A “New” Theory of Obesity From Kevin Hall

paleo diet, paleolithic diet, caveman diet

Not Kevin Hall

At Scientific American:

Nutrition researcher Kevin Hall strives to project a Zen-like state of equanimity. In his often contentious field, he says he is more bemused than frustrated by the tendency of other scientists to “cling to pet theories despite overwhelming evidence that they are mistaken.” Some of these experts, he tells me with a sly smile, “have a fascinating ability to rationalize away studies that don’t support their views.”

Among those views is the idea that particular nutrients such as fats, carbs or sugars are to blame for our alarming obesity pandemic. (Globally the prevalence of obesity nearly tripled between 1975 and 2016, according to the World Health Organization. The rise accompanies related health threats that include heart disease and diabetes.) But Hall, who works at the National Institute of Diabetes and Digestive and Kidney Diseases, where he runs the Integrative Physiology section, has run experiments that point fingers at a different culprit. His studies suggest that a dramatic shift in how we make the food we eat—pulling ingredients apart and then reconstituting them into things like frosted snack cakes and ready-to-eat meals from the supermarket freezer—bears the brunt of the blame. This “ultraprocessed” food, he and a growing number of other scientists think, disrupts gut-brain signals that normally tell us that we have had enough, and this failed signaling leads to overeating.

*  *  *

At the end of the 19th century, most Americans lived in rural areas, and nearly half made their living on farms, where fresh or only lightly processed food was the norm. Today most Americans live in cities and buy rather than grow their food, increasingly in ready-to-eat form. An estimated 58 percent of the calories we consume and nearly 90 percent of all added sugars come from industrial food formulations made up mostly or entirely of ingredients—whether nutrients, fiber or chemical additives—that are not found in a similar form and combination in nature. These are the ultraprocessed foods, and they range from junk food such as chips, sugary breakfast cereals, candy, soda and mass-manufactured pastries to what might seem like benign or even healthful products such as commercial breads, processed meats, flavored yogurts and energy bars.

Wasn’t David Kessler, M.D., saying the same things ten years ago?

Here’s another new theory from me: If you had to kill and butcher your own animals, you’d eat less.

Steve Parker, M.D.

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Our Skulls Have Been Changing for the Last 20,000 Years, Not Necessarily for the Better

Wide-set teeth and prominent jaw

Did you know that human brains have been shrinking over the last 10,000 to 20,000 years?

Other parts of our heads have also been changing. An article at OneZero has some of the details, with a focus on breathing problems that interfere with sleep in children:

Skeletal records show that for hundreds of thousands of years, people had beautiful skulls: straight teeth, wide jaws, forward faces, large airways. Robert Corruccini, an emeritus anthropology professor at Southern Illinois University, found perfectly straight teeth and wide jaws in children’s skulls from pre-Roman times among Etruscan remains in southern Italy.

Then, about 250 years ago, our faces began to change. Boyd argues that industrialization interrupted the ancestral patterns of weaning and feeding, with babies nursing on demand for years while also trying solid foods under adults’ watchful eyes. Boyd says that the widespread adoption of bottle feeding, pacifiers and soft processed food deprived toddlers of practice chewing and distorted the shapes of their mouths. (“In modern society you have Gerber’s baby food,” Corruccini told me. “Etruscan kids had to chew once they were getting off breast milk. Babies have remarkably powerful chewing capabilities.”) Just like diabetes and heart disease, malocclusion — the misalignment of jaws and teeth — followed industrialization around the globe. Meanwhile, people in societies that never industrialized enjoyed well-aligned teeth and jaws.

*  *  *

There is no easy way to turn back the evolution of our skulls. It’s unrealistic to advise parents to eschew processed food, breastfeed longer, move to open-air cabins in the country, or perhaps put children on the Paleo diet to prevent these changes taking hold in the skulls of the next generation. We are stuck with our smaller modern faces, but there are steps we can take to address the conditions that come with them.

Source: Our Skulls Are Out-Evolving Us – OneZero

Steve Parker, M.D.

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Tighter Blood Pressure Control Benefits Folks With Diabetes

Not bad

For decades, physicians thought a blood pressure of under 140/90 was adequate for preventing heart attacks, strokes, and premature death. Not so.

From Diabetes Self-Management:

The new study evaluated roughly 11,000 people with type 2 diabetes in 20 countries over four years, finding that those who received the blood pressure drugs perindopril and indapamide to keep their blood pressure levels at or below 130/80 had fewer heart attacks, strokes and other complications than those receiving placebo (inactive treatment). They also had a “lower overall risk of dying from any cause.”

Source: Tight Blood Pressure Control Benefits Type 2 Diabetes: Study – Diabetes Self-Management

You may think the aforementioned health benefits stem from use of perindopril and/or indapamide. It’s either that, or simply the result of BP lowering. I suspect it’s the latter while admitting that not all BP drugs are created equal. As a hospitalist in Scottsdale, AZ, I rarely run across patients taking perindopril, and only occasionally folks on indapamide. The popularity of various drugs often depends on which part of the country you’re in and the attractiveness of the drug reps visiting the prescribers. We need to be more scientific than that.

