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Monday, February 11, 2013

Wagons, Wheels and Eating Disorders

This post is a little past its shelf life, but I figured I'd publish it up anyway.  On the tail of Angelo Coppola's remarks on Jimmy Moore's 10 Things Paleo needs to address so I can continue scamming off of "paleo" post -- blogged on here -- Emily Deans over at Evolutionary Psychiatry picked up on another aspect of Angelo's remarks.  If you missed it, the first post was Orthorexia in the Paleo/Primal Community, and she followed up with Orthorexia in the Paleo/Primal Community: Further Considerations.  If I have one general criticism it is that I'm not entirely sure Angelo was talking about orthorexia when he listed "Recognizing and addressing eating disorders among those who are trying Paleo approaches" among his suggestions countering Jimmy's.

So while they are excellent posts, I fear the focus on the more controversial orthorexia overshadows what I see/saw quite frequently -- the development of binge eating disorders.  I'm not so worried about the orthorexics so long as they don't sanctimoniously lecture me about my supposed addictions and failings or inflict their diets and dogma too stringently on their children.  And even those who do, hopefully there are people in real life looking out for those kids, because the internet really isn't the forum to discuss such matters constructively.  No, I'm more concerned for those who previously ate "normally" who now binge frequently and seek assistance breaking the cycle.  It's the people continually falling off the wagon or having the wheels coming off their wagons, hence the title of this post, that I think of when someone mentions the lack of attention to ED in the community.  Whether or not this is what Angelo was referring to or it was orthorexia I don't know.  Both need to be addressed, IMO, but when I hear "eating disorders" I can't help but think bulimia and to a lesser extent anorexia in the Incestral Health Community.  (I won't address anorexis in the remainder of this post, except to say there are some fairly prominent folks in the IHC who may possibly be.  Also, for some reason paleo seems to attract a cadre of recovering anorexics whose specific needs possibly tenuous states are often ignored when blanket advice is being doled out.)


This is all complicated by the fact that there are some genuinely sick people out there who need to remove the "sickening" agents from their diets.  These people often do not have weight issues and are looking to heal.   So they have gone on various diets that include some of those agents ... perhaps many times before and then they discover paleo.  In comments on her second post, Emily seems to have decided the days of low carb paleo are over and irrelevant to the topic of orthorexia  (how I'm not sure, since Angelo's comments were, after all, made on Jimmy Moore's blog but ...).    However many high profile gurus come out in favor of more carb consumption, you still have Mark Sisson's Insidious Carbohydrate Curve out there on the most visited website in the IHC.  Throw in his seemingly arbitrary pronouncements on what is or is not primal (I say seemingly, because for the most part the line is still drawn at carb content, but mostly it's his whim) and it can be a recipe for disaster.   Some of these who are drawn to the IHC to heal, seem to develop what I'll call BLD (bulimia-like disorders) as they find themselves obsessing over their food intake like never before with increasing desire/compulsion to "purge" when they go astray.  I use BLD, because the "classic" bulimic (postprandial emesis -- howzzat for a sciencey term ;-)  ) is but one manifestation of the mindset that includes fasts, detoxes, strict protocols, etc. designed to rid the system of the sins of the indulgence and get the person back on the wagon to the land of Puritopia. This is not much different than what the classic bulimic goes through on shorter time scale with more aggressive means.

Yet caught up with those with true issues are various folks who were just a tad unhealthy.  They get swept up by the success stories and begin to believe that they, too, must have X-osis or whatever the health cause du jour is.  Throw in a hefty dose of those with weight issues who do lose some weight and feel better as a result, now presuming that they, too, must have been suffering from X-osis for decades and dedicate their lives to spread the word on the evilz of X and glories of paleo.  However as the excitement of weight loss wears off, etc. some little ailments seem to reappear.  Were they ever gone?  More importantly, are they due to having a slice of bread a couple times a week, or slacking off on your morning walks because Rover seems to enjoy shorter potty runs.

At this point, you don't really hear Mark Sisson's 80:20 rule/message cautioning against perfectionism.  This is actually a very lax rule, and, frankly, allows for almost an entire week out of every month of non-primal debauchery.  He wrote it, but he rarely mentions it, and the primal paleo bloggers who pick up Grok's torch and run with it almost never do either.  Further you read how one dinner roll derailed Grokarina Gurette's quest for immortality and vow never to "go there" ... or go there again.  The whole notion of moderation is impossible in the paleo world, even if you preach the 80:20 word, or whatever you want to call it.  Put simply:
You cannot hand down decrees from on high that demonize some food item/type/class/macro and scare the bejeebers out of people, and then say it's OK to indulge in said poisonous agent here and there, it won't kill you. 
That message is contradictory.  I mean take Lustig who asserts that fructose is a poison.  We have no use for it.  It's metabolized just like alcohol so there's no difference between them, which inspired this meme I came across (no, not my doing).  Eenfeldt is so steeped in his dogma, he didn't get it as he featured it on his blog!

Now we have to couple with calorie denialism.  Whether it's micronutrient deficiencies or food intolerances or bacteria gone wild or hormonal mahem or greedy renegade fat cells or too much of the demon nutrient ... many of the purveyors of the way out of the "trap" will vehemently deny the role calories play in weight.  On first blush these purveyors are like saviors.  No doubt calorie obsessiveness has triggered eating disorders in many.  A very low calorie diet was my ticket, but so too can be restriction of carbs, or favorite foods, etc.  Calorie counting certainly can become obsessive and rise to disordered standards, but I'm beginning to think that irrational fear of calorie counting might well be a more insidious eating disorder!!

