Disgusted with Diet Doctor

The Swedish Diet Doc (does he have any patients?) has been on a roll of late, and it's reached a point where I just have to comment.

For starters, although it would be impossible for every bariatric doc or even a small minority of them to be real-life examples (in the been there, done that department) to be able to promote what has worked for them, at least one might expect that such a doctor wouldn't hold such disdain for them.  When you think about it, medicine is one of those professions where the experts rarely have first-hand knowledge of the fields in which they are often doling out the most personal of advices.  But if you don't like "fat people" then why are you making a living off of "treating" them and dissing them behind their backs (and to their faces)?  

Diet Doc even has a label:  Why Americans are Obese.  Sounds OK though.  Yeah, obese is the technical term.  But here is one of the posts on that label: http://www.dietdoctor.com/why-americans-are-fat-part-2.  Note that I didn't change the bare URL which belies the original title of the post, and many others, before someone informed the doc that calling people fat might be insulting and not appropriate for a person of his stature to be doing.

First of all, the general clientele on a cruise is not reflective of the American population as a whole ... no matter how "fat" we are.  But secondly, Andreas was sitting there, on the low carb cruise, snapping pictures of "fat Americans" ... and he would then stand up in front of audiences of devout low carbers that are no less so.  What does he think of them?  What do they think of that?  

Eenfeldt's solution to everything is to just eat a LCHF diet.  It's the insulin stupid.  Don't throw the baby out with the bathwater on Gary's working hypothesis.  His blog is a never ending series of short quips when an American gets sick ... as with his "blogging" about Tom Hanks' diabetes diagnosis.  If only Tom would just give up the carbs.  More on diabetes in a bit.

Andreas triumphantly announced that a new Swedish study had concluded:  A Low-Carb Diet Most Effective for Weight Loss.  Why do I think the authors had him in mind when they fired back with:  Nej, vi sa inte att LCHF alltid är bäst (No, we did not say LCHF is always best).  {translated by Google}

Two of [mis]interpretations have , in our opinion occurred in the wake of the publication of the SBU report. One is that lågkolhydratkoster is by far better. Yes, during the first half of you go down faster in weight for advice on low carbohydrate diets. But after one and two years are no different than other dietary in people with obesity. Possibly this may be due to adherence to dietary advice abate over time. Compared with low-fat diets are low-carb diet some beneficial effects, albeit small, in some laboratory values. If this can be put into effect on morbidity and mortality, we do not know - lågkolhydratkostens long term safety is not yet investigated

The most important aspect is the food affects the risk of becoming ill or dying prematurely, but most studies are designed to investigate the weight loss for up to a year or two. However, there is evidence that intensive counseling about the Mediterranean diet for obese individuals reduces the risk of stroke, heart attack and cardiovascular mortality, compared with advice on low-fat diets. For other food types, such as low-carbohydrate diet (like Atkins or carb) or diet with low GI, no scientific evidence to determine whether they affect morbidity or mortality in people with obesity.

Somehow this update didn't make the blog.

OK so they say Mediterranean is better than LF, which ties into today's post by the doc.  This post goes after MyPlate that is apparently similar in Sweden.  The only thing I see wrong with the picture there (is this their MyPlate?) is that all the veggies are starchy.  Replace peas and corn with spinach or broccoli and that looks like a healthy plate that would not promote fattening unless the whole thing were drenched in his beloved butter.  But here's the money quote:

- We have to learn that fat is not the enemy and that we ourselves have to change, says Ulf Rosenqvist.

At the same time he underscores that there are no studies on how saturated fats affect us long term.

- The safest bet so far, is the richer Mediterranean diet with oily fish, nuts and olive oil, where mortality rates are lower than in people who eat a low-fat Mediterranean diet.

This is NOT Atkins or any version of modern Paleo, most such diets are "rich" in these fats but not drenched in them, and include both grains and legumes.  But, as you can see, Eenfeldt is a champ at cherry picking just the parts of studies or media reports that fit his agenda.  Such as in this post where he states:

According to a recent study it seems to be good for type 2 diabetics to start the day with eggs and meat for breakfast. A high-carb breakfast produced worse results in many ways.

This was an interesting study, that is only available as an abstract here, and you can view the poster here (this is somewhat readable if you C&P into Word and zoom in, but the graphics are not quality enough to read it all).   This one made the #paleo hashtag on Twitter aimed at Robb, Jimmy & the Whole9 gang recently as well linking to this report claiming:  "Big breakfast rich in protein and fat may be best for diabetes patients".   Sounds very LCHF-ey, no?  Well.  No. 

There are no details on the "balanced hypocaloric diet" consumed, but one can presume this is the standard 15% protein, 35% fat, 50% carb diet, and hypocaloric generally means 1500 cal/day for women, 1800 cal/day for men.  So what did they compare?  Well, shifting calories to the morning, 33% vs. 12.5% so a little more than 2.5X the cals and changing the macro makeup of the breakfast (rough averages of range, P/F/C) BB: 26/32/42, SB: 16/18/66.   For the big breakfast this works out to approximations:

1500 cal/day:   500 cals, 30g protein, 17.5g fat, 50g carb
2000 cal/day:   650 cals, 40g protein, 25g fat, 70g carb

This is not just eggs and meat, or low carb, or a lot of butter to slather on your eggs.   But let's see what they compared it to.  The small breakfast would work out to:

1500 cal/day:   190 cals, 8g protein, 4g fat, 30g carb

2000 cal/day:   250 cals, 10g protein, 5g fat, 40g carb

There is no indication of whether or not they balance out the macros later in the day, but come on!!  The "high carb" breakfast is lower in carb than the big breakfast by almost half.  I mean that's what, a slice of toast with a hard boiled egg and a spoon of jam?  Or add an extra slice of toast and a schmear of butter for the 2000 cal-ers?

