Why Aren't We Taking Anti-Obesity Drugs?

This post was prompted by the following article on Medscape

Why Aren't We Prescribing Pills for Obesity?

It is written by Caroline M. Apovian, MD 

I'd encourage you to read this whole thing first, as I'm genuinely interested in that response. Additionally I'm curious as to whether or not your response changes after reading this blog post (or other sources I'm about to link to).

"Real Food Keto" Quips

Rather than formally reviewing Real Food Keto -- an abomination of a book written by Jimmy Moore and his "Nutritional Therapy Practitioner" wife Christine Moore -- I've decided to compile a collection of my tweets here in a blog post.  I'll sort from most recent, with the newest before the "page break" after each update.  Feel free to comment here, but I'm also embedding tweets if you wish to go respond on Twitter.   Some may include additional commentary, others just the tweet. Enjoy!

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This book is littered with nonsense about how low stomach acid causes everything from ass itching  to zygomycosis.   No doubt there will be more of these tweets coming!

Fun #RealFoodKeto "facts" from @livinlowcarbman and his NTP wife.

FACT: Lemon juice (mostly citric acid) gives it a pH ~2.  Add some to neutral water (pH 7), the lemon water will be less acidic (e.g. higher pH, closer to 7) but will not become alkaline (pH >7)#LCHF-raud pic.twitter.com/QX7gJ1x6qS

— Evelyn (@CarbSane) October 31, 2018

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Swan Song

[no I'm not retiring the blog]

TLDR:  Rather than dragging things on by dismissing more black swans, Gary Taubes could eat crow and go quietly into the night.

After a long hiatus from any meaningful new content, and monumental blows to TWICHOO (Taubes Wrong Insulin Carbohydrate Hypothesis Of Obesity -- c'mon, it has a much better ring to it than the Ludwigian version),, Gary Taubes has gotten back to blogging a bit.*

He has apparently been reading (in fits and starts, in other words, probably not really reading) obscure books about obscure cultures from long, long ago.  Mind you, that in five years plus of arduous and comprehensive research put forth in Good Calories, Bad Calories, there was no mention of the Yahgan people he's about to discuss.   One wonders why not.  Heck, this is right in his time period of excellence for nutritional research and reporting!  (Uttermost Parts of the Earth, this is to a 2007 version of a book Taubes states was published in 1948).  But alas, no Yahgan (I also checked Wikipedia's alternate spellings), among the conventional-wisdom-challenging by Taubes circa 2007.

It's OK really, nobody expects you to track down every obscure culture, especially one that counters your hypotheses.  Shhh... look away ... no paradoxes to be found here!

Fast forward to 2018.  Currently, Gary Taubes has been  thinking about black swans as he engages in a bit of light Summer reading.  Perhaps no longer needing to devote so much time to NuSI has opened up a lot of free time for such endeavors.

(*something I still hold out hope of doing more of myself)

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Where did the fat in this blood come from? ~ An Ead-iotic Analysis

NOTE  (8/7/2018):    So I've edited this post, originally written/published 5/5/2011, to omit the no longer relevant back story and defunct links.  I refer to a discussion on Jimmy Moore's now-long-defunct LLVLC Discussion Board that made me aware of the Eades' post discussed.

I'm bumping this for reasons that should become obvious soon.

SUMMARY:  Fat in the blood following a fatty meal is almost entirely due to the fat in the meal. 

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Several years ago, Dr. Michael Eades wrote the following post:  ABC’s big meal propaganda.  Sadly, the video is no longer available.  It involved subjects consuming a GIGANTIC meal of 6000 calories, after which blood was drawn two hours later.  This "after" blood was very cloudy, and the technician holds this up and identifies the source of the cloudiness as fat.  The meal was deep fat fried mac&cheese, a bacon cheese burger quesadilla and fries and an ice cream smothered giant cookie.  Yes, high in fat and carbs, but favoring the starches.  While they pointed finger at just the saturated fat -- it was 187g of saturated fat == it's not too much of a stretch to estimate this meal contained around 300-350g total fat or more.

Quotable Quotes: Taubes the Radical!

Due to a recent article in Wired, I think this (6/30/14) post could use a hearty bump.  These words were uttered just over a decade ago by Gary Taubes. 

THE COLLAPSE OF A $40 MILLION NUTRITION SCIENCE CRUSADE

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Seth Roberts:  But you'd seen Nobel-Prize-winning physicists get it very wrong.

Gary Taubes:  But what they were getting wrong were subtle; yes, they'd believe incorrectly that they'd discovered elementary particles, but what they were doing was a real subtle game. What they were misinterpreting were extraordinarily subtle aspects of the data.  

This obesity screw-up is fundamental; it’s like a grade school error in the interpretation of the laws of thermodynamics.  

And I made it as well, up until five years ago. I never thought differently. 

