The Problem with Science in the Incestral Health Community
I've been discussing lately the entangled web of relationships and referencing in this community, and I have decided that henceforth I'm going to call it on this blog what I've called it in my head for a very long time: The Incestral Health Community. This is because everyone has ties to everyone else (or enough) and apparently nobody feels even the slightest bit interested in vetting one another, let alone any professional obligation to do so before slapping the affiliate logo on their website or inviting fellow IHC members to speak at their events.
I've also been highlighting credentials of late, and will continue to do so when I feel that it is pertinent. I want to make sure that everyone reading here understands that I am not passing judgment on anyone's academic record, highest degree held, etc. Fer crying out loud, two of the smartest women I've had the privilege of knowing both dropped out of high school in the 9th grade. And sadly, the number of functional illiterates matriculating at prestigious institutions these days is mind-blowingly astounding. This is not about academic elitism or snobbery. It IS about discussing just what makes for an authority, an expert, etc.
Let's say I notice a small blackish-reddish mole growing on my hip in a place that would be covered by even the teensiest bikini, and it is a teensy tiny mole at that. What do I do? If you are part of this community, you might go get a can of the new-fangled freeze-off wart removers and be done with it. And if it got infected, eh, rub on some Neosporin, and if that didn't work, go on the internet and buy antibiotics from Whogivesadamistan or buy rub some coconut oil from Tropical Traditions on it because we know CO cures all. I probably have the therapeutic order in reverse there. Coconut oil first, then the "hard stuff". When the mole returns with a vengence, you go on a ketogenic diet just in case it's cancer, but you remain unphased. When it still doesn't go away, you go to your local tatoo parlor to have them "erase" the mole like a bad tat. Anything ... and I do mean A.N.Y.T.H.I.N.G but go to a dermatologist, because we all know their training is the low point of intellectualism in their lives and they are just trained to run tests and prescribe pills and collect your insurance money. Oh ... and make sure to blog on how smart you are for doing that and thumbing your nose at idiot doctors and the remedies developed by Big Pharma. If the mole metastasizes and causes serious issues down the line? Well, that must have been from your month experimenting with veganism in your 20's followed by the year on the Little Debbie and Coke diet that blew out your pancreas. Nevermind you never had blood sugar issues. We can manufacture those if need be .....
Look, if I were to advocate for anything, and perhaps someday I will, it will be for patient advocates, or advocacy for patient education. ADVOCACY TO COMPLIMENT AND FACILITATE CARE FROM A FORMALLY TRAINED COMPETENT PHYSICIAN. Even back in the days of house calls and hour long appointments, doctors only know as much as you told them, and can only make their best appraisals based on what you present to them during short periods of time. (Though the insights they used to get from house calls are quite interesting). Look, if I found a mole, my GP referred me to a derma, and the derma recommended good old fashioned "cutting out" of the mole, here's what I'd do. I would first ASK about less invasive treatments and why the doctor suggested a seemingly more crude/extensive intervention. And look, if my doc said, "If I cut it out and take an extra millimeter of tissue around it in all directions, then the odds of you ever having any problems arising from your mole are next to nil, and furthermore this is far cheaper than the next alternative", I'm probably going for it. I'll have a little divet on my hip that only my husband will ever see. Done. If the mole is on my face or chest? Well, perhaps I ask about the risks and costs of other options. Isn't that how it is supposed to go? If the issue is more complicated than a little mole, perhaps the problem is not the doctor, or the manufacturer/developer of potential cures, but patient education and advocacy so they can arrive at an informed decision WITH their doctor.
The IHC seems to thrive on promoting anything but such a path. Of course you get all of the disclaimers, and the "discuss anything with your doctor", but that all rings hollow against the certitude with which various gurus and such mock, malign and otherwise foment mistrust in conventional medical care (unless, of course, it is an IHC approved doctor espousing alternative superior ways.) Buy the book, ignore the LDL, hack your condition! It is all rather disgusting, really. But this community fosters such a distrust of anything and everything "mainstream" that such disclaimers are nothing more than legalesed butt savers.
Sorry for the set-up rant here, but it needed to be said to discuss a recent post on Balanced Bites: A Biochem Snapshot: 5 Facts That Keep Me Paleo. Of course in light of recent posts, that word "biochem" popped out at me over at paleobuzz.com. Who is this written by? Why a graduate student at UNC Chapel Hill pursuing a masters degree in Public Health Nutrition, Courtney Locklear.
Being in grad school sometimes has its perks.
