we eat too much because we are fat.  That blew my mind. I had to go back and read it several times. I won’t reproduce Gary’s arguments here: if you want to check them out, go buy the book on your Kindle or on your PC and read it: it’s a pretty easy read. Or really splash out and buy a real copy that you can carry around with you.

The biggest effect that this book had on me was to show that there are nutritional principles in common use that were just plain wrong. There is some inconvenient data.  Maybe our paradigm is wrong.

And that there are also some nutritional principles that are based on ideas that just seem to make sense to me. I get to choose which to believe and which to use to base my own personal research on.

For instance, the whole “fat is bad for you, eat low fat stuff” is based on some really bad epidemiological studies. The idea was introduced into American national consciousness because the authorities were worried about an increase in death from heart disease. Well, it’s controversial to say the least whether or not there was an increase in deaths from heart disease at the time, but there certainly has been a massive increase since we’ve been following the “low fat” ideas. Not to mention obesity, diabetes, Alzheimer’s syndrome and a whole host of other nasty and expensive things.

The powers that be are convinced that it’s because we’re all fat, lazy and greedy (and stupid, I suppose) and won’t do as we’re told. Grrr! Taubes provides a (for me) believable and viable alternative, and he provides the facts and figures to back it up.

Gary’s book opened up some new doors for me and on the other side I saw the whole nutrition field in a different light. I was able to see some large groupings of ideas and within those I could see some that made sense (to me); some that didn’t. Some that were clearly just commercial, some that came from people who believed something with huge passion, which I can respect, but I didn’t have the same beliefs as I do. So that saved me a lot of time. I could see that the vegans were principled people with their hearts in the right place; I wasn’t going to damn them, or even try and convert them. However, I didn’t believe that veganism was for me. And I was vegetarian for about 10 years or so, but that hadn’t worked for me, and when I finally gave it up several illnesses cleared up within days. But again, I’m not about to try and convert any vegetarians (my own daughter is vegetarian: I wouldn’t dare!) I’m sure that there are plenty of vegetarians who can tell you stories of things that cleared up for them when the stopped eating meat.

There are fierce arguments between vegetarians and meat eaters and both can point to anecdotal evidence to support their arguments (that means “I can tell you an anecdote about a friend of mine who did _______ and ______ happened”).  All true scientists dismiss anecdotal evidence out of hand.  And if there is just one anecdote, that’s reasonable.  But when thousands of people try something over and over and you have tens of thousands of anecdotes, then there is something that, maybe, needs further investigation.  And if 10,000 people report that cherries cured their gout, and you can’t construct a research study that confirms that, then I would tend to believe that it’s more likely that there’s something wrong with your research design than that 10,000 people are deluded.  (And I have no basis what-so-ever for knowing how many people believe in the cherry-gout thing.)

One of the biggest confounders that both of these armies often miss is this.  Although there are millions of people concerned with nutrition and the diet industry is huge, the vast majority of people pay almost no attention to their diet: they eat what they see on TV or on the shelves of the supermarket. In America, amongst people who know about this stuff, it’s called the Standard American Diet or SAD (how appropriate!). Those people are eating artificial food that is packed with sugar and high-fructose corn syrup. It is processed to the point where it isn’t food: people talk about “food-like substances”.  This TED-talk video shows how one person (Robyn O’Brien) switched their paradigm from “there can’t be anything wrong with food in the supermarket”, to being concerned and doing her own research:

 httpv://www.youtube.com/watch?v=rixyrCNVVGA

Now there are no meat-eaters who would say that you shouldn’t eat fresh vegetables and salads (well, there may be one or two, but they are off the scale!).

So when you find a vegetarian who can point to people who got better from various illnesses when they switched to a vegetarian diet, or you find someone who recommends the cave-man diet who can point to similar success stories, it’s probably because those successful people switched from the SAD diet and started to think about what they were eating.

Whether you go Atkins or South Beach, or Paleo or Vegetarian or Vegan, or 100% meat eater, or ketogenic … all those arguments pale into insignificance when compared with whether you are eating artificial “food-like substances”, or food: food that your great-grandmother would have recognised as food. Some people (and I will be one of those … just give me a while to get around to it) will argue that it might be a good idea to eat food that your great-great-grandmother 200 times over would have recognised as food, but let’s start with just one grandmother at a time!

