Still More Calories ... And a rant :-)

Probably the most annoying calorie discussion I'd come across recently has to be Stefani Ruper's discussion about this article in Science Magazine, Have We Been Miscounting Calories?, entitled They’re Still Doing It Wrong: Have We Been Miscounting Calories?  Read the article first and then Stefani's take.  I sort of wish I had to know if her take came off as badly in that order, but you can't undo.  

From the article:
In a wide-ranging discussion of how food is digested in everything from humans to rats to pythons, the panel reviewed a new spate of studies showing that foods are processed differently as they move from our gullet to our guts and beyond. They agreed that net caloric counts for many foods are flawed because they don't take into account the energy used to digest food; the bite that oral and gut bacteria take out of various foods; or the properties of different foods themselves that speed up or slow down their journey through the intestines, such as whether they are cooked or resistant to digestion.
The process used to estimate calories for food was developed at the turn of the 19th to 20th century by Wilbur Atwater. It was a simple system of calculating four calories for each gram of protein, nine calories for each gram of fat, and four calories for each gram of carbohydrate (modified later by others to add two calories for a gram of fiber). Although it has been useful for approximating the energetic costs of metabolizing many foods, its shortcomings have been known for decades—and some nations, such as Australia, have dropped the system because it is "inaccurate and impractical,"
This is quite disturbing actually -- because a system is imperfect you just ditch it entirely?  I'm also curious about this writer and these scientists who act like this is groundbreaking new information they've just discovered.  I'll come back to this in a bit.  First, Stefani writes:
In a few small ways we can discern pinpricks of hope in the article, but in most ways it falls egregiously short of what a picture of true health really looks like.
Perhaps it falls short because the article, and the symposium referred to therein, had nothing to do with "true health".   The symposium, entitled Why a Calorie Is Not a Calorie and Why It Matters for Human Diets, was specifically about how total metabolizable energy present in foods may differ significantly with the energy that is "bioavailable" -- e.g. makes it in to the body in a form the body can process.    Stefani continues:
According to the article, calorie scientist specialists at the most recent American Academy of Science symposium convened in a panel to discuss the latest findings in calories and weight loss. Their opinion? That part of the reason weight loss has remained a pipe dream is not the fact that we’ve been emphasizing calories at all, but rather that we’ve been counting calories incorrectly.
Huh?  I didn't read that.  It wasn't a symposium on obesity.  Sure, they mentioned the implications -- in providing more accurate information to people so they can make better choices for themselves.   But they don't say anything about difficulties in avoiding and/or reversing obesity or that this is due to counting calories incorrectly.  Here's the lineup with links and a snippet of each summary.
Richard Wrangham, Harvard University:  Calorie Mismeasurement in Past and Present Human Diets
Food-processing is a human cultural universal whose positive effect for net energy acquisition has been increasingly clearly documented thanks particularly to the use of animal model systems and ileostomy patients. A critical next challenge is the quantification of energy consequences from food processing. This is important for research on human evolution because evolutionary success depends crucially on the ability to acquire energy ...

Klaus Englyst, Englyst Carbohydrates Ltd.:  Bioavailability of Dietary Carbohydrates
Carbohydrates typically represent the largest single contributor to energy, which is derived either directly through the metabolism of the available carbohydrates absorbed in the small intestine, or from the resistant carbohydrates fermented in the colon. Metabolic responses to, and energy derived from, carbohydrates is influenced greatly by the ingredients used and how the product has been processed. This presentation will discuss how in conjunction with in vivo studies dietary carbohydrates have been characterized analytically to reflect their nutritional attributes. ...

Peter J. Turnbaugh, Harvard University: Taking a Metagenomic View of Human Nutrition
The human gut harbors trillions of microorganisms that influence both sides of the energy balance equation, enabling dietary energy harvest and promoting fat deposition. Our recent studies have emphasized the unintended consequences our dietary choices can have on gut microbial ecology, and how studies in human cohorts and animal models can be combined to identify the mechanisms underlying the microbial component of human nutrition.
Stephen M. Secor, University of Alabama: The Metabolic Cost of Food Digestion and Its Determinants
An obligatory physiological response following feeding is an increase in metabolic rate stemming from the activities involved in the ingestion, digestion, absorption, and assimilation of the meal. The accumulated energy expended across these activities is referred to as the cost of digestion, heat increment of feeding, diet-induced thermogenesis, and specific dynamic action. Across a wide diversity of invertebrate and vertebrate species over a broad range of feeding conditions, this mandatory expenditure is equivalent to 5-30% of the meal’s energy. ...
Rachel N. Carmody, Harvard University 

The caloric consequences of a highly processed diet have remained unclear, in part because few studies have evaluated energy gains associated with a processed diet independently of other lifestyle factors, and in part because the metabolizable energy values reported widely in the scientific literature and on nutrition labels suggest that food processing has little caloric effect. However recent controlled experiments in our lab employing animal models show that processing by thermal and/or non-thermal means contributes importantly to energy harvest from plant and animal foods. For instance, controlling for food intake and activity, omnivorous adult mice exhibited increased body mass outcomes when eating cooked and/or pounded sweet potatoes or cooked beef versus when eating these foods in unprocessed form. ...

Geoffrey Livesey, Independent Nutrition Logic Ltd. 

Despite its limitations, use of the Atwater system is so pervasive that amending it to better reflect energy harvest poses a significant challenge. The presenter will review key shortcomings of the Atwater system, discuss the benefits and costs of implementing improvements with respect to scientific efficiency and public acceptance, and present thoughts on how we might consider modifying the Atwater system, balancing the goals of accuracy and practicality.
Aside:  Two of the presenters are evolutionary biologists from Harvard.  I realize it's water under the bridge, but did the AHS even try to reach out to either of these two last year?

The symposium raises fascinating issues about calories and my first thoughts are that perhaps we aren't really eating all that much more than we used to, but we're absorbing more due to cooking methods and processing.  It's hardly a far fetched notion.   It also raises the interesting moral question of how best to feed all humans on this planet -- more efficient calories would clearly be preferred, right?