Where weight loss is concerned, here is where I am so passionate about sharing the scientific truths behind the myths peddled to convince people that it is the carbs, O6's, fructose, toxins, wheat, etc.etc. that made them fat and if only they just cut that from their diet, they'll be magically thin.  Because if obsessing over something so easily quantified as calories can lead to problems, obsessing over mysterious metabolic mayhems -- most of which cannot be readily measured on any sort of accessible fashion -- sure can breed a new class of eating disorders.  But not only do you end up with weight gain anxiety, you can add a whole lot of health anxieties on top of that!

The low carb diet is an interesting case, because as I have discussed here before the original Atkins book was almost all about the calories.  The claim was that you peed out thousands of calories in ketones, thus why one bite of mashed potatoes could undo all your ketotic diligence for days.  This is why so many never really make it out of induction, especially those who peed with bated breath on that ketostick.  All was lost if you fell out of ketosis.   Now I was a lucky one in that LC didn't trigger carb binges and whatnot, but the "science" behind Atkins at that time made it an all or nothing deal -- if you weren't in ketosis there really wasn't a point, and if you have some carbs you might as well just eat "normally".  What I see in the LC forums is too many who have some carbs and then go face down into the plate of pasta or ice cream because they've "fallen off the wagon".  They then berate themselves for giving into their addictions and go back to induction.

We see this repeated throughout the IHC.  If you decide to eat a normal Thanksgiving dinner, many will look down on you for not heeding all of their sage advice and follow the recipes and meal plans they've so thoughtfully laid out for you.  If you survive the sanctimony and eat it anyway, you are then bombarded by fellow sinners who feel they must cleanse their systems to repent.  But how about this? Just eat however you normally eat when you're hungry the next day?  There is no easier way to induce disordered eating than to overcompensate for an indulgence with a "cleanse", fast, etc.

But it seems the overwhelming majority of gurus in this community will have none of that.  For some, the very notion of "cheating" is a sign of your weak moral character.  The worst of this is this crap about feeding one's carb addiction -- implying we all are addicted and in denial of said addiction if we choose to consume the addictive agent.  Sigh.  I cannot overstate how utterly irresponsible this kind of diet advice is if these people really want to help people achieve lasting weight loss maintained in non-neurotic fashion.  Because atop all of the fears of fattening, the gurus of the IHC have piled on fear of this or that toxin or  agent of inflammation, etc.  Nora Gedgaudas sees no reason to ever eat a carbohydrate, if it's poison then why eat just a little, or "gasp" in moderation!  I'm not sure who is worse, her or Rosedale, but I've seen L.Ron state he does eat a small nibble of bread from time to time but he actually considers that it will shorten his life before doing so.  Couple this with the "allowed" foods on various IHC plans that are consumed in excess for that very reason.  Stacy of Paleo Parents brought that up in comments on her Metabolically Broken post.  Jimmy Moore is adamant that his body can't tolerate fruit while nowadays he consumes 2-3 oz regular (sucrose sweetened) dark chocolate most days.  Ever notice how much coffee some of these people drink (and I'm not casting stones, I am a coffee drinker myself)??    Many of these people think the Buttertons were paleo!   Cheaters and sinners are now living in fear that they will become diabetic ... dropping out of pee-stick ketosis is so passe.

Now let's mix in the hefty dose of those for whom the dietary prescriptions du jour are not working but who are now so utterly petrified of eating food they don't know where to turn, and is it any wonder that sites like Paleo Hacks are rife with posts begging for help to "stay on the wagon"??   Many of those questions disappeared from PH.  During my years at Jimmy's forum and perusing other LC forums the number of folks who fell off, came back, did induction, lasted 3-4 days, "blew it" then rededicated anew again and again was astounding.  If you dared suggest to such people an approach other than fewer and fewer carbs and more and more restriction of allowed foods, the shout down was  harsh.

Which brings me to comment once again about Stefani Ruper of Paleoforwomen.  If I hear eating disorders and paleo, she is name number one that comes to mind.  There are some others that come to mind, like two prominent examples of nuttyK experimenters, but this really was Ruper's schtick before her popularity ballooned artificially thanks to the bizarro paleo world.  It is truly disturbing that people like Stefani are counseling people on eatind when they are clearly still suffering themselves.  Emily Deans seems to think that Stefani's work on fasting outweighs this, because she got the dialog started.  Really?  First of all, a keyed in to the buzz in this community as I am, I was unaware of her post criticizing Mark Sisson until quite a while afterwards from her FTA guest post.  It was a lightly referenced piece on gender differences.  Important?  Sure.   But I know that Martin Berkhan of leangains.com -- the IF guru -- had addressed gender differences years ago and uses a 12 hour window for women, which is hardly much of a true fast.  But how about IF vs. periodic fasting, vs. occasional random fasting?

But how about the prevalence of fasting in a community with many eating disordered people?  I recall someone on a LC forum insisting that IF was not calorie restriction and how this person literally shoveled food in during the eating window like the Cookie Monster.   There would always be people who could not adapt to the IF and would end up binging.  Then there was Jimmy Moore's infamous 6 day fast.  While there is certainly a place for fasting (I'll cover the other side of this coin in another post, e.g. needless fear-mongering over fasting and/or losing weight too fast, etc.) I have always found its prevalence in a community almost anti-obsessed with any sort of structured eating or attempt at portion control to be odd.

This has been a ramble, more than usual, which is why it's sat in pieces in the bin for a bit.  But I do wish Angelo's words had been heard regarding eating disorders in general.  Eating real, whole, nutritious foods in no way guarantees effortless weight loss, and when it doesn't happen, you see ever more stringent protocols.  This coupled with fasting and all of these various cleanses -- especially when suggested to "undo" all of that damage from one's indulgences -- and you've got a recipe for eating disorders.