Beyond the chronically stressed, sleep-deprived state we regularly experience, there are moments of fulfillment and satisfaction. This past semester I participated in an advanced biochemistry class, which focused on macronutrient metabolism. Although at times it felt like this class could be the end of my sanity, the science I learned has really solidified my belief in ‘eating like our ancestors’. I’ve included the corresponding slides to show that I didn’t pull this stuff out of thin air (and maybe improve my street cred!).
OK. I'm going to just focus on Point1. She may not have pulled any of this out of thin air, but she sure did pull it WAAAY out of context and into the IHC web to boot. Hang on gang, this is a little nerdy!
1. Consuming carbohydrate, especially in excess, can potentially increase the production of fat.
When we consume carbohydrate, whether they are simple or complex, our insulin levels increase significantly. When insulin rises, enzymes are activated that help build fat molecules for storage in our adipose (fat) tissue. From an evolutionary perspective, it’s a protective mechanism to help us store energy after a “feast” which was often followed be “famine”. After a prolonged diet high in carbohydrate, these enzymes that help synthesize fat (in the form of triglycerides) will actually increase in quantity and therefore function. Without insulin, fat cannot be as easily produced in our fat cells for storage. This contradicts the idea of low-fat diets for fat loss.
Yeah, and? I'm willing to bet this isn't what you learned in your classes, it is taken out of context. Let's do the straight biochem first, shall we? The enzymes don't synthesize triglycerides, they synthesize fatty acids. A minor distinction, but if we're going to get all science nerdy, let's get it right, shall we? Secondly, fat does not need to be produced to be stored in fat cells.
I will never understand the ridiculous obsession over the de novo lipogenesis metabolic pathway with low carbers. Your body stores fat as fat. If you eat fat the odds are it spends some time residing as fat in your adipose tissue for some period of time. Fact. It may not, but the odds are in favor of that happening. If dietary fat is so great, and saturated dietary fat is at the very least not harmful, what, pray tell, is the problem with converting carbs to fat?
While Susan Powter was whacked about not being able to get fat on carbs, she had a point -- it is energy intensive to convert carbs to fat. This, by the way is an argument (rightly) made by Jonathan "Not-so Smarter" Bailor regarding protein. Well, it holds for carbs as well. The production of fat from carbs is "inefficient", which, when it comes to getting away without storing excesses, is what you want.
Courtney's contentions are based on two studies she links to:
The first one is absurdly irrelevant. In that study they overfed subjects 75% of normal intake in pure carbohydrate and guess what happened? DNL was upregulated and the subjects made some more fat from the carbs and stored it. Duh?! This is relevant to weight maintaining and/or weight loss diets, how? Or even overeating in general of mixed macros? It's not.
The second one is a little more relevant (and relevant to the hypothesis) as it discusses a eu(iso)caloric context. Still, on 75% liquid glucose polymer carb, it is not surprising that DNL is upregulated. I have actually been meaning to email Marc Hellerstein about this study as it seems to be somewhat in conflict with a substantial amount of other (later than 1996) research he's published on the topic. Research utilizing radiolabeled substrates that demonstrated DNL is not a major source of the fatty acids of VLDL trigs in humans. I'm looking right now at my copy of Nutrition by Insel, Turner & Ross. There are many editions of this text, mine looks like the one at right (sans the 2002 update banner, mine is copyrighted 2001 but has the wheat cover which is the updated one. In any case, on p. 241, there is an FYI insert "Do Carbohydrates Turn into Fat?" by none other than Marc Hellerstein, MD, PhD. In that half page section he writes: "Other conditions yield similar findings. Very-low-fat diets (10% energy as fat; 70% as carbohydrate) stimulate lipogenesis, but, again, not a large amount." So I take this as Hellerstein's *authoritative* word on the matter.
And ... here's the IHC angle ... Mark Sisson's "work" is referenced??!! Yes, that academic work that is the utterly laughable carbohydrate continuum that states that over 150g/day will lead to insidious weight gain. Really, Mark, you gotta take that down if you want to be taken seriously for your science. And really, Courtney, Mark Sisson? You are going to graduate school why? Have you no more reputable sources to cite from your graduate education?
This is depressing really. But this is the crap that passes for "nerdy" biochemistry in the Incestral Health Community these days. Don't forget to buy your books!
Speaking of books, however, may I HIGHLY recommend that Nutrition book pictured above? It is written at a very accessible level and you can get a copy for a song (I think I paid $4 for mine) albeit perhaps an older edition. Yes, you will find some "mainstream dogma" there, but, like the insert from Hellerstein, it contains those unusual gems from the scientists themselves interpreting their results! It presents biochemistry in straightfoward, dogma free fashion. No. I have no affiliate links to the authors.