But except for some recent semi-obsessiveness over gut bacteria (that may free up and contribute roughly 5% of energy in humans) the calorie conversation in the low carb and paleo communities has focused on hormones and mitochondria.  None of the issues raised here have any bearing on that discussion, they only address how much gets into the body.  Once inside the body, the calories are calories and it is known and should be taught in any reputable nutrition program, that the Atwater factors are both estimates and averages (e.g. long chain fats have more energy than medium chain fats, glucose can be "burned" aerobically and anaerobically, etc.).  Still, and somewhat surprisingly in many ways, these have held up well in metabolic ward studies that often involve liquid or uniform "muffin" diets for comparisons.  

One thing that I've mentioned here before is this fixation on thermogenesis.  It has been a while since I read Atwater's original work, but I'm not entirely unsure his factors didn't include thermogenesis.  Even if not, as warm blooded animals part of our basal metabolism is generating heat to maintain a relatively constant body temperature that is commonly elevated compared to our surroundings.  Heat generated in digestion/metabolism is just heat that doesn't need to be generated by oxidizing nutrients for the sole purpose of keeping us warm.  I've seen many studies looking at TEF and despite dramatic differences, many under metabolic ward conditions, no demonstrable differences are seen over a 24 hr period.  

So anyway, given all the pseudoscientific theories we're already having to deal with in the diet/exercise/supplement industry, my personal feeling is that the Atwater system as it is works just fine as an approximation.  If they tweak it to try to estimate the energy that would ultimately be absorbed it would leave waaaaay too much room for nutrition label hanky panky.  And in the end digestibility can highly variable, so we'd be back where we started to averages and estimates anyway.

One would think the Atkins veterans would be particularly "hip" to this!  After all,  none other than the esteemed scientists and doctors Volek, Phinney and Westman dished out dishonest advice to deduct all carbs for sugar alcohols in The New Atkins.

When it comes to low-carb foods, you subtract grams of sugar alcohols (including glycerin), as well as of fiber, from total grams of carbs to get the Net Carb count."
"Many low-carb products are sweetened with such ingredients as glycerin, mannitol, sorbitol, xylitol, erythritol, isomalt, lactitos and maltitol. ... Because sugar alcohols are not fully absorbed by the gut, they provide roughly half the calories that sugar does, although each one varies slightly. The incomplete and slower absorption results in a minimal impact on blood sugar and insulin response. This means that sugar alcohols don't significantly interfere with fat burning, making them acceptable on Atkins. ... Most people find that they can handle 20 to 30 grams a day without undesirable effects."

Now, they do acknowledge that there are some calories to be had ... but they skirt around acknowledging that those calories are effectively carbs.   Incredibly, they perpetuated the Atkins Nutritionals "missing carbs" FRAUD regarding glycerin -- aka glycerol.  AN tried to get glycerin classed as a fiber despite the fact that glycerol is easily absorbed and metabolized.  Then you have outfits like Julian Bakery who take great liberties with their reporting of digestible carbs and even Dreamfields with their nonsense proprietary "protected" carb structure.  Need I remind you who made his living hawking these products to you for years?

So one would do well to leave things as is and simply educate on the importance of eating minimally processed foods where food is abundant, and improve food efficiency to prevent starvation where it is not.  Otherwise, more hucksters are bound to come out of the woodwork.   Stefani clearly views this work differently.  
They don’t see issue with counting calories as it is. No, it’s best not to question the dominant paradigm, right? Instead of investigating what may be wrong in this big picture approach, these scientists are nitpicking whether there are, say, 200 or 220 calories in a slab of steak. Yes, certainly, that makes a difference. Thank you so much, AAAS.
This is clear calorie denial here.   She's also clearly ignorant of the amount of research that has been done on human nutrition in the realm of calories.  How else to explain this passage? (bolding hers)
Today, scientists are finally coming around to the idea that food burned in a lab is probably a little bit different in quality than food making it’s way through the human digestive system.
She's joking here, right?   While there's some new work here, it's not all new and there exist decades of research on exactly this topic!  As mentioned in Wrangham's snippet, a lot of this comes from trying to get nutrition into people with digestive impairments (e.g. ileostomy patients).  A note to the coconut oil fans, it has been used as a source of calories for those with fat malabsorption issues (because a significant proportion of its fatty acids do not need to be transported in chylomicrons).  Scientists coming from this perspective are not interested in "optimizing" inefficiency, so someone can eat 4000 calories without gaining weight.  Any Google Scholar search will net copious hits for Atwater Factors including this 1948 paper on the dynamic action of high carb and high protein diets.  Atwater aside, has Ruper missed the works of scientists like Eric Jequier and others on the fates of various nutrients once they are absorbed by the body.  So you'll have to pardon a little snark here regarding Ruper's smugness.
However: I would argue that fiber is more important because of the way in which it impacts therate of digestion, rather than calorie interference. Fiber can significantly slow the absorption of food, which in turn can prevent blood sugar from spiking. So that’s another angle that isn’t being considered here. At what rate is the food absorbed?
I would argue, who cares?  It is only in fairly massive overfeeding that this will make any difference at all (in terms of small amounts of carbohydrates converted to fat -- a calorie expensive process I might add).  I'm not talking health here, I'm talking what ultimately happens to that blood sugar, which is that once it's in the body it eventually gets burned for energy  (glucosuria in poorly controlled diabetes aside).  I'm reminded that many in the IHC -- especially the LC camp -- consider fiber to be overrated. I think it plays a significant role in satiety, not to mention the oft overlooked role in gut signalling, but can actually pose problems for those with high energy needs.  Stefani goes on to discuss hormones and nutrients (micro presumably), etc. and sums up with:
All of which is to say that the medical establishment en masse still has no respect for the conditions of a body into which the calories are introduced.
Which is an assumption, and nothing more, and not what this symposium was addressing.
How might a difference of 20 calories in a piece of steak actually matter at all when there remain vast disparities in metabolic health between insulin sensitive and insulin resistant individuals? That far and away determines a much larger proportion of a person’s weight status and ability to metabolize food than a difference of 20 calories a day.
Unscientific speculation at best, and I don't want to quote much more, you can go read for yourself.  As with her excitement that the scientists might be going in the right direction, I, too, was hopeful when Stefani says caloric intake matters.   She ends with some more inferences to health and how calorie counting won't make us healthy.   We get more of the same about how proper quality will bring quantity magically inline, which there are far too many examples she herself is friends with that demonstrate this to be more the exception than the rule.  As to calorie counting getting us healthy?  It sure isn't the only way, but in many cases it's all that's needed.  Prof. Haub got healthier eating Twinkies or do we just ignore non-paleo biohacks?  