Steve Parker, M.D.

PS: Losing excess weight and exercise are two ways to lower blood pressure without the expense and side effects of drugs.

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Fitness Markers Deteriorate After Just Two Weeks of Sedentary Behavior

Starting a hundred-yard dash

From UPI:

A new study proves that the old adage “use it or lose it” is definitely true when it comes to fitness.After just two weeks of sedentary behavior, formerly fit people had:

—A decline in heart and lung health

—Increased waist circumference

—Greater body fat and liver fat

—Higher levels of insulin resistance

Source: Study: Two weeks of no exercise enough to damage fit people’s bodies – UPI.com

It’s a small study, just 28 subjects, so may not be reproducible.

Steve Parker, M.D.

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Does Calcium Consumption Help Prevent Brittle Bones in Older Women?

Waste of money and effort?

Due to a lack of milk products, paleo diets may not meet the Recommended Daily Intake of calcium. Your blood must have a certain amount of calcium, and if that level is too low, your bones donate calcium to the bloodstream.

Many physicians worry that inadequate calcium consumption causes or contributes to thin, brittle, easily breakable bones in postmenopausal women. A recent study suggests that calcium intake doesn’t matter.

Abstract

CONTEXT:

Calcium intakes are commonly lower than the recommended levels, and increasing calcium intake is often recommended for bone health.

OBJECTIVE:To determine the relationship between dietary calcium intake and rate of bone loss in older postmenopausal women.

PARTICIPANTS:

Analysis of observational data collected from a randomized controlled trial. Participants were osteopenic (hip T-scores between -1.0 and -2.5) women, aged >65 years, not receiving therapy for osteoporosis nor taking calcium supplements. Women from the total cohort (n = 1994) contributed data to the analysis of calcium intake and bone mineral density (BMD) at baseline, and women from the placebo group (n = 698) contributed data to the analysis of calcium intake and change in BMD. BMD and bone mineral content (BMC) of the spine, total hip, femoral neck, and total body were measured three times over 6 years.

RESULTS:

Mean calcium intake was 886 mg/day. Baseline BMDs were not related to quintile of calcium intake at any site, before or after adjustment for baseline age, height, weight, physical activity, alcohol intake, smoking status, and past hormone replacement use. There was no relationship between bone loss and quintile of calcium intake at any site, with or without adjustment for covariables. Total body bone balance (i.e., change in BMC) was unrelated to an individuals’ calcium intake (P = 0.99).

CONCLUSIONS:

Postmenopausal bone loss is unrelated to dietary calcium intake. This suggests that strategies to increase calcium intake are unlikely to impact the prevalence of and morbidity from postmenopausal osteoporosis.

Source: Dietary Calcium Intake and Bone Loss Over 6 Years in Osteopenic Postmenopausal Women. – PubMed – NCBI

Steve Parker, M.D.

PS: Elderly men get osteoporosis, too. But when the Emergency Department calls me to admit an older patient with a hip fracture, it’s a woman 9 out of 10 times.

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Diet Changes Help With Diabetic Gastroparesis

bariatric surgery, Steve Parker MD

The only picture of stomach I have

When you eat a meal, your stomach holds it there for a while then gradually releases contents into the duodenum, the first part of the small intestine. The stomach makes those releases by contraction of muscles in the wall of the stomach. Those muscles are under control of the autonomic nervous system. In some folks with diabetes, the nerves controlling the stomach muscles don’t work very well, so stomach contractions are weak. Food just sits in the stomach for too long, delaying digestion and absorption of nutrients. One result is unpredictable blood sugar levels after meals, no matter how carefully you count carb grams. The medical term for these weak stomach contractions is gastroparesis.

From Diabetes Care:

“How is diabetic gastroparesis best managed?

Consultation by an RDN [registered dietitian, I reckon] knowledgeable in the management of gastroparesis is helpful in setting and maintaining treatment goals. Treatment goals include managing and reducing symptoms; correcting fluid, electrolyte, and nutritional deficiencies and glycemic imbalances; and addressing the precipitating cause(s) with appropriate drug therapy. Correcting hyperglycemia is one strategy for the management of gastroparesis, as acute hyperglycemia delays gastric emptying. Modification of food and beverage intake is the primary management strategy, especially among individuals with mild symptoms.

People with gastroparesis may find it helpful to eat small, frequent meals. Replacing solid food with a greater proportion of liquid calories to meet individualized nutrition requirements may be helpful because consuming solid food in large volumes is associated with longer gastric emptying times. Large meals can also decrease the lower esophageal sphincter pressure, which may cause gastric reflux [heartburn], providing further aggravation.

Results from a randomized controlled trial demonstrated eating plans that emphasize small-particle-size (<2 mm) foods may reduce severity of gastrointestinal symptoms. Small-particle-size food is defined as “food easy to mash with a fork into small particle size.” High-fiber foods, such as whole intact grains and foods with seeds, husks, stringy fibers, and membranes, should be excluded from the eating plan. Many of the foods typically recommended for people with diabetes, such as leafy green salads, raw vegetables, beans, and fresh fruits, and other food like fatty or tough meat, can be some of the most difficult foods for the gastroparetic stomach to grind and empty. Notably, the majority of nutrition therapy interventions for gastroparesis are based on the knowledge of the pathophysiology and clinical judgment rather than empirical research.”