Before I go, I'm going to call out Robb Wolf and Chris Kresser for their Paleologix supplements that are really designed to assist the transition to VLC HF paleo.  If someone  develops cravings for carbohydrates when they "go paleo" this is a problem!  Eat some carbs.  There are people who cannot get past the Atkins flu.   I say these people should probably not be on a low carb diet, or if they think they must be, a cold turkey "induction" style approach is not for them.  But no, you just need some (overpriced) supplements to help you with that transition.  Whether it's their's or some other supplement if it doesn't work, you need more.  Or you are even more broken, obviously, than we previously thought.  You need more and more supplements.  There are folks who take a boatload of supplements to support their way of eating.  I think this at least deserves more attention than it   gets as well.

Lastly, because I'm sure someone will take objection.  Following a necessary therapeutic diet is not an eating disorder.  Following one when you don't need to may be, however.  And insisting that all others should follow it or that it is the healthiest diet for all, is irresponsible and can contribute to others adopting diets that lead them down the path of eating disorders.

54 comments:

SamAbroad said...

I know you said this was a ramble, but I'm not entirely sure of your point on this.

You said:

"Where weight loss is concerned, here is where I am so passionate about sharing the scientific truths behind the myths peddled to convince people that it is the carbs, O6's, fructose, toxins, wheat, etc.etc. that made them fat and if only they just cut that from their diet, they'll be magically thin."

The thing is, if I do that (probably with more fructose than fructophobes are comfortable with) I AM effortlessly thin without counting a calorie. Lots of people are, hence the plethora of testimonials you see on various forums. Why would paleo ever have become popular if it didn't work for a hell of a lot of people?

Of course there are exceptions, mostly perimenopausal women who when I was frequenting cal counting forums were always the ones who found it immensely difficult to maintain the severe calorie levels they needed to lose weight.

So don't deny the reality that for a majority of people, cutting out industrially produced food does spontaneously reduce calorie intake and cause fat loss. The younger you are and the more you have the genetic cards stacked in your favour, the more effective it will be.

Charles Grashow said...

"cutting out industrially produced food does spontaneously reduce calorie intake and cause fat loss."

What does this have to do with calorie counting? Something done spontaneously does not involve planning it just happens! My problem with Atkins, Taubes, Eades, etc. is their statements that calories DO NOT count - that as longas you reduce carbs you can eat WHATEVER you want in WHATEVER quantities you want.

As to carbophobia -

http://www.sciencedaily.com/releases/2007/09/070909184006.htm

"To think that world domination could have begun in the cheeks. That's one interpretation of a discovery, published online September 9 in Nature Genetics, which indicates that humans carry extra copies of the salivary amylase gene.

Humans have many more copies of this gene than any of their ape relatives, the study found, and they use the copies to flood their mouths with amylase, an enzyme that digests starch. The finding bolsters the idea that starch was a crucial addition to the diet of early humans, and that natural selection favored individuals who could make more starch-digesting protein."

"Other primates eat mainly ripe fruits containing very little starch. A new ability to supplement the diet with calorie-rich starches could have fed our large brains and opened up new food supplies that fueled our unrivaled colonization of the planet, Dominy said."

"Some anthropologists have begun to suspect the new source of food consisted of starches, stored by plants in the form of underground tubers and bulbs--wild versions of modern-day foods like carrots, potatoes, and onions. Once early humans learned to recognize tuber-forming plants, they opened up a food source unknown to other apes."

OMG - POTATOES!!! CARROTS!!!

We are meant to eat starches - it's in our genes.

Unknown said...

The objection to counting calories has always been the thing that amazes me most. The caloric breakdown is printed on the packaging of the food product itself, if not you can simply Google the calories for the food product.

WHAT is so objectionable about keeping a rough running tally of what you consume on any given day? Is it the MATH? Is addition and multiplication too much for you?

It's like having a rough idea of how much money is in your checking account, keeping track consumes maybe 3 seconds of your time, if that, during any 24 hour period.

What exactly is your objection to math?

Re testimonials, if you pick 500 people at random and put them on a diet of nothing but pork jowls, a few of them are going to have amazing results, that doesn't mean that pork jowls are the key to life. Also there are a lot of mentally ill people on the internet.

SamAbroad said...

Huh? Did you read my post? I mentioned nothing of calorie denial.

Have these comment sections become such a circle-jerk that even well reasoned criticism of a point immediately brands the writer as a Taubesaphile?

BTW, Eades has often said if you aren't losing weight on low carb, it's because you're eating too many calories.

I'm not personally low carb, but I can see why people are. More people on here would do well to stop foaming at the mouth for a second and wonder why that is.

SamAbroad said...

There's nothing objectionable about counting calories. But for some people it makes them neurotic about food, it definitely did to me, the same way that paleo does to some people.

Also, if you want to bring mental illness into the equation, aren't most anorexics obsessed with calorie counting?

Unknown said...

aren't most anorexics obsessed with calorie counting?

==

It could be that they are, I have no knowledge regarding anorexics. Lots of people keep track of what they are consuming. For example if you are physically active, you may want to keep track of how many carbs you are eating, to make sure that you will have the energy for your chosen activity.

Counting calories made you neurotic about food. Can you even define "neurotic"? That term has no real meaning. What, exactly, do you mean by "neurotic"?

To me the act of counting has no psychological significance, I count things. How much I have in my savings account, how much I have in my investment accounts, to me it is natural to count stuff.

I have trouble understanding how the act of counting can result in a neurosis, whatever the hell that means.

coconutz said...