Ya know, I got in a little Twitter tussle with Robb Wolf the other day over him tweeting a link to yet another quack doctor.  It got me to go back and re-read a few things he has written recently including part deux of his low carb/paleo series.  In summing things up he wrote:
Someday I’ll farm coconuts, but it wont happen until our medical and food production systems have dramatically changed and there are enough people who know about this Evolutionary Medicine schtick that our kids and grand kids will have things better than we have them.
Have things better than we have them?  It's not just Robb here, it's pretty much damned near this entire community that has it's collective head so far up the collective microflora house that comments like this seem praiseworthy and selfless.  Forget that the economics are such that younger generations are the first in basically the history of this nation that will not, as a whole, have it better than we have it.  We have it pretty darned fucking good, and you know I'm pissed because I just used that word.  Modern medicine is not perfect ... far from it ... but I have it to thank for the fact that I still have my mother, and have had her for the 20 years since she was diagnosed with breast cancer in 1993.  Or that we've had my father-in-law for almost as long since his diagnosis with prostate cancer and because his bypass surgery was almost a matter of routine when he had it 20 years ago.  His older brother just passed at 89.  Amongst our four parents they have known true struggle and hunger and starvation and malnourishment at various times in their youths.  People say I nit pick, well for crying out loud there's a paleo blogger out there who considers putting vinegar on your salad a transgression!  (Paleoista).  You and I might not even be here were it not for the Neolithic "evils" of agriculture and, dare I even say it, "industrialized" animal food production.   Sure, there are some people who should not eat grains, but please ... go witness TRUE poverty.  Go witness TRUE starvation.  People wonder why I don't just lose the rest of the weight and all manner of wondering about that and I let it roll off me because for crying out loud, my universe does not revolve around some pursuit of the arbitrary.  

Think about how ridiculous it is to desire to eat food that is inefficiently absorbed and/or inefficiently used for energy.   Or a community that longs for a return to the days before the "invention" of insulin to treat diabetes. There are far more healthy cultures thriving on high carb low fat (and I mean really low fat, like 10-15% fat low fat, not this BS we call low fat) diets than there are high fat low carb, and for the umpteenth time if you're not eating seal meat and brains in the frozen tundra, or whole coconuts in the tropics, as major parts of your diet, cut the crap!  Dining on grassfed prime rib in a heated restaurant or eating spoonfuls of coconut oil at your desk in an air conditioned office is not paleo or primal or whatever.  Nor, dear Stefani, is eating frozen veggies with balsamic vinegar normal.  I'm sorry.  I just tire of the food snobbery in this community while claiming to care about the health and well being of the masses.  I looked for local sources of grassfed beef and I would have to travel 30 miles to get it at the farm ... or I could pay up the wazoo at Whole Foods -- while the great unwashed must settle for being looked down upon for buying there's at Costco.  And best not buy that giant bag of rice or beans to go with because Grok didn't eat that, or gawd forbid they eat wheat because an obese lowcarbevangelist might snap pictures to put in his next post of pictures of how nobody cares about their health but him (as he pees out protein and oxalate crystals).

I swear if aliens came to this planet after humans became extinct and all that survived were the scrolls of paleo they would wonder how the human race lasted as long as it did ... what with all the rampant illness amongst former elite athletes and such.  Without modern medicine who would treat all the CrossFit injuries sustained by 100 lb women climbing rocks for the fun of it (instead of for food) and still searching for more?  The law enforcement officers on the paleo diet are still taking statins and other meds, which is responsible IMO.  Meanwhile Westman is going to coauthor a book on cholesterol with Jimmy Moore.  Is he aware of Jimmy's atrocious numbers?  It boggles ....

So please.  A little perspective sometimes?  


Anonymous said…
'I realize it's water under the bridge, but did the AHS even try to reach out to either of these two last year?'

Refresh my memory - does AHS have 'Ancestral' in it and is 'S' for 'Symposium'?
CarbSane said…
Yes, should have read AHS organizers ;-) These evolutionary biologists are working on modern nutritional dilemmas. Their input would have been most relevant, no?
Unknown said…
Thanks for this and other rants - for example I've come across a few papers which show that taking stains can cause regression of arterial plaque - a good thing IMHO - so I e-mailed Dr Briffa for his thoughts - he e-mailed me back to say that basically he was only interested in studies that show the adverse effects of statins

So - if Westman is co-authoring JM's book then he must have NO PROBLEM with JM's numbers!!

I wonder how many people will follow these fools and their "advice" and wind up with heart disease and then REFUSE statins!!

BTW - will JM interview Dayspring for this book?? Remember that he told JM that if his LDL-P numbers did not come down considerably (to under 1000) he would recommend that JM start using statins.

Unknown said…

“I have not actually read Gary Taubes’s books. I have listened to him on Jimmy Moore’s podcasts, and watched him on Dr Oz, Larry King and Google. He has the sexiest voice and a definite “eye candy” appearance.”
From the #2 top “Paleo”(R)(TM) & Low-carb blogs Jimmy Moore thinks you should check out
Stephan Guyenet said…
I think the AHS did reach out to Wrangham.
Travis Culp said…
The whole thing is such a red herring (with unknown calories since Poseidon won't put nutrition labels on his fish). If you eat this a few times a day: and aren't losing weight, it's not because the sausage patties were mislabeled, it's because you're eating a metric fuckton of calories.
Gabriella Kadar said…
No Evelyn. AHS is mostly an amateur organization. It is not recognized (as far as I could discover) as a source of continuing education for professionals. Basically it's a hobby thing as opposed to a professional educational thing. (which is not to say that all professional education accreditation is quality).
Gabriella Kadar said…
'Prof. Haub got healthier eating Twinkies or do we just ignore non-paleo biohacks?'

Dude lost weight. Doesn't mean he got healthier unless the only parameter for health is weight loss. I'm pretty sure if he ate the twinkies diet for a year he would have had some issues.

Michael said…
Evelyn, appreciate your blog, I've been 'lurking' on it for some time and its good to have a balancing
perspective of LC/Paleo et al - However, I couldn't let this statement pass without comment

"Sure, there are some people who should not eat grains, but please ... go witness TRUE poverty. Go witness TRUE starvation."