So here’s something that may be different between you and me and our grandparents. In our modern western society we don’t have to know much about food if we don’t want to. We don’t need to know how to catch it, find it, prepare it, cook it, or keep it. We can just go to the supermarket, buy something in a box, sling it in the microwave, eat it out of the packet; not even have to wash up. Job done. My mother-in-law went into hospital in February 2012 and we flew out to help her move home in April. In the fridge was half a loaf of bread: it had been there for three months. As far as we could see there was nothing wrong with it. I can’t quite get my head round what a manufacturer must have done to that bread to keep it from going stale or mouldy for three months. And this is in Florida: in Florida you only have to stand still for 10 minutes before you start growing mould! It’s a state-wide obsession.

We may live to be 100, in full health, on such a supermarket regime. But it’s not likely.  My dad made it to age 91 having been a moderately heavy smoker all his adult life.  And he didn’t die of cancer or lung disease.  But that doesn’t mean smoking is good for you.

If you are choosing your food this way, you are doing the same as I was before I learned co-counselling, when I went to see the doctor. You’re saying to a food manufacturer, “you’re the expert; feed me” and assuming that that food manufacturer has your good health as his primary motivator, when you don’t.  There is vanishingly little evidence to support that belief and almost overwhelming evidence to the contrary, as I will list elsewhere.

Remember what my co-counselling teacher told me?

The client is in charge.

It’s sort of like that old Latin saying, caveat emptor, “Let the buyer beware”. It’s a principle of law that says it’s up to you to make sure that what you’re buying does what you want. Around the world laws are changing to give “the consumer” greater rights and protection, but the manufacturers are always one step ahead, except when they are two steps.  Around the world there is a principle that says you can’t introduce new things into the food chain until they are proved safe.  In America it’s the other way round: you can’t prevent new foodstuffs until they are proved dangerous.  So people have been going to court and asking for a judicial injunction on planting GMO crops in their neighbourhood until proved safe.  The US Congress has just passed a law that says judges can’t issue such injunctions.  Many would argue it’s unconstitutional.  I would argue that if you want to stay healthy you need to learn about this stuff!   When it comes right down to it, doesn’t it make sense to get educated, to learn about your own health and your own nutrition, and to make your own decisions?

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.

 

Why We Get Fat

Why We Get Fat by Gary Taubes

My lovely friend, Kali Harmen, recommended that I read Why We Get Fat by Gary Taubes, and I sighed, deeply!

It is an occupational hazard of being overweight (in America the current politically correct term is “a person of size”!) that every second person wants you to read their favourite book, and when you run a website called Live Free From Obesity the frequency rises dramatically!

Why We Get Fat: Kindle Edition

Why We Get Fat: Kindle Edition

But I rate Kali’s opinion, so I thought I’d at least follow the link to Amazon, discovered that it’s only £4.05 on the Kindle (or on my iPad), thought “what the heck” and downloaded it just before Susan and I jumped into the car to head to Gatwick to catch the plane to Florida (to look after her sick Mom).

I had wanted to go to bed early, because we had to be at the airport early, but I started reading it in bed in the hotel and had to force myself to put it down and go to sleep at about 01:00am.  By the time we landed in Orlando the next day I had read it one and a half times.

Gary is a science writer, but/and a very good one.  He has been fascinated by all the bad (or non-existent) science behind nutritional advice, both in the USA and the rest of the world.

Gary’s theme is that we “people of size” (not his term) don’t get to be this way because we eat too much and exercise too little.  And in the first half of the book he completely demolishes “gluttony and sloth” as adequate explanations for obesity.  Gary says that we don’t get fat because we eat too much, but that we eat too much because we are growing fat.  Does that scramble your brain?  It did mine, until Gary talked about teenage boys.