"The objection to counting calories has always been the thing that amazes me most. The caloric breakdown is printed on the packaging of the food product itself, if not you can simply Google the calories for the food product."

People are so stupid, just follow the labels.


http://www.princeton.edu/main/news/archive/S26/91/22K07/index.xml?section=topstories

http://www.fasebj.org/cgi/content/meeting_abstract/24/1_MeetingAbstracts/562.1

Diana said...

I read your comment, Sam. It's you who do not seem to have apprehended its meaning before pushing click. Charles pointed out that it doesn't matter if the eater conscious counts calories or spontaneously reduces caloric intake, as long as calories taken in are less than before.

Regarding the significance of calories, since you brought up the name Taubes, which Evelyn did not in this post, are you aware of what he says about calories?

"Yes, I believe that calories are a useful measure of the energy contained in the foods we consume and a useful measure of the energy our bodies expend. (Just as I believe miles are a useful measure of how far I have to travel to get, say, from Oakland to Los Angeles.) Yes, I believe in the laws of thermodynamics and I believe, as I say in both my books, they always hold true. That’s why we call them laws.

But, no, I do not believe that we can learn anything useful about why people get fat or why they get the diseases that associate with getting fat, by focusing on the calories they consume and expend. It’s not about the calories."

And Attia?

"Obesity is a growth disorder just like any other growth disorder. Specifically, obesity is a disorder of excess fat accumulation. Fat accumulation is determined not by the balance of calories consumed and expended but by the effect of specific nutrients on the hormonal regulation of fat metabolism. Obesity is a condition where the body prioritizes the storage of fat rather than the utilization of fat."

It is disingenuous to deny LC denialism. It's true that Eades makes grudging allowances as to their reality. Well all I can say is, "Thanks a lot."

Diana said...

meant to write, "consciousLY counts calories..."

Diana said...

Does counting carbs make them neurotic about carbs?

Unknown said...

I have no idea what your links mean, can you explain them?

Unknown said...

I am getting neurotic about people who claim to get neurotic about counting calories.

Charles Grashow said...

@SamAbroad - you said "BTW, Eades has often said if you aren't losing weight on low carb, it's because you're eating too many calories."

http://www.proteinpower.com/drmike/weight-loss/low-carb-and-calories-part-2/

"Once you’ve reached maintenance you can pretty much eat all you want without gaining as long as you watch your carb intake. Like the lady who wrote the letter above, you can feast on all kinds of cheese, nuts, meats, etc. while remaining at your new lowered weight. The calories that come from these sources will sabotage your weight loss if you eat too many of them, but won’t make you gain weight as long as you keep your insulin low.

As you may recall from the earlier post, a lowered insulin levels opens the door to the fat cells, allowing fat to come out to be burned. If your dietary intake meets all your body’s energy needs, however, your body will simply use these dietary calories and leave the calories in your fat cells alone. And you won’t lose. But lowered insulin levels pretty much prevents fat from going into the fat cells, so even if your caloric intake goes up – as long as your insulin stays low – you won’t store more fat in the fat cells. And your weight will stay the same."

"How can this be?

The phenomenon is pretty vividly demonstrated in people with type I diabetes, the type of diabetes in which no (or very little) insulin is produced. Most of the time these people get their diagnosis of diabetes when they come to the doctor because they are losing weight like crazy while eating everything in sight. It’s not all that unusual for a person with new onset type I diabetes (who isn’t aware of having the disorder) to lose 40 pounds in a month. These people have no insulin and a lot of glucagon. Without the insulin they can’t store fat, so they dump fat from their fat cells. Much of this fat is converted to ketones since there is no insulin to shut off the process. The glucagon makes them convert muscle protein to sugar even though their blood sugar levels are already sky high. The end result is that these people have elevated levels of sugar in their blood and elevated levels of ketones. They dump both sugar and ketones in their urine, but not enough to account for the amount of weight they lose. The combination of calories lost to ketones and urine can add up to a few pounds per month, but not 40. Other factors are at work. The body has the ability to waste calories, but doesn’t usually do so unless it has to. In the case of type I diabetes it has to. And people with uncontrolled type I diabetes eat and eat and eat and lose and lose and lose.

Charles Grashow said...

The same phenomenon holds true in low-carb dieting. Insulin is low and glucagon is high, making it difficult to gain weight. That’s not to say it can’t be done, but it is difficult. Which means that once you lose your weight and get to maintenance, if you keeps your carbs (and thus your insulin) low you can pretty much go back to snacking on cheese, nuts and other high-fat, high-caloric density foods without the fear of gaining. You won’t lose, but you don’t want to lose on maintenance. You simply want to maintain.

You will ditch these extra calories by a number of means. Your caloric-wasting systems will be going full blast. You will be futile cycling, increasing the mitochondrial proton leak, increasing the number of uncoupling proteins, and spending extra energy converting protein to glucose. You will also increase your NEAT. What’s NEAT? It’s Non-Exercise Activity Thermogenesis. Your total energy expenditure is composed of four things: resting metabolic rate, the thermogenic effect from food (the energy required to metabolize what you eat), thermogenesis from exercise and activity, and NEAT. NEAT is from all the little things you do without conscious effort – fidgeting, moving more, moving more briskly, stretching, standing more, etc. These are activities that you don’t really think about but that you perform to dissipate extra energy. It’s why you feel more like exercising after you get going on a low-carb diet; it’s why you perceive your energy levels to be higher. And it’s why you’re less hungry. Your body has access to its stored fat and is using it and even wasting it. As Key’s showed in his semi-starvation studies, subjects on low-fat, reduced-calorie diets pretty much got rid of most of their NEAT in an effort to conserve energy. The opposite happens on a higher-calorie low-carb diet."