I do - regularly - I live in and work across Africa - Diabetes and obesity have become as big a problem in Africa as developed countries, probably worse really with the inadequate healthcare. So from my 'unscientific', but reasonably extensive observation over the last 10 years I have been in Africa, is that the typical 'African' diet has increasingly become based around grains and seed oils - cheap, calorie dense but nutritionally bankrupt.

Lack/abundance of calories is not the primary problem, adequate nutrition is, and the 'best bang for buck' nutrition comes from fat and protein - I've seen the positive health (and, albeit, much less important, body composition) changes when people reduce empty carb based calories for fat and protein...unfortunately good fat and protein is a lot more expensive than grains.

So while I think total caloric intake has some level of importance, I don't believe a calorie is a calorie - at least from a health perspective.

Travis Culp said…
From the CNN article:

"Haub's "bad" cholesterol, or LDL, dropped 20 percent and his "good" cholesterol, or HDL, increased by 20 percent. He reduced the level of triglycerides, which are a form of fat, by 39 percent."

Even cholesterol skeptics would read those results as an improvement in health.
Gabriella Kadar said…
Longterm, there is more to good health via diet than reduction of cholesterol. Methinks.
What was the diet these folks were on before the obesity and diabetes rise, and what changed? Whatever that was before these health degradations, maybe they should return to THAT, rather than an expensive one they can't afford centered around meat and quality fats that a poor African family might not be able to sustain. Even in the US, I have pals who kept asking, "How can we do Paleo affordably." It's not cheap to buy organic, grassfed, pasteured, hormone-free, non-oxidized, fresh, etc. I pay nearly 7 bucks for a dozen organic and pasteured-hen eggs and my organic ghee and coconut oil and quality EVOO are pricey. A poor person can't sustain that grocery bill.

Seems to me there wasn't a whole lot of obesity and diabetes in previous generations among groups not at starvation levels, even in the US when we ate white flour with impunity. What else is going on? I find it hard to believe that groups that weren't inherently fat and protein eaters suddenly have to switch to that to be fit. Seems to me looking at what their previous generations ate without getting fat and diabetic might serve them well. My mom and dad lived chronic disease free up to their 70s. No diabetes. No heart attacks. No high blood pressure for 7 decades eating lots of rice and beans and tubers (Caribbean food) with salads that had olive oil and vinegar and lots of fruit and coffee with sugar and ice cream and milk shakes. I look at old family photos. Hardly any chunky folks. Family pics now: we're huge. They were not folks with money. Poor folks can't buy grassfed beef and free-roaming chickens weekly. Rice and beans and tubers can fill poor stomachs. Should these be discouraged where hunger prevails? Don't think so. Should they be minimized where obesity reigns? Maybe sugar and processed foods should go first, before legitimate food grown and eaten for generations upon generations.

Maybe just seeing how folks ate 50 and 75 years ago, rather than 5000 or 15,000 would be illuminating for our purposes.
CarbSane said…
@Gabriella, I'm well aware of what the Ancestry Foundation is and what it aspires to be. When one looks at the presentations at AHS12, these Harvard scientists from this symposium would have made good contributors ... and given that it was held at Harvard, I was mentioning/wondering aloud whether or not they had been reached out to.

As to Haub, weight and health, I would hope that by now you understand that I don't believe weight and health necessarily go hand in hand. However, there is a goodly percentage of metabolic disorders that are first and foremost an issue of overnutrition (calories). In many cases losing weight by any means trumps eating the most nourishing diet to excess. This does not mean quality is irrelevant, but especially where toxicity is concerned many are fixated on them to the exclusion of evidence of millions of humans consuming certain agents for millenia.
Unknown said…
If your grandparents and great grandparents were healthy all of their adult life just eat like they did - it's probably a lot less stressful than trying to find grass fed/finished beef, pastured free roaming chickens, the purest olive oil, etc. AND it's probably healthier in the long run than the HFLC diets people are on

UNLESS your ancestors came form the South Seas why would ANYONE eat a diet high in coconut oil/milk - they probably used the whole coconut and ate a great deal of fish and breadfruit

Eat like your recent ancestors and it may be much better long term

Also - if you follow your natural instincts you may find that you will eat very healthy
Gabriella Kadar said…
And? Wrangham was smart enough to stay away from a bunch of amateurs. He has his reputation to consider. Not to say that every single presenter is a hobbyist. But when most are, it's a problem for the entire AHS to be taken seriously. I was considering attending at one point but when I took a closer look it wasn't worth the money or the time.
Unknown said…
Jimmy Moore advising people on their blood test results

"Jimmy MooreFeb 28, 2013 - Public
I had an awesome encounter today with a nurse of all people who was drawing my blood for some new tests I am having run. She asked "So what are you doing today?" I replied "I'm having blood tests run to see how my health is doing." After crinkling her nose at me a bit as if to say "well duh" she clarified that she wanted to know if I was going to the gym, going to work or what. I told her I work from home and that I'm currently writing a book.

"What's your book about?" I went on to tell her about CHOLESTEROL CLARITY and how I'm trying to help laypeople understand what their cholesterol test results mean. Her eyes lit up and she told me "I just got my cholesterol test results and they were really bad because my doctor wants to put me on a statin drug." I told her I'd be delighted to take a look at her test results to give her my opinion about her numbers since I've interviewed many of the world's top experts on cholesterol for my book.

When I looked at her numbers, it was just as I suspected: SHE DIDN'T NEED A STATIN DRUG! This young African-American woman has a total cholesterol of just 221, HDL of 39 and triglycerides of 117. I explained why LDL (which was about 135) isn't telling you the whole story and neither is total cholesterol. I said the HDL could go up well above 70 if she ate more natural fats from butter, coconut oil, full-fat meats and cheeses and avoids anything labeled low-fat. As for triglycerides, I noted that while it was in range for the lab, ideally you want this number to be under 100 and optimally well under 70. I told her the best way to do that is to cut down on the sugar, grains and starchy carbohydrates she's likely eating. When I mentioned potato chips, cookies and cakes, she admitted she ate them all. "I know it's hard to give these things up, but do it for 60 days and get retested," I shared with her.