But what radicalized me is that they don't care.  If they successfully ward off my threat to their beliefs, then I'm in a very dangerous place.  Then it's, like I said, where I end up a bitter demented old man, one of those guys who's muttering to himself all the time that they, the establishment, didn't listen to him…

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I don't mean to wish ill on a person, but if he doesn't end up a muttering demented old man, it means that fantasy wins out over fact, and sensationalism over science.  

Thoughts on Obesity as "Disease" or Choice ~ Part 1: Smoking & Lung Cancer Analogy

Recently (May 2018) comments about obesity at a Pediatric conference have made the rounds. Specifically: Obesity Is a Disease, Not a Choice, Experts Advise.  Here is link to the full text in  "print version".

The AMA classified Obesity as a disease in 2013. Five years later we've made little to no progress, likely because we've got "experts" pontificating and arguing over semantics and false dichotomies.  The false dichotomy of Disease vs. Choice is right out of whatever master playbook teaches that if you keep the "masses" arguing, they might not notice you're full of it.  It's really the only explanation I can think of for the circular arguments made with nary a tinge of irony on board straight faces.

I have a bunch of stuff in the draft pile here on this topic, but cannot seem to organize it. I decided to start a series.  In no particular order.  

This installment deals with the following statement from the 2013 Resolution by the AMA:

Whereas, Progress in the development of lifestyle modification therapy, pharmacotherapy, and bariatric surgery options has now enabled a more robust medical model for the management of obesity as a chronic disease utilizing data-driven evidenced-based algorithms that optimize the benefit/risk ratio and patient outcomes; and

Whereas, The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes; and

Whereas, The Council on Science and Public Health has prepared a report that provides a thorough examination of the major factors that impact this issue, the Council’s report would  receive much more of the recognition and dissemination it deserves by identifying the enormous humanitarian and economic impact of obesity as requiring the medical care, research and education attention of other major global medical diseases; therefore be it 

Mind over Milkshakes!

This post was prompted by yet another discussion on Facebook involving cravings and hunger and the supposed magic of keto/LC in fixing this aspect.   As the thought process goes:  it's not about calories (even if they count), it's about how the food impacts us that causes us to eat too much (or just enough).   A hat-tip to Melanie (Mac Smiley) who sent me this study almost three years ago! 

TL,DR Summary:  Same people, different days, same shake, different labels.  Hormonal response differed based on expectations.

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Jimmy Moore -- Big Fat Liar -- Steps in it AGAIN! It Was NOT a Joke, He Is!

Blogstress Note:

A quick note to all:  Please share!!

An apology:  Parts are long, and I threw a bunch of images in at the end and such just to preserve for posterity.  Sorry!

An open letter to my critics who may be in the audience:

It's OK for you to think what you may of me.  If you find yourself wanting to blame me, realize this is exactly what Jimmy Moore wants from you so that he can continue perpetrating his fraudulent livelihood.

Jimmy Moore, and now his wife Christine Moore, are not really interested or seeking optimal health.  Jimmy has long given up on weight loss, and it matters not what the actual weight is on the scale at this point, he's behind the ball position on January 1, 2004 (when he began Atkins) in so many ways.  He has a serious eating disorder at the root of all of this ... something he shows no desire to address.  Very sad for him and those who love him. 

Still, he inexplicably preys on desperate obese people seeking solutions or excuses.  He does this to feed an insatiable need for accolades from others, and to live a higher life than he otherwise would be (like multiple cruises each year!).

He makes carbohydrate restriction-based plans -- I don't care what the next fad (and that's what it is!) incarnation is -- look bad.

If keto or LCHF or Atkins or whatever has worked for you, and continues to work for you, go for it!  I'm NOT anti-LC.  But do not spread junk science.  Do not follow and elevate the likes of Jimmy Moore who is FAILING eating that way.   Go forth and share your own story if you want.  Or not.  Probably not a good idea to turn it into your primary source of income.  If you disagree with my assessment of "failing", step back, imagine if he's any fill-in-the-blank spokesperson for some diet you think is bull$#!t and see if you wouldn't agree.    He is the one delegitimizing your successful way of life in the eyes of others.  He is the one adding to all the confusion by spouting nonsense like steak is chocolate cake (true story).

Carbohydrate restriction plans could gain more mainstream traction if its promoters, ESPECIALLY doctors and researchers, stuck to the facts and what the science shows.  It's just that won't make those folks rich, and the accepted science will be nowhere near the exaggerated claims you've heard repeated in your echo chambers. 

Lastly, if you know someone who follows Jimmy or is thinking of following him, share this post with them.  If they still feel he's a reliable source of information, at least you've done your part.  I'd rather you encourage them to chase success.