HUH

Charles Grashow said...

http://paleodietlifestyle.com/paleo-guide-to-ketosis/

"To summarize the documented health benefits of a ketogenic diet, it seems that ketosis is most clearly useful for people with severe health problems like obesity or epilepsy. For these conditions, ketosis is a relatively safe and effective treatment – certainly better than spending the rest of your life on a cocktail of seizure medications or suffering all the side effects of uncontrolled diabetes. However, healthy people who aren’t at risk from one of these conditions might want to think twice about adopting a ketogenic diet, because ketosis doesn’t come without its own set of risks."

"Conclusion: Is Ketosis for You?
The answer to that question is, of course, “it depends.” Since we have evidence of hunter-gatherer tribes eating such a wide variety of macronutrient ratios, it seems clear that human beings are not evolutionarily designed to be in ketosis all the time; it’s more likely that we have a very flexible metabolic structure that can function quite well burning either ketones or glucose for fuel.

Thus, if you’re pregnant, extremely athletic, or have another contraindicating factor, or if you do just fine on a moderate-carb diet and see no reason to change, then there’s no reason to strive for a constant state of ketosis. If you are interested in the potential benefits but don’t want to go all the way, a cyclic ketogenic diet might be a better choice – this will allow you to experiment with ketosis without risking the side effects of a long-term very low carb diet. On the other hand, if you feel better on a fat-burning metabolism, want to lose weight, or you’re trying to manage a neurological disease, there’s no reason to worry that ketosis is somehow harmful or unnatural."

coconutz said...

"A Princeton University research team has demonstrated that all sweeteners are not equal when it comes to weight gain: Rats with access to high-fructose corn syrup gained significantly more weight than those with access to table sugar, even when their overall caloric intake was the same."

http://www.princeton.edu/main/news/archive/S26/91/22K07/index.xml?section=topstories


"However, the carbohydrate contents of beverages determined after acid hydrolysis were substantially (4–5 fold) higher than the listed values of carbohydrates."

http://www.fasebj.org/cgi/content/meeting_abstract/24/1_MeetingAbstracts/562.1

Maybe these studies are BS, or maybe not.

Are calorie counts on labels accurate? I don't know.

I picked up a box of Cocoa Puffs at the store the other day and read the ingredients. Corn Syrup and Frutcose are now listed seperate.

Hmmmm, maybe because HFCS has such a bad rap?

Swede said...

Maybe people are turned off by the "perfectionist" habit of counting calories? As they say, "don't let the prefect be the enemy of the good." Maybe folks feel that they have to keep a perfect tally or it doesn't work? I agree with keeping a "rough" tally, I have had plenty of sucess with that even if my tally may be over/under my actual intake by a few hundred calories. It also requires extra planning, especially if you are cooking for a family.

Hugh said...

This topic has been on my mind for well over a year now. It's no surprise paleo bloggers don't dive into the research showing how labeling foods as "good/bad" or "healthy/unhealthy" can have negative downstream effects on eating behavior. I personally have had to spend some time un-learning much of my paleo & low carb beliefs, and by allowing myself to eat formerly forbidden foods without judgment much of their allure actually begins to fade. I just shake my head in sadness when people go on about sugar detoxes or 30 day challenges.

George Henderson said...

If you are really addicted to sugar, as opposed to carbs, so that you can't go a day without something sweet or even limit your consumption even if other carbs are available, that could be something worth fixing with supplements and abstinence, given the context of sugar in the diet and the fact that losing your teeth isn't pretty.

However, I have to take you to task over bulimia. Binging and fasting isn't the same, bulimia creates a particular set of health issues that can't be compared, for instance damage to aesophagus and teeth, loss of electrolytes and poor absorption of what is eaten. Someone who binges and fasts is at least still nourished. An anorexic isn't, and a bulimic is malnourished in a special way and also a victim of self-harm.

Evelyn aka CarbSane said...

George, As someone who has been there, done that, I stand by: Some of these who are drawn to the IHC to heal, seem to develop what I'll call BLD (bulimia-like disorders) as they find themselves obsessing over their food intake like never before with increasing desire/compulsion to "purge" when they go astray. I use BLD, because the "classic" bulimic (postprandial emesis -- howzzat for a sciencey term ;-) ) is but one manifestation of the mindset that includes fasts, detoxes, strict protocols, etc. designed to rid the system of the sins of the indulgence and get the person back on the wagon to the land of Puritopia. This is not much different than what the classic bulimic goes through on shorter time scale with more aggressive means. Sure, "classic" bulimia has unique health issues. I'm talking about the mindset of some of these fasting behaviors.

Evelyn aka CarbSane said...

Internet popularity is not a good measure of overall usage, and internet successes are not a good measure of success rates. In early 2000's low carb was way more all the rage than paleo and look at now. Someone on the internet would think it's still huge, but Atkins is still not opening up weight loss centers next to every WW etc.

BTW, if I'm not mistaken, you once commented here when I suggested that a person could eat a small serving of Doritos and you said that was impossible. Was that you?

Have you ever had a weight problem? The vast majority who have generally cannot reverse that "effortlessly" ... which does not mean it has to be calorie counting but it involves something deliberate,restrictive,etc.

Paleo doesn't own eating real foods. I have no doubt that most who eat real food the majority of the time will have little problems.

Lowcarb team member said...

Spot on Sam, cut the junk, eat less move more, weight problem sorted. I am beginning to think many with a weight problem, want a weight problem. Also, if they spent less time sitting at a computer and off their butts, well you get the picture.