Here's this wonderful nurse who was listening to everything I had to share about this and it was obviously all brand new information to her. I encouraged her to have an NMR Lipoprofile test done to see what the make-up of her LDL particles is like and that eating a high-fat, low-carb diet will help improve every aspect of her cholesterol panel. She seemed genuinely appreciative and this let me know that my book is going to have the potential to improve the lives of so many people. I just had to share this with you today!"
Gabriella Kadar said…
Princess, I have noticed the same. People from Trinidad with lots of siblings have parents who live into their late 80s and early 90s. But they and their sibs are dying in their 50s, 60s, and develop type 2 diabetes, heart disease, the whole nine yards.

I think their parents were the tough ones of their sibships who survived childhood. Death rate in under 5 was very high 80 to 100 years ago in the West Indies. (When I lived there in the 80s babies were not given a name until they survived for 3 weeks.) Death pruned the stock, so to speak. The hardiest survived, bred and with changes in public health, vaccination, pest control (malaria, yellow fever, dengue) and sanitation, lots of sibs survived. Doesn't mean they are a 'quality product'.

Look at what we are doing: Super preemies are being kept alive and they go on to grow into adulthood. But are they 'quality product'? Some body parts are set in utero: heart structure, major blood vessel structure, other organs etc. When an embryo and fetus doesn't get what it needs, then what's going to happen later on in life? Adaptive reserve runs out at average age 35. Less fortunate people have their adaptive reserves running out at much earlier ages. Look at India. The women there must breed in their late teens and early twenties or not breed at all. I'm refering to the poor and malnourished here. There are always exceptions. Even in North America with well nourished populations, after age 35 fertility declines significantly. In places where nutrition from before birth is sketchy, women become infertile before age 30. Hence the tendency for early marriage (which all of us here consider socially retrogressive).

The preemies who have survived through medical interventions born the size of a can of Coke are young still. All these sophisticated medical interventions are quite recent. In the 80s a fetus before 24 weeks was considered to be non viable. These days even a delivered fetus weighing 8 ounces is 'saved'. We probably won't know how they fare into late middle age because by then we'll be gone. But looking at the health issues of people born shortly after the end of World War 2 in Europe it's not all that promising. Life expectancy for this cohort is certainly not what it is in North America.

Regardless of diet after birth or in adulthood, the basic ingredients which formed the fetus are also important. If the mother's diet was deficient and the fetus did not receive optimal nutrition, then what? It's not necessary to go to extremes like atrial septal defects or spina bifida or cleft palate. There are other deficiencies which do not present as fatal until late middle age.

We are bigger than our ancestors. Some of the bigger is good. Some of it isn't. Body proportions and height count for a lot. A tall fat person doesn't have the same risks as a short fat person. The fact that the tall person grew to optimal height and proportions implies that they are better constructed internally as well. Very short people generally die sooner regardless of whether they are skinny or fat. Statuarial studies indicate these things.

Gabriella Kadar said…
I don't disagree with you Evelyn. Just I wonder about people who have 'overnutrition' as you put it but actually have malnutrition and overconsume calories. Yes, if someone's diet is providing all the nutrients and just has calorie excess, then whatever, starve for a while. But the Twinkie diet has it's limitations time wise. Eventually and not too soon, it will result in some form of malnutrition.

I think scientists and researchers from Harvard did not participate because AHS is a fringe group with no cohesive message. No one wants to be affiliated with that sort of organization. Scientists are a very conservative bunch who don't want to have some bizarro black mark associated with them.

Granted, all scientific communities have their little wars and major disagreements. But AHS is not an accredited organization. So why take the risk of participating in the forum if it could have adverse effects on a person's future in academia?
Thomas said…
Love the rant!
Susanne said…
I went to read the Stefani article, which honestly I found rather incoherent (I would probably give it a "D+/C-: appears to contain some evidence [check source] but no comprehensible argument: REWRITE"). Then I clicked on and read her article on the 1000-calorie muffin and became even more confused about what her point is. In the muffin article she beefs about how it appears to be paleo because it contains sweet potatoes and dates, but Shock-Horror, dates have 64 calories each. I too was puzzled by that enough to go and check the nutrition information: this appears to be the figure for a Medjool date (pitted), weighing a whopping 24 grams, almost an ounce --

I have never had a Medjool date, but for comparison I went to the kitchen and weighed a couple of my local dates, which come out to 4-5 grams each (with pit). The Medjool has 66 calories and 18 grams of carbs, 16 of which are carbs, 2 of which are fiber, which she seems to think is good, as you note in your quotation above. It's not clear how she's counting the fiber calories in the date because she says 64 of the 66 calories are sugar, but 16g/18gr = 88% sugars by weight, 12% fiber which is rather good for a food that weight. There's also a puzzle in that 6 grams somehow disappear from the NutritionData readout, not appearing as fat or anything else.

All of the above, for me, is background to this: any serious calorie counter would class dates with other dried fruit and nuts, which require portion control or weighing because of their calorie density. Only someone who said "Doh, it's OK because it's natural/wholesome/Paleo and I can eat however much I want" would be surprised that high consumption could add a lot of sugar to the diet, and potential weight gain, if that is an issue for an individual person. So the score still appears to be calorie counters: 1, Paleoista: whaa?

My concern is that these sort of "calories are SOOOO confusing" articles are only more discouraging and off-putting to the average person wanting to lose weight. There are hundreds of historical studies out there that show that in a controlled environment, a person who is maintaining on a 2000-calorie diet will lose on a 1500 calorie diet, calculated according to standard CW accounting, whether it's canned shakes, vegan Pritikin or low-carb: if NuSi ever gets around to doing their closed-lab testing for their version of "Paleo", what will they use to track the calories? Some people lose slightly faster, some more slowly: but most people who are successful in real life know that you have to be prepared not just for small unknowns in recording calorie intake, but also things like daily variations in water weight, etc. That's why you frequently see advice not to weigh daily, but weekly, and watch for trends rather than variation at one weigh-in.
Sanjeev said…
"standard" paleo retort: the plants and animals have been bred to high-yield, long-storage, high-reward (texture, juiciness, chewiness, crunchiness, sourness/sweetness mix and so on) varieties.