I may revisit this study if I can get a better/readable description, but it is hopelessly confounded in that they changed all three macros and calories so the results are of very limited value other than "future studies are needed".  But this is an example of Eenfeldt using studies to push his agenda that don't really qualify when you look past the headline.    Oh ... and I know English is not his first language, but "produced worse results" could imply it was harmful in some way and all results were either insignificant or improved so he should be careful (as well as calling the SB high carb being woefully misleading).

Speaking of headlines, Diet Doc jumped on the publicity stunt bandwagon of Sam "Look Ma Carbs Made Me Grow Taller" Feltham.  Most recently Sam gained more weight gorging on a carby junk diet than he did when he shoveled 3000 cal/day extra in nuts.  Doc weighs in: Is Overeating Carbs Worse Than Overeating on an LCHF Diet?  It's OK to overeat LCHF because you won't have to "pay" for your gluttony.  Or is the correct interpretation that overeating LCHF is not to be derided because your body wastes the excesses and you won't gain as much weight.  Or is there something just pious about advocating LCHF.  Yeah, that's it.

A calorie is not a calorie. This has already been proven in study after study, but Feltham provides us with a nice real world illustration.

Yeah, because all of those metabolic ward studies that demonstrate time and again that a calorie is indeed a calorie are no substitute for free-living studies with questionable accountability, or especially the "real world" example of a skinny dude running fatloss bootcamps where we have only his word that he even did what he claims, and he can't even be bothered to verify what his weight maintaining caloric intake is to begin with.

But what did Sam's Jokesperiment show us?  That you supposedly can't gain when eating more expensive food that does nothing to fuel your body whatever the mechanism?  Think about it.  The Eades MADieters would have you believe that you just "waste" excess fat calories, it's only the dastardly carbs that will fatten you.  The problem with this is that while obesity is generally undesired, the ability to store fat is not.  It is desired for metabolic health, and perhaps more importantly it is desired not only for individual survival during sparse times, but also the survival of the species.  So there's something especially wasteful about promoting a diet whereby adherents would have to eat more to maintain their bodies.  This was claimed by Peter Attia during his ketogenic experiments -- if memory serves he claimed to consume 1000 cal/day more in NuttyK than with his usual diet, and even his generally lower carb diet.  It is claimed again and again.  It is now claimed by Sam.  Oh such wonderful bragging rights!  Well ...

there’s something sick and environmentally unfriendly in eating fats unnecessarily just to poop them out

Oh wait, that wasn't me ... or Andreas ... what he said recently was:

there’s something sick and environmentally unfriendly in eating carbs unnecessarily just to pee them out   {emphasis his}

He said this in a post about a new diabetes drug:  Low-Carb Diet in a Pill – A Good Idea?  I will definitely be blogging about that drug, or more specifically how it fits in with the hyperglycemia in diabetes and treatments, but the post was already appalling before I reached that closing salvo.   The drug he was discussing, Forxiga, apparently works quite well -- in conjunction with metformin -- to control blood sugars in diabetics by lowering the threshold for glucosuria.  Essentially, by inhibiting reuptake of glucose in the kidneys, subjects lose about 250 cal/day or 70g of glucose in their urine which is one of the mechanisms by which untreated type 1's have difficulty maintaining weight.  Over the course of several months there was some weight loss, but more importantly improvements in HbA1c.  Again, I'll discuss this, but physiologically this is NOT LC in a pill, that would be acarbose.   Acarbose is to LC what orlistat is to LF.  

Is Eenfeldt really passing judgment on diabetics that might choose to use acarbose to assist them in maintaining blood sugars while enjoying their life?  (Heck too much would be unpleasant enough "punishment" for their "sick behavior" anyway.  Right? )  But back to Forxiga, this is not like eating LC ... they eat carbs and have the insulin spikes and all that.  They simply urinate out some of the excess glucose their livers manufacture.  

But far be it for diet doc to ever miss an opportunity to pass judgment on diabetics that don't care about their health because they insist on eating carbohydrates.  Said carbs that he thinks are making or keeping them fat and diabetic, and without which all would be right in the world.  This is his worldview.  It appears to be Wheat Belly's too.  And so many other low carbers and advocates.  I don't know which is worse, those like Andreas that have never known and likely will never know a need to alter their diet to be lean, or the many that are themselves overweight or obese or not all that healthy after all.  

I don't get this.  It would make a bit more sense if LC really did lead to miraculous weight loss and maintenance.  It does not.  It would make a bit more sense if LC really did cure diabetes.  It does not.  But that doesn't stop the Diet Doc from repeating ad nauseam that it does and peering down his nose at those who don't comply with his simplistic solutions

I suppose it is too much to ask that someone who should be concerned for his patients overall welfare, might actually care for them as a person or consider all the other myriad factors -- both within and outside their control -- that have culminated in their current obesity and/or disease.   At least not voice their disdain so publicly even if not always overtly.  I don't know ... if for no other reason ... just in case a real life patient happened to stumble across his blog and discover what he really thinks of them.   

It really makes me sick, and I needed to rant about it.