Regards Eddie

Mateo said...

Hello Evelyn and all in the blog world. New to this site---I have followed the LC camp for about 3 years. I am familiar with all the sites you reference. Before I weigh (PUN!! Ha-Ha)in with my 2 pesos worth--as I am new to this particular party, could you please clarify your position?? For example, didn't you use to run with the paleo crowd? I missed what your main beef is with Jimmy Moore?? I, too have recently begun to re-think my stance on the whole CrossFit, Paleo, dogmatic rubbish. Just wondering where you officially stand here. Thanks to all, Mateo...

Diana said...

@Evelyn "the vast majority who have generally cannot reverse that "effortlessly" ... which does not mean it has to be calorie counting but it involves something deliberate,restrictive,etc."

For some reason the reply feature isn't working for me now, so this comment is at the bottom. Whatever...

I will add my experience w/calorie counting because I think it's generally true.

Calorie counting was like training wheels, or toddling before walking. A lot of people have NO idea how much they are eating. So keeping a journal with a calorie count is important. After a while you get a gut feeling as to what constitutes a portion, and noting the foods eaten is enough. You don't have to count. It's in your eyeballs.

Most foods are easy to figure out, but some are not. I remember the total shock I had when I actually weighed a lump of peanut butter. What I had thought was 100 calories (because a TBSP of PB is @100 cals, right?) was really more like 300. Oh dear! And some foods are tough. 4 ounces of pasta is really pretty paltry, to me, anyway, and when you put the stuff on it that makes it palatable, you are in heaven or hell, depending on the circumstances.

Calorie counting is a means to an end. I agree that some people can get lost in a maze - but that is true of anything, including carb counting.

A second point. To be totally fair, Evelyn, there is another form of calorie denialism. There are people who claim that weight plateaus and even some forms of obesity are caused by not eating enough calories. They believe that eating too few calories slows up your metabolism. It's the old broken metabolism theory, in gym bunny clothes.

Diana said...

@Sam, Apologies - you did not bring up Taubes, Charles did. I missed that. But Evelyn didn't, and those quotes are true, from his and Attia's blogs. They deny the centrality of calories in weight regulation.

SamAbroad said...

I was technically obese at one point yes. Now I'm maintaining a 50lb weight loss for about 5 and a half years in the normal weight range.

When I say 'effortlessly' I mean by cutting out processed food. Does that mean cutting out processed food requires no effort, just that if I do that, food quantity takes care of itself, I've the same happen in countless people, we are not miracles of science, though to read this blog sometimes, you'd think we are mythical creatures.

You said before that all people need to do is put the bag of Doritos down like THAT required no effort, I never said it was impossible (nice exaggerating) but that suggesting that that is all people had to do was completely useless and almost totally redundant as most people know that already.

SamAbroad said...

It definitely can do. As I mentioned in my post, paleo drive people batty sometimes too.

What my point is that neuroses is not magically averted by counting calories, most, if not all, hospitalised eating disorder patients' modus operandi is calorie counting. If your looking for a genesis of disordered eating, start with that.

SamAbroad said...

I can replace 'calorie counting' in your entire post with 'paleo/real food/low carb/vegan/diet du jour' and tweak a few things and you'll find people on various forums saying the same thing.

'I had no idea how many carbs were in chinese takeaway!' Yada yada.

Diet changes fullstop are a means to an end. This blog deifies calorie counting and falls for all the same hubris that all other blogs proponing diets fall into.

Princess Dieter aka Mir said...

Totally agree with this. We can never be super accurate with calories (on labels or even weighing at home) as it's not a pristine and perfectly calibrated laboratory. It's life. But caloric counting, weighing, measuring helps RECALIBRATE US...because the portions we get "out there" in restaurants and drive-thrus train us to think THAT is a normal portion, when it may be 3 abd 4x a normal portion. I don't know any Cuban who would believe 1/2 cup is considered a portion of rice. It's more like scoop it out until the plate is half full of rice. Hah. But when you learn portions and calorie counts, it opens your eyes to just how oversized we've come to think of servings. And when we notice how much we can eat to maintain, how much we gain, how much to lose...we start to learn what we CAN or SHOULD eat.

There is also portion creep. I find when I've stopped measuring/portioning and wing it, then after a while there's a "bit more" syndrome and I can't fully rely on the ballpark/eyeball anymore. I have retrain my eyes by a spell of strict measuring again, paying attention again.

SamAbroad said...

By neurotic, I mean thinking that if I skip lunch I can eat that candy bar later. Or if I eat less at dinner I can drink more wine later (this is a bit of a problem amongst my peers).

By neurotic, I mean I can lose 3lb a week instead of 2lb if I eat even less..or maybe 4lb?

Looking constantly at my total for the day at night then looking in the fridge to see what I can get for a 100 calories because I'm really hungry.

CONSTANTLY obsessing about food and the numbers associated with it.

Now I don't think about it too much. I make everything from scratch and my hypothalamus seems to figure out the rest, like all normal people since the dawn of time :)

I'm not saying all are as lucky as me, but I'm getting the impression that you think everyone SHOULD be like you.

Unknown said...

I think that everyone SHOULD be like me in that they should be capable of counting and multiplying numbers without having to put a great deal of effort into it.

I have a hard to believing that it is unduly burdensome for a person with a weight problem to count and multiply numbers. If that is too much for them they might as well jump off a bridge because life is full of problems that are a lot more burdensome than adding and multiplying numbers.

SamAbroad said...

I'm amazed you're managing to reply to me without addressing a single one of my points, it's quite astonishing.

Good luck expecting everyone in the world to feel and act like you, I'm sure it will make for a frustrating life.