Also the soil has been depleted and the coexisting bacteria(symbiotes/parasites) has been changed by the chemical/antibacterial/(genetic modification)/breeding/(animal husbandry) measures.
CarbSane said…
Gabriella, I think you misinterpreted my query regarding AHS and Wrangham. I am aware that the AF folks do have aspirations beyond being a "hobbyist" group, though not sure they are going far enough quickly enough to make it through what I see as a brief window of opportunity to evolve, as it were. There's no such thing as an accreditation body for such organizations, they are self created and gain prestige and credibility through affiliation -- it's just that most have been around since before you or I were born so they are considered "accredited". These symposiums are generally to share new research and are topic centered -- a problem AHS has as many of the talks do not seem to have anything whatsoever "ancestral" in the material. I don't think AHS wants to be purely academic, but AF is supposedly launching a journal at some point. Publishing a journal is also an area in which there are no real rules, hence getting a paper published some journals carries much more weight than others.

As to the Twinkie diet, I'm not promoting or endorsing it, but he saw health benefits of the same sort that are hailed for various diets in studies of similar length. It is no more appropriate to speculate that his health would have declined any more than other diets, and when it seems the longer many follow regimes promoted in this community the more they seem to develop further issues requiring supplements and whatnot. Haub got healthier on his diet or are you disputing that?
Unknown said…

"A team of researchers walked every street in 228 census tracts around Los Angeles and New Orleans and recorded every outdoor ad they saw. Another group surveyed 2,881 residents of the same census tracts by telephone, paying them to report their height, weight and other information.

After analyzing this hard-won data, the authors conclude: “For every 10 percent increase in food advertisements, the odds of being obese increased by 5 percent.” That is, areas with more outdoor food ads have a higher proportion of obese people than ones with fewer ads.

Referring to their advertising-obesity link, the authors later write, “If the above associations are confirmed by additional research, policy approaches may be important to reduce the amount of food advertising in urban areas.” They discuss bans, warning labels and a tax on obesigenic — that is, obesity-generating — advertising."

Outdoor advertising, obesity, and soda consumption: a cross-sectional study

"If the above associations are confirmed by additional research, policy approaches may be important to reduce the amount of food advertising in urban areas. Bans on certain kinds of alcohol ads have reduced consumption in many countries [41]. Although efforts to control the placement of a particular type of outdoor advertising are likely to be deemed unconstitutional in the United States, requiring warnings on those advertisements are likely to be constitutionally acceptable [42]. Innovative strategies, such as warning labels, counter-advertising, or a tax on obesigenic advertising should be tested as possible public health interventions for reducing the prevalence of obesity."
Unknown said…
"For many years, the focus in preventing and treating heart disease has been lowering cholesterol and saturated fat; however heart disease is still the number one killer of both men and women in the U.S. The new thinking is going back to eating a traditional diet focused on nutrient dense whole foods for a heart healthy diet.

Eating foods high in saturated fat and cholesterol are not what causes heart disease. Instead, the culprits that lead to heart disease are a diet that’s high in polyunsaturated fats and processed foods and low in fruits and vegetables coupled with a lifestyle that promotes oxidative stress. Here are some of the guidelines to eating heart healthy diet"
Diana said…
Hi Mike,

I think that the people you have observed who suffer from "diabesity" aren't starving, by definition they must be exposed to a calorie rich but nutritionally bankrupt environment. Perhaps we need a new word or acronym for this environment - as "diabesity" is a new word.

Empty Calories But No Nutrition = ECBNN.

Evelyn, as if you need another acronym, I nominate the above.
Diana said…

I think very tall people also die sooner than those who fall into the normal statistical range.

I've noticed in my own family with respect to longevity. My parents, aunts and uncles were first generation Americans who mostly lived to old old age - well past 90, and one to 104. Their parents died earlier (men in their 60s due to stress, the women in their 80s - looking awful but pressing on in that old world way).

Their kids, my cousins and me - different story. The story isn't over yet, obviously, but we have already had two deaths, one cousin at 72, and one at 64. The latter died of a form of cancer that went untreated because like Steve Jobs he tried a quack diet cure, but even if he had been treated properly how long would he have lived? To 70 maybe? His parents died at 90 something.

My point is, lifestyle matters a LOT, but all this health obsessiveness is either useless or counterproductive. What did that first immigrant generation do? They quit smoking, ate moderately (no health foods, but no overeating), kept a normal weight, moved around a bit but didn't exercise furiously. (God, no.)

My ultimate conclusion is, get out of the way of your genes. Don't damage them with crazy behavior but don't pester them with obsessiveness either. I don't think Nikoley and his crowd will live nearly as long or as well as my aunts and uncles, none of whom ever lifted weights or drank kombucha.
Diana said…
@PD - "Maybe just seeing how folks ate 50 and 75 years ago, rather than 5000 or 15,000 would be illuminating for our purposes."

I can tell you how they ate because (a) I remember 50 years ago and (b) my parents were young folks 75 years ago, in 1937.

Giving my father as an example, he ate....not much! When he was drafted into the US Army in 1942, he weighed 125 pounds (he was 5'9"), and this was AFTER he'd gained 8 pounds as a result of working in restaurants during the Depression. Before that he was a lightweight boxer - 118 pounds.

His favorite foods and staple diet were steak and potatoes. I saw him eat an apple once. His customary breakfast was two soft-boiled eggs and a slice of white toast.

In other words, he ate SAD but in smaller amounts and no junk, because no junk was available and he didn't have much of a sweet tooth.

In other parts of the country during the Depression people ate corn bread, white bread, lard, and whatever meat scraps they could scrounge.

In other words, the US during the Depression was like a gigantic Cuba. Look up any database of Depression era photographs and you'll see lean people, but not starving. The human body can get along on very little, although even I would agree with Eade$ - this is not "optimal."
Diana said…

I see my father and his sibs as people who were extremely "well constructed internally" but quite lean. Despite the fact that my father abused his health horrifically with chain-smoking, he lived to 76 and was an active manual laborer until age 67. I believe that if I had known about all this and I had caught him when he retired (which was when he quite smoking), I'd have added a few years to his life by encouraging him to exercise moderately with walking. What happened was that he retired, sat down - and it killed him.

Whatever, the point is that despite his smoking and high stress life, he did reach his three score and then some. Why? Because he was conceived and born in a rural area 100 years ago, his mother ate nourishing food during her pregnancy and he was born without undue stress. He was adequately nourished during young manhood and what food he got was nourishing.

All that has been totally destroyed by modernity. People have choices now - and they make bad choices. What are we going to do about that? That's the dilemma. Nanny Bloomberg is trying to fill the vacuum with government.