We all know that teenage boys have growth spurts.  We know that teenage boys eat a lot, and any of us who have had anything to do with teenage boys know that they can appear very lazy.  But no-one would think to say “my son is growing tall because he eats too much”.  We wouldn’t think of saying that the boy is growing tall because he never gets out of bed.  We know that his hormones have triggered the growth spurt, and that his system craves more energy to fuel the growth spurt … and takes so much energy in making him grow tall, that he frequently doesn’t have the energy to get out of bed.

So why would it be any different if we’re growing width-wise as opposed to height-wise?

But why do we get fat?  Popular wisdom says that it’s all down to the 1st law of thermodynamics, and that you can’t deny the physics.  Take more calories in than you expend through exercise, and you’re bound to get fatter.  Hmm, says Gary.  Imagine there are a row of rooms and each of these rooms has an entrance door and an exit door.  Now imagine that a crowd of people is moving through the rooms.  But one room has many more people in it than all the rest.  You ask me why, and I say it’s because more people are entering that room than leaving it, and you look at me as though I’m losing the plot.  ”Well, obviously!”  but why?  I have just stated the obvious, without any sort of explanation.

That’s the same as saying that I’m fat because I ate too much and didn’t exercise enough.  Yes.  Obviously.  But Why?  Again, popular wisdom would say that it’s obvious that I’m a greedy, lazy slob.

Well, maybe.

But nowadays we get children as young as 6 months old who are obese.  Can it be that they are already greedy and lazy?  Unlikely.

Gary explains how it’s all down to our endocrine system, and gives us a series of lessons: Adiposity 101, Endocrinology 101, etc.  I can’t reproduce the entire book here: go get your own copy!

But if you’d like to sample Gary’s writing before lashing out a whole £4.05 for the Kindle edition, or a massive £4.49 for the paperback, try some of his New York Times articles:

A good place to start is with “What If It’s All Been a Big Fat Lie“, published in the NYT in 2002.

Next try “Is Sugar Toxic“, a response in the NYT (April 2011) to the runaway viral success of Robert Lustig’s You Tube video, which I wrote about in my “Truth About Sugar” blog post back in early April.

But maybe you’d like to see and hear Gary.  He did a lecture at Crossfit (a physical training outfit for people serious about getting fit: that Crossfit link is scary, but Crossfit is actually for everyone: check out this story in Sydney, Australia.) and the lecture was videoed and posted in three parts on You Tube: here they are:

Gary Taubes Cross Fit Talk, Part 1

httpv://www.youtube.com/watch?v=obUBaclfsys

Gary Taubes Cross Fit Talk, Part 2

httpv://www.youtube.com/watch?v=BNFlbRjOeHA

Gary Taubes Cross Fit Talk, Part 3

httpv://www.youtube.com/watch?v=KSq_J5acEto

The Diet Delusion

The Diet Delusion

In that lecture Gary referred several times to his first (500 page) book, called Good Calories — Bad Calories in the USA, and The Diet Delusion in the UK.

If you want to study this stuff in depth, or you’d like to see what a serious scientific investigative journalist can get up to for five years, then this is the book for you!

It arrived Friday morning (today is Saturday) and I’m just a couple of chapters in, but already I am enthralled.

[simpleazon-image align="left" asin="1439190275" locale="us" height="110" src="http://ecx.images-amazon.com/images/I/51C4YyKhT2L._SL110_.jpg" width="73"]Just by way of interest: having read Why We Get Fat on the plane to Orlando, I decided (despite having two week’s worth of Lipotrim in my case) to try Gary’s eating plan.  I ate really well: eggs and bacon for breakfast (with mushrooms and tomatoes), cold meats and salad for lunch, and steaks, broccoli, salads for dinner.  My weight dropped slightly (I had been worried it might soar!).  My blood sugar continued to fall, and my blood pressure fell slightly.

[simpleazon-image align="left" asin="0345484045" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/51-h3UmqMEL._SL160_.jpg" width="127"]I will return to Lipotrim, just as soon as I have the psychological and emotional support I need in place, to go through what Atkins would call the Induction Phase.  I will be writing blog posts about Atkins, The Gabriel Method, and about T-Tapp training, and will then start to tie all these together.

Watch this space!

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