Evelyn aka CarbSane said...

Who said neuroses were magically averted by counting calories? Not I!! Same games can be played for sure. I really hate the commercials for Egg Beaters where they compare two omelets with like 180 and 250 cals. That's insane! Or the 80 cal/serving yogurt that is better than the 100 cal/serving one. The anorexic who eats 2 baby carrots and laments the second is seriously disordered. And it's no where near as serious to be orthorexic, whatever that really means.

Evelyn aka CarbSane said...

Welcome Mateo! That would be difficult as my position has changed over the years. I was a low carber who didn't buy the LC junk science. Lost a ton of weight but plateaued at still too heavy. My main beef with Jimmy? LOL. Well, nowadays it is that he's a lying scammer ;-) What initially got me annoyed with him was when I used to participate on his forum. He'd drop in infrequently and offer up some pat advice like "just stick to meat and veggies and the weight will come off", or "up the fat" etc. His bios gave no inklings that he was struggling with his weight. I only sort of got "dragged" into paleo b/c of Jimmy and I guess one could say b/c of the overlap caused when AHS11 featured Taubes, Naughton and other LC'ers prominently in the ancestral world. There are all sorts here from Weight Watchers to DASH to paleo to LC and all the way around. So jump in and tell us how you feel! We don't have to agree here, it's what makes this place fun IMO.

Evelyn aka CarbSane said...

I think most people of a certain age have unnecessarily bad/anxious memories about calorie counting. The first time I ever tried it I found one book that had a pretty good listing of calories but "real foods"? Well what's a small potato really. For weighing, the only affordable scales were those little spring loaded ones that were accurate to like 100% LOL. It was truly an effort to count and I think a case could be made that calorie counting sometimes caused folks to gravitate towards packaged foods -- it had a label and you just had to measure out, etc.

But I purchased a scale -- actually not for calorie counting but for being able to better micro-thaw and estimate cooking times and small packages -- for under $20. It weighs to the 10th of an ounce accurately. There are any number of apps online and otherwise to count calories where you just put in the item and portion and voila! You can even create custom foods, etc. Heck, nowadays there are phone apps where you scan a bar code and it logs your foods for you.

There are a lot of people who find good old calorie counting amazingly freeing after being on some of these fill-in-the-blank-o-phobic diets.

Derek H said...
This comment has been removed by the author.
Unknown said...

"I'm sure it will make for a frustrating life."

Well now we are branching off into philosophy but yes, life is pretty frustrating, imo the Buddha nailed it.

http://en.wikipedia.org/wiki/Four_Noble_Truths

Diana said...

@Sam: "This blog deifies calorie counting and falls for all the same hubris that all other blogs proponing diets fall into."

Ya think? I don't.

You make me laugh, Same.....deifies? So Kommander-Evelyn, Kamp Kommandant of Ze Karbsane Stalag/Gulag, forces people into vorshipping ze almighty calorie, at a flaming altar?

Not really. Calories count. Studies cited herein prove that over and over, different macronutrient combos produce different satiety levels, and affect LBM differently, etc. No worship here.

SamAbroad said...

Forgive me, but I thought that was the general tone of the post, that paleo or low carb type restriction can lead to disordered eating.

What I am saying is that calorie counting has the exact same potential, arguably more so.

SamAbroad said...

Tell me please, where I said calories don't count? It's like there are blinkers on and that's the only thing a person disagreeing with Evelyn can be possibly thinking. Too much exposure to trolls maybe?

This blog supports calorie counting as a method to lose weight as uncritically as most paleo blogs. When has there ever been an article listing or referring to the issues with calorie counting? You may say that's what the myriad of paleo/low carb/vegan whatever blogs are for, but they are seen as cesspools of pseudo-science generally so why not a more honest appraisal of the potential drawbacks on here?

I'll be leaving now as I don't really see a point to further unproductive dialogue.

It's a pity since I agree with so much here (I'm guessing the real science posts don't draw as much traffic as the high-school bitching session ones). To be honest the negativity gets to me the same way low carb blogs used to do when bashing this or that dietician/organisation/vegetarians.

Lowcarb team member said...

"we are not miracles of science, though to read this blog sometimes, you'd think we are mythical creatures."

Sam you hit the nail on the head. But so many want to spend ten years reading all sorts of so called science, anything rather than face up to reality. It's always somebody else's fault.

Eddie

Unknown said...

"This blog supports calorie counting as a method to lose weight as uncritically as most paleo blogs."

I think most of the people here would agree that losing weight is very hard and requires a great deal of effort, I don't think that anyone has proposed that counting calories will result in weight loss. If counting calories resulted in weight loss then everyone with a Smart Phone would be thin, there are plenty of websites that count the calories for you.

I still can't understand your objection to keeping track of how much you have consumed in any given day, you say it makes you "neurotic" but that is a mental health issue not a diet issue.

There really isn't a down side to keeping track of how much you have ingested. The worst that could happen is that a person with OCD tendencies looks up the caloric content of each meal that he/she eats, it is hardly life threatening. Maybe an extra five minutes of each day.

Of course people with eating disorders have a serious problem, but I don't think that keeping a rough tally of how much you consume each day amounts to an eating disorder.

Lighthouse keeper said...

" Miracles of science" is somewhat oxymoronic, mythical creatures do not exist , the hammer missed the nail Eddie vis-a-vis science.

Diana said...

@Sam, well, you are gone so I guess this answer doesn't matter but for the benefit of the regulars...."Tell me please, where I said calories don't count?