I don't know what exactly prompted him to try to claim his butter eating stunt was a joke, but that lie don't fly!  In the past with Kimkins and the David Duke KKK scandals, he had to address controversy.  But this must be coming in reaction to "friendly fire" -- criticism from within the community.  I am encouraged by this development!

It was no joke, Jimmy Moore is the joke

That (other) time when Christine Moore watched Jimmy Moore eat an entire stick of Kerrygold at his momma's house

The Cause of the Obesity Epidemic

I couldn't help but snap a picture of this at the playground yesterday.  Asylum regulars will recognize the true cause of the obesity epidemic in this picture. 

Babies In Ketosis

April 2018 Update:

Here in the year 2018, it's fair to say that #Paleo is pretty much over. Nothing tells us this more succinctly than a quick trip over to Mark's Daily Apple, a website I rarely frequent these days. I'd heard rumors that Mark had "gone keto" ... given the seemingly meteoric rise of #Keto of late, is anyone really surprised?  This is the same man who developed the "more addictive than crack" P90X recovery drink and other things, 

Ever the businessman (can't fault him for that), Mark seems to have transitioned from using his blog to sell paleo/primal-related books (did he ever find a proper ghostwriter for his wife's book?) to selling over-priced avocado oil products.   The whole "primal" thing is about as downplayed as possible for someone whose signature product is The Primal Blueprint, can be.    Poor Grok.  Now it's Keto Reset time!  Can these marketeers PLEASE make up their minds?  

When someone doesn't "take" to a so-called keto diet, it's always "they probably weren't fat adapted yet".  This mythical and magical fat-adaptation has been purported to take 6 months to a year to reach full nirvana-level.  But now?  Why you can reboot your metabolism (whatever that means!) in just three weeks, and be a fat burning beast evermore!  Kewl!!

What brought this post update about?  I came across a link to a recent post by Sisson addressing What Happens “After Keto”?

"Google searches for this question have shot up in recent weeks. I’m not surprised. An unprecedented number of people went keto in January purely as a quick weight loss hack, and now they’re looking to transition off of “this weird diet.” ...

Well duh.  The best indicator of the fad-factor of a diet may well be the January bump it receives in Google trends. 

Keto is a reset (a Keto Reset (if you're going to buy this, why not use my affiliate link?), even). It’s a return to the ancestral metabolic state, the metabolic state we were born into (newborns are filthy with ketones, even on their relatively sweet mother’s milk diet). Keto happens really easily in humans compared to other animals. You go 12 hours without eating and then wake up in the morning? You’ll have detectable ketones on your breath. It’s almost like we’re made for it. "endquote

So I tweeted out a tongue in cheek response.  Basically, if you even believe in some sort of rebooting/resetting of your metabolism to its infantile state, why stop with diet and metabolism?  The more one thinks about this, the more absurd the "babies are in ketosis" argument becomes.  Read on.  Don't fall for this!!

As to Mark's contention that "it's like we're almost made for it" ... there's a table at his own link that shows that as a species outside of infancy and pregnancy, compared to rats, we're actually "not so much".   Mark knows this.  Staying in therapeutic ketosis as an adult (not this nutritional gimmick nonsense) is rather difficult for most people.  I've been reminded recently that for some, even a leaf of spinach or the taste of artificial sweeteners can be enough to banish one from planet Keton (coined by @LouSchuler on Twitter).  I won't even quibble (again from conversation on Twitter) with evidence that we aren't "born in ketosis".  

As the recent Gardner-led, partially NuSI funded study demonstrated, modern American humans -- for various reasons -- have difficulty adhering to extreme diets.  This is not evidence against the *potential* for various diets to be effective, nor is it evidence that following such diets is harmful for the long term.  But it is evidence that as a dietary prescription of sorts, neither is going to garner much success in the general population.  But one last thing before I go on this point.  I've mentioned this before, and I'll mention it again.  We have BILLIONS of humans who have thrived on very low fat diets throughout their lives, for generations.  We just don't have anything near this for low carb diets, let alone keto versions.  In his article, Sisson says the following:

Studies as long as five years (link to full text) show no negative side effects of long-term ketogenic dieting, so, provided you do it right (no salami and cream cheese keto diets), I see no reason not to continue.

Look at the full text I provided.  This was a case study on THREE young adults with GLUT-1 deficiency.  Two who were normal weight at baseline lost a little bit of weight in the form of fat.  One who was underweight at baseline gained weight:  this individual grew 1.5 cm indicating she wan't fully grown at baseline, and gained more fat than weight (gained 1.5 kg overall, 2kg fat, thus lost 0.5 kg FFM).  The authors mention that the results here are in contrast to those seen in children treated for epilepsy because of full bone mineralization at baseline.  Perhaps, at the very least, there should be extreme caution for growing children or teens to embark on a keto diet!   I see no reason to trust Mark Sisson on the long-term appropriateness of any diet.  

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