Did you know that the lowest infant mortality rates in the US are among immigrant Hispanic women?
CarbSane said…
My concern is that these sort of "calories are SOOOO confusing" articles are only more discouraging and off-putting to the average person wanting to lose weight.

Exactly Susanne! It's hard to believe it's been two years since Gary Taubes launched his campaign to save TWICHOO -- it's the carbs not the calories. He said, point blank, on more than one occasion that it was not the calories it was the carbs. Coupling this with the silly 20 cal/day can't be done so calorie counting is impossible crowd and we get waves of this from time to time.

I don't care if it's not some fraction of what the gods of paleo reach, it's things like the thank you email I got the other day from someone who had reached her goal and gave me a shout out for the blog helping them find their way. Folks can mock CICO approaches all they want, but they work for many people -- including many of those successful on paleo and low carb.

In terms of practical application, it takes little cost or effort these days to measure and log one's food for a period and figure out where they stand. Then figure out an approach to altering that balance. For all the more elaborate "hacks" out there, I know it doesn't seem very sexy or cool or whatever, but you don't need to prick your fingers incessantly!
Unknown said…
Unknown said…
The idea of energy excess (calories) and malnutrition (actual deficiencies on grounds of nutrient status) don't have to be mutually exclusive. In many cases that I have seen, they aren't either. I've had it as a child and it was rectified with supplements and a few dietary tweaks without any change to the energy or weight side of the equation.
Unknown said…
Well, there's also the 'live like your ancestors' side of the argument. Do one have ample reason to copy the dietary approach of their grandparents if one doesn't live in the same environment and deal with the same challenges?
Giuseppe said…
Reminds me of that post last summer by the AHS volunteer that later deleted her blog after being harassed by the usual suspects. She wrote, among other things:

"Several attendees are incensed that no one from the Harvard School of Public Health attended. Well, why in hell would they? They weren’t invited, they previously attended Taubes’ tirade, were treated in a contemptuous fashion, and then were not included in this venue in any fashion. Why would they pay to attend a circus?"
CarbSane said…
Mike, there is certainly an additional factor here where you don't have true caloric starvation but malnutrition. Indeed that famous Minnesota Experiment that is referred to many times is a dose of both. When I refer to true starvation I am talking lack of food, pit of the stomach pain hunger. My FIL experienced this, my Mom less so dealing with rations in war time in a war zone.

I think the malnourished obese in Western countries is largely overblown. Two common deficiencies associated with diabetes/obesity -- D & Mg -- may well be (and I think the evidence points strongly to) the result of excess adiposity/adipose dysfunction, not the cause.

In terms of malnutrition, protein has mostly been the major thing. You need amino acids to make all manner of things and if you are not consuming them they come from "expendable" sources. This is where the poor in this country are not malnourished.

Speaking of which, if animal proteins are not available in Africa, resources would be better spent providing veggie sources.
CarbSane said…
Mir, all I can say is YES!!! Exactly!
CarbSane said…
Kade, I would say that this approach is far more likely to be beneficial than trying to eat like some nebulous paleolithic ancestor or even modern day hunter-gatherers or the Inuit. Whether the epigenetic trends we see in mice and such would translate to larger/longer-lifespan beings such as ourselves remains to be seen, but it is clear that adaptations have occurred and persisted. Lactose tolerance comes to mind.
CarbSane said…
I saw that on his discussion board. Improve EVERY aspect? If Jimmy were randomized to the keto diet in a clinical trial, he would be terminated from the treatment for ethical reasons because he can protest as much as he wants, his LDL is horrible. That he is now close to the weight he was when he had near normal lipids but still presenting with horrific values does not look good.

I'm amazed someone of Westman's credentials would associate with the JM fluckshow.
Gabriella Kadar said…
No Diana, I had no idea that infant mortality rates are lowest among Hispanic women. Why do you think that is?

On ancestral heath: My maternal grandmother was a 'roll your own' cigarette smoker forever. She was a chronic espresso drinker and her favourite meal was soft boiled eggs. She just didn't do much in the way of cooking, exercise or anything else being recommended by life extension experts. She was never overweight (probably the smoking and the espresso). She lived to 78 and did not die of cancer. That's in Hungary. She did have emphysema though. I think she died of pneumonia which isn't a surprise for someone with emphysema. It was difficult to access antibiotics at the time so at her age even without emphysema, pneumonia may be a killer. Her life was all about her flower garden, painting, playing cards and village gossip. Seems to have worked well for her.
Gabriella Kadar said…
Diana, what is the reason for lowest infant mortality among immigrant Hispanic women?

I'm not sure that comparing the Cubans to depression era Americans is totally valid. Cubans literally live on sugar when there's nothing else. What no one talks about is the rate of birth defects as a consequence. Good thing they have a surplus of doctors for experimentation on newborns.

I was thinking now that Hugo Chavez died of cancer or probably the chemotherapy he got in Cuba, it's pretty sad that in all of Venezuela he couldn't find appropriate care. So much for all the 'improvements' he instituted. Probably the homegrown doctors would have surreptitiously killed him seeing as how their lifestyles were severely truncated by the socialist policies. Which is not to say that the lives of the poor were not improved by his policies, which they were.
Gabriella Kadar said…
Evelyn, if the guy on the twinkie diet (which actually wasn't exclusively twinkies unlike the guy on the potato diet which included nothing more than salt and oil) had some positive changes in his blood test results and lost weight, then a person could consider that he got 'healthier'. But the thing is what effect did this diet have on his pancreatic and biliary function? Short term maybe it's not a problem. And as you say, most of the diets are not studied longterm.

Based on the topics and very short presentations (like TED lecture length) there were many mini lectures at last year's AHS which had some incredulity for me. The first AHS meeting seemed to be of better quality and I wished I could have attended but could not. The second AHS wasn't tempting at all. Let's hope this year's sets some sort of higher standard.
I do think eating Paleo and Primal with common sense attached (ie, don't pig out, don't douse everything in double fat) is a good way to eat--lots of fresh produce, good protein amounts to satisfy hunger and build muscle, etc. However, I see more and more Paleo/Primal folks coming up with all these recipes that are highly caloric for pseudo-foods--the Paleo muffin, cake, pie, casserole. When I first heard about these eating methods-- maybe mid-2010--the emphasis was on NOT processing or overheating foods, eating them as naturally as possible. Well, eating produce and protein as naturally as possible isn't all that caloric (again, unless fat is being poured over everything in 1/4 cupfuls at a time.) A big butt balad or 5 servings of greens and colorful veggies with some berries is not very caloric.