Source: Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report | Diabetes Care

Steve Parker, M.D.

PS: In my current practice setting, I see more gastroparesis caused by chronic opioid use than by diabetes.

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Were Early Homo Carnivorous?: The feeding behavior of early Homo at Olduvai Gorge, Tanzania

From the Journal of Human Evolution:

Abstract

The regular consumption of large mammal carcasses, as evidenced by butchery marks on fossils recovered from Early Stone Age archaeological sites, roughly coincides with the appearance of Homo habilis. However, the significance of this niche expansion cannot be appreciated without an understanding of hominin feeding behavior and their ecological interactions with mammalian carnivores. The Olduvai Geochronology and Archaeology Project (OGAP) has recovered a large and well-preserved fossil assemblage from the HWK EE site, which was deposited just prior to the first appearance of Acheulean technology at Olduvai Gorge and likely represents one of the last H. habilis sites at Olduvai. This taphonomic analysis of the larger mammal fossil assemblage excavated from HWK EE shows evidence of multiple occupations over a long period of time, suggesting the site offered resources that were attractive to hominins. There was a water source indicated by the presence of fish, crocodiles, and hippos, and there was possible tree cover in an otherwise open habitat. The site preserves several stratigraphic intervals with large fossil and artifact assemblages within two of these intervals. Feeding traces on bone surfaces suggest hominins at the site obtained substantial amounts of flesh and marrow, particularly from smaller size group 1-2 carcasses, and exploited a wide range of taxa, including megafauna. A strong carnivore signal suggests hominins scavenged much of their animal foods during the two main stratigraphic intervals. In the later interval, lower carnivore tooth mark and hammerstone percussion mark frequencies, in addition to high epiphyseal to shaft fragment ratios, suggest hominins and carnivores did not fully exploit bone marrow and grease, which may have been acquired from nutritionally-stressed animals that died during a dry period at Olduvai. The diversity of fauna that preserve evidence of butchery suggests that the HWK EE hominins were opportunistic in their acquisition of carcass foods.

Source: The carnivorous feeding behavior of early Homo at HWK EE, Bed II, Olduvai Gorge, Tanzania. – PubMed – NCBI

Steve Parker, M.D.

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Is Protein Restriction Necessary If You Have Diabetic Kidney Disease?

Steak is high in protein but it ultimately depends on serving size

From a Diabetes Care Consensus panel:

Consensus recommendation:

In individuals with diabetes and non–dialysis-dependent diabetic kidney disease (DKD), reducing the amount of dietary protein below the recommended daily allowance (0.8 g/kg body weight/day) does not meaningfully alter glycemic measures, cardiovascular risk measures, or the course of glomerular filtration rate decline and may increase risk for malnutrition.

Are protein needs different for people with diabetes and kidney disease? Historically, low-protein eating plans were advised to reduce albuminuria and progression of chronic kidney disease in people with DKD, typically with improvements in albuminuria but no clear effect on estimated glomerular filtration rate. In addition, there is some indication that a low-protein eating plan may lead to malnutrition in individuals with DKD. The average daily level of protein intake for people with diabetes without kidney disease is typically 1–1.5 g/kg body weight/day or 15–20% of total calories. Evidence does not suggest that people with DKD need to restrict protein intake to less than the average protein intake.

Source: Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report | Diabetes Care

Steve Parker, M.D.

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Soft Drink Consumption Linked to Premature Death

The study at hand involved Europeans. It’s the first time I’ve seem artificially-sweetened soft drinks linked to premature death.

From JAMA Network:

This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

Source: Association Between Soft Drink Consumption and Mortality in 10 European Countries | Cardiology | JAMA Internal Medicine | JAMA Network

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What’s a Chaffle?

I assume the word rhymes with waffle. No, it’s not chicken and waffles. From Diabetes Daily:

If you haven’t heard of the term “chaffle” yet, are you really living? The latest craze has taken the diabetes online community (DOC) by storm. One moment I was inquiring about what exactly a chaffle was, and the next, I found myself a golden ticket to an underground world with over 100,000 keto-crazed chaffle fanatics! What is a chaffle you ask? A chaffle is basically a cheese and egg alternative to bread, cooked in a mini (or regular, just adjust recipes accordingly) waffle maker that can be used for anything from breakfast foods straight through your after-dinner treat. It basically acts as a base to any creative concoction you can conjure up. Why are people with diabetes so excited about chaffles? Well for one, those of us who love to experiment with new low-carb options now have this new blank canvas to create from. But more importantly, this latest invention can also help keep your blood sugars in check straight from morning till night!

Click the link for recipes

Source: 5 Chaffle Ideas to Get You from Breakfast to Dessert – Diabetes Daily

Steve Parker, M.D.

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