You didn't. Your first comment was that you became "effortlessly thin" without counting a calorie and some of us just simply said that this isn't possible for a lot of people, many of us DO have to count calories to get an accurate read on just how much we are eating. And you seem to have taken an emotional exception to that, I don't know why. What worked for you doesn't necessarily work for us.

" ....This blog supports calorie counting as a method to lose weight as uncritically as most paleo blogs"

Calorie counting isn't a method of losing weight, it is one way of tracking one's intake so that one can lose weight - you don't seem to want to accept that.

The only way you can lose weight is to oxidize fat, and the only way you do that is to take in less (whisper) calories than you expend. Calorie counting may help in that endeavor. This is not a geeky nitpick. It's a fundamental distinction.

As for the crack about more comments cropping up on the personal posts than on the science ones: guilty as charged! But it's true, I've become more interested in the science posts since April 2011, when I discovered this blog and they are the reason why I keep reading.

If you don't believe me that's fine.

I like the science, but I also enjoy the mischief, the backstage gossip, the tantrums, the bitchfests, the drama, the makeup sex...so sue me, I'm human.

Mateo said...

Thanks for that reply Evelyn!! I find the honest discourse to be refreshing, to say the least. I will definitely be back soon with this one man's opinion. Thanks and hello to all in blog-land!!

eulerandothers said...

http://www.theheart.org/columns/bob-harrington-show/31-atkins-diet-obesity-and-cardiovascular-disease-risk-with-dr-eric-westman.do

It's somewhere around the 9:30-10:00 interval that Westman says study after study has shown you eat fewer calories if you restrict carbs. This interview was done in 2010. I notice in a 'Duke office hours' broadcast (http://www.ustream.tv/new/search?q=eric%20westman) in 2012, he doesn't really mention calories. He does mention an app that counts carbs! That onerous counting task again.

I notice that even though Westman says vegetarians can 'low-carb' and there are guidelines for that in the New Atkins For a New You book, I can't find any mention of vegetarian choices in the program as it's presented on the website.

He also mentions the Rice diet, the diet in the same town (Durham, NC). That high, high carb diet!

eulerandothers said...

Interview done in 2011, not 2010.

Evelyn aka CarbSane said...

Sam, I tried to respond yesterday but my connection would not have it :-( I don't know whose blog you are reading but it certainly isn't mine! My basic position is that ultimately it boils down to the caloric balance. Sure obsessing over calories can be the route to ED -- did you miss that part? My point here was to address the paleo-LC part. Counting carb grams or obsessing over every supposed toxin in foods can be just as bad if not worse and I've seen it in desperate pleas on PH and folks freaking out that they are killing themselves with non-existent diabetes. If someone falls off the calorie wagon, well that's that. If someone falls off the LC-paleo wagon? There's the insulin damage (fictitious), glycation (WAY overblown), dysbiosis, the O6 & transfat assault that will be with you for a decade (exaggerated - grin) and so forth. Not to mention you've shut down your fat burning beast and dropped out of ketosis.

Emily Deans said...

I'm going to do another post on binge eating. My "paleo" folks who have come to see me at the clinic have not had binge eating problems after the transition (though many have a lot of food anxiety), though I have plenty of binge eaters who eat a standard diet or weight watchers or overeaters anonymous or whatever. And a quick pub med search for low carb binge eating comes up zero. http://www.ncbi.nlm.nih.gov/pubmed/?term=low+carb+diet+binge+eating However, it is an interesting question and I will see if there is anything in the literature. I know of one online person who reactivated her bingeing when doing primal.

Woodey said...

This commercial pretty much sums up the mentality of a large portion of the LC/Paleo community: http://www.youtube.com/watch?v=yjayxnZBd4w

I agree that the fad diets tend to promote or be for people with some kind of a behavioral disorder. There were moments when I posted on the Fathead Facebook page in regards with people having a self righteous attitude towards those that don't eat LC and boy was I met with some heavy venom. One person even followed me to another post to vent her rage because I dared to challenge her attitude of going off on people at the store who were overweight and not eating LC. Another time I met some militant people was when Davey Jones died and people were pointing fingers at his vegetarian diet. I spoke up that it might not have been his diet and that he was a wonderful talent, wrong thing to say.

I don't know how many posts I read of people talking about stuffing themselves on foods thinking it's OK because the food had no carbs. One person stated that once she discovered that it was ok to eat eggs and mayo because of the lack of carbs she made a dozen deviled eggs and downed them in one sitting. She also complains about not being able to lose weight...hmmmm.

I will go so far as to say that fad diets are equal draws for eating disorders and for people who are just desperate for change and are willing to shut out the common sense voice in their head and plunge headlong into the diet. I know because I was one of them. It took me a year to come to my senses. Anyhow now that I have, I have lost 65 lbs and 48 of that has happened while on Weight Watchers. All I am doing is eating less, not eating much in the processed food department, and doing some exercise.

Travis Culp said...

For what it's worth, I think Paleo, or at least a more red meat-centric diet, could work to reverse an established eating disorder like anorexia nervosa. I've seen studies where zinc supplementation alone reversed AN. Presumably the same could be true for red meat (or oysters) eaten over an extended period.

I think the reasoning was that a zinc deficiency decreases taste acuity and the reduction in food intake decreases it further, thus causing it to cycle out of control.

As an aside, this is the first time that I've seen "incestral health community." That's gold, Evelyn! Gold!

Evelyn aka CarbSane said...

Nice to "see" you Travis! Thanks about the IHC. It is so perfect :D

The thing about anorexia (and I often get in trouble between the eating disorder vs. plain anorexia, but mostly when people refer to it, it is the ED) is there are factors other than appetite, etc. A nutritious diet will help far more than trying to get the person just to eat more crap. I'd be on board with that!

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