But take almond meal or coconut flour and add coconut oil or ghee and bake up pseudo-grain-treats and you can eat a lot of calories. I just saw Paleo "Girl Scout Cookies" recipes going around on FB. Isn't this what they were trying to GET AWAY from? The processed and hyperpalatable ? Eating simply and ancestrally? I dont' think Great to the Nth Power Grandma was making up coconut oil drenched almond flour cookies with melted chocolate on top.

So, really, for folks trying to control the obesity problem in their life, how does that help, exactly? Calorie Paleo bombs?

I do think that eating Primal/Paleo with, as I said, common sense is a great and healthful way to eat. You'll get all sorts of colors, nutrients, protein, and some stable fats. Anyway you cut it, that's better than a fast food diet or a call for deliver fried rice and pizza diet full of who knows what chemicals and additives and crap.

Of course, silly me, calories don't count, right? Portion control is idiotic. So, scarf up that almond meal and coconut flour and oil....and 86% dark chocolate on top.

CarbSane said…
I agree it is incorrect to call it a Twinkie diet, but junk was the main component of his diet. I'm no fan of junk food, but you can't write off his improved labs and then when someone's get worse on a "better" diet say that it is OK.

As to AHS, we'll see. I'll do my best to add to the quality ;-)
Diana said…
"No Diana, I had no idea that infant mortality rates are lowest among Hispanic women. Why do you think that is? "

I was wrong - Asians have the lowest IMR. But Hispanics are lower than whites. Here are my answers.

Asians: no brainer.

Hispanics: two pronged answer. One, good habits.

I don't want to get into too controversial areas here, I just don't need the agita, but among poor whites and blacks, bad habits during pregnancy are all too common.

But I have a further answer: my guess is stress levels are lower amongst Hispanic women. A Mexican-American friend and he was intrigued, too. He told me that when "mami" is pregnant, she is worshiped, adored, and spoiled. This makes up for a lot.

I think maybe all of this
CarbSane said…
I credit Mark Sisson for reintroducing fruit into my diet which is something that was very dicey in the LC community when I found it. The basis is very good, I agree. But more and more it seems to be a diet of what not to eat rather than what to eat -- and as you say, as long as the ingredients are "paleo" approved (there is even a blogger who puts seals on stuff! -- really!!) it was OK. Even Paul J is quite carbophobic in the end, which makes the controversy over 100 g starch all the more ridiculous!

Paleo Hacks is littered with folks who gain weight when they go paleo b/c they start right out with the various paleo concoctions or think that just because it's paleo it doesn't count and their homeostasis will magically return.
Gabriella Kadar said…
Evelyn, I guess you've been listening to all the media stuff regarding the book Salt, Sugar and Fat. I was reading the Amazon reviews and watched an interview with Michael Moss plus a woman writer from Texas who has also been studying processed foods.

Okay, so Americans are supposedly eating 33 pounds of cheese annually. That's actually not a huge amount of cheese if let's say a person eats 8 ounces of Brie or Feta per week. I guess context is more important.

The woman whose name escapes me stated that Vitamin D is obtained from 'sheep grease'. I found this to be deliberately inflammatory. Why not just say 'lanolin'? Then it wouldn't be a potential for grossing people out. I haven't checked up on this yet though as to if all sources of Vitamin D on the market are from lanolin. She did mention that products made from 'sheep grease' are used as moisturizer and lip balm... but really? Far as I know, lanolin isn't being used extensively due to allergenicity. These days a small bottle of liquid lanolin is quite expensive.

Books like this are informing the informed. The people whose lives are most adversely affected due to the consumption of junkfood are probably the least likely to read a 400 page book. So really, it would be up to the government to do something about the situation which in the USA isn't going to happen.
CarbSane said…
Ummm.... no! WRT vitD I'm thinking of a study I read cited by Obesity Panacea blog (not sure). Have heard of that book but no plans to read it.
Unknown said…
Perhaps it can work out, but it's no sure-shot formula. I know plenty of people with 'thriving' grandparents who ate things that those individuals probably could do without. Just as people adapt, gene expression can also change down the road. . . and not always for the better. Really, I think lifestyle can also be a major player, which I don't think anyone here disputes.

Even I, sometimes, find modern populations in generally better health to be more fitting templates than hunter-gatherer populations because of that lifestyle confounder.
Gabriella Kadar said…
Evelyn, I checked up on this lanolin vitamin D business. Yes, it can be made from lanolin. But there's also the fish liver oils which contain it. I take the Carlson Vitamin D3 in Norweigian Cod liver oil although I doubt that any fish liver oil would contain 4000 IU D3 in the volume contained in a gel cap. Don't care if it's fish oil or lanolin: it works.
CarbSane said…
I'm pretty sure I personally managed to OD on VitD. I wouldn't care if mine was made from sheep or fish or horses. ;)
Diana said…
"Jimmy Moore advising people on their blood test results"

Jimmy advising anyone on health issues is really a joke. Via email, he advised me to throw away my scale. I did and promptly gained more weight. When I got real about my weight issues, I bought a scale. Weight isn't everything but it is one objective measurement. I notice that Jimmy weighs himself obsessively, so maybe he's changed his mind.

I do think that he said something sensible about his church group feeding the guys nothing but sugary junk. Eating sugar as a staple, rather than as a once in a while treat, is very bad. Of course, to Jimmy, it's the carbs. Sigh.
Diana said…
"Also - if you follow your natural instincts you may find that you will eat very healthy"

I dunno. By the time you are an adult, your natural instincts have been so tampered with, with respect to food, that it's really difficult to tell what's ingrained and what is instinctual.
Gabriella Kadar said…
Evelyn, the OD levels at which it could be toxic are something like 1000ng/ml. Getting there would be pretty difficult.

I had mine tested in January: 93 ng/ml serum calcium normal.

In Germany Turkish women were given 55,000 IU or more for backpain. It worked. Now I'm not going to that extreme. Maybe that's why my back still doesn't like me.
Anonymous said…
I'm in Australia and as far as I'm aware we have not stopped using the conventional method for determining caloric values of foods.
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