On Nutrition: The "Calories In = Calories Out" Fallacy

Many people who have thought deeply about nutrition, obesity (and other health problems) will proclaim that it is clearly that "Calories In = Calories Out". They mean that if you eat more ("calories in") than you spend on physical activity ("calories out"), then you gain weight. To loose weight, they proclaim to increase physical activity and decrease food consumption.

And it has some logic to it.

But it is utter bollocks, with no personal knowledge of the problem, and it is putting the cart before the horse.

Before I changed my nutrition, I had problems with hunger. Hunger, hunger, hunger. Murderous, ravenous, hunger.

After I changed my diet to Lutz/Aktins Diet (and now more to a Paleo Diet) my hunger became what it is supposed to be: Information that my body needs food.

So I can say that clearly and unequivocally the problems I had with my hunger were caused by what I ate, which in turn caused me to eat more.

My diet was making me hungry.

Now, how is someone who is hungry supposed to eat less and exercise more?

As I said, utter bollocks.

(And it was not that my change in diet curbed my appetite – the problem was too much hunger, not too much appetite. I still enjoy very much what I eat – it's just so that I eat until I'm satiated, usually twice a day. And then I don't overeat, because like I did with the foods I used to eat. Somehow it is very difficult, if not impossible to overeat on meat, potatoes and salad, versus for example pasta.)

"Safety And Efficency"

For all those who think that the FDA will help solve ME/CFS, that the pharmaceutical industry will help solve ME/CFS, that "we, the patients" should lobby the FDA and doctors to help the pharmaceutical industry:
You are deluded.



BBC Panorama - "Paxil Study 329"


(Via 1 Boring Old Man)

Translational Medicine Has Failed

1 Boring Old Man (emphasis mine):

One reason that I suggest you read the whole article is that in his thinking, the perspectives of the pharmaceutical industry, psychiatry, and the NIMH are discussed as if they are the same thing. For example, he discusses academic research and pharmaceutical research as if they are in synergy with different strengths and weaknesses, an unbroken chain:
…
Here’s the thing about that argument – I can’t think of any examples. The drugs that have characterized the post-DSM-III era are all me-too drugs developed by pharma. What the academics have done is sign on to the industry’s papers as KOLs, involve themselves as sites for drug trials, and traveled around on speaker’s bureaus. If the academics are doing what he described, I missed it. Dr. Hyman, Fibiger, and Insel should be in a better position than I am to know about such things – but I think that this scheme, at least over the last quarter century, is more their shared delusion fantasy than some hard reality.

So while it seems a cynical thing to say, I can’t think of any accomplishments by the Translational Medicine era to mention other than to produce a lot of articles and a few new journals. So how could it be stalled? It never took flight in the first place except as a monotonous rhetorical device and a name for a bunch of centers that haven’t produced very much. The Translational Medicine rallying cry "from bench to bedside" has lacked in productivity from the bench side of the equation.

It seems "Translational Medicine" is nothing but a fancy buzzword to get funds for research, and to hide the fact by how much medical science has been stalled in the last couple of decades…

Anecdote: Remove Dairy, Remove Brain Fog

Another one for the list:

I feel great. I actually feel as if there’s nothing wrong with me at this point in time. Nothing hurts, my brain is functioning adequately, my mood is euthymic, I’m never hungry, I have acceptable energy levels. Occasional mild anxiety/irritability but kava kava takes care of that (thank you Woo).

Was a stressful week at work. I was like “so what, let’s deal with this shit in a stepwise fashion” and handled it just fine.

This is a very unusual occurrence in the life of Sid, that nothing is hurting or broken. Is it possible I’ve been poisoning myself with dairy all these years? I haven’t felt this good since I first went VLC two years ago. In hindsight, I wasn’t eating that much dairy at the start because I wanted to lose weight as rapidly as possible and we all know cheese is stalling.

My brain works again. I don’t have horrible brain fog and the feeling that brain is functioning at 20% capacity.

(emphasis mine)

It's been only a week, so one will have to wait, I'll guess. But it looks promising.

Anecdote: Paleo helps for Fibromyalgia

Robb Wolf has the details.

Idiots

Funny thing, as I googled something else I stumbled about a commentator on a blog accusing me of basically being "anti-science", "wittering on about XMRV”, and in essence by saying that my topic would be "medical oppression" that I am an "Mikovits shill" – I beg to differ. I tried to collect as much about what was wrong with the XMRV disaster as was possible for me (cf. the sidebar on the right, titled: XMRV/"HGRV" Post-Mortem).

It would be really funny if it wasn't in the context of conspiracy theories (and self declared rational "pro-science" people trying to dispel conspiracy theories), that this straw man was raised. If they really would try to first look before they attack something, they might be able to actually learn something – you know, the scientific method. Instead they attack straw man, presumably because it makes them feel better, or something – don't know, haven't got a doctor in confirmation bias psychology.

Oh well, idiots abound – the reason why I state my opinion and go, it simply makes no sense to discuss with such people.

And I for one – seeing such idiots – am fully confident that science, and especially anything to do with medical science, is unable to clean up their house, these fine scientists are so unable to even see what problems they have. With people like these, I get misanthropic urges and want to advise them to consume more seed oils, in order to speed up the necessary paradigm change.

On Nutrition: The "Healthy Food" Paradigm Is Wrong

We all hear and talk about (supposed) "healthy" foods versus (supposed) "unhealthy" foods. Now I think this blinds us to reality. I think talking of "healthy" foods leads to two mistakes:

1. We think that we can offset consumption of "unhealthy" foods with consumption of "healthy" foods
2. We think that the more "healthier" food we eat, that the more "healthier" we get.

Now if we define as "unhealthy" food as some food that causes disease (by containing a disease causing agent), say through interference with the immune system or intereference with the endocrine system (so practically an low-level poison) then no amount of "healthy" food will offset that disease causing mechanism.

If we define "healthy" food as an food containing essential nutrients (water, proteins, fats, carbohydrates, minerals, vitamins, and so on), and only nutrients (no disease causing agents), then we will see that overeating such "healthy" food will not make us more healthy. In fact, for most foods constituents we have a certain range that our body needs and is able to regulate. The mechanisms with which the body regulates this are hunger and taste.

For the most basic food constituent – water – we will get problems if we consume too little and get problems if consume too much water. And the same goes for everything, from salt to meat, from vegetables to tubers. A healthy individual, with foods from his/her environment of evolution, will choose those foods (and then in the "right" amount) to stay healthy. No animal needs to be fed "healthy" food to stay healthy, no animal needs to be told to not overeat, and no animal needs to be told to exercise (I just need to look at our dog to see how much he likes to run), if it is in its natural environment (or something that is close enough).

Conversly: If an food is not present in the natural environment of an animal, then it has the potential to cause disease. And the same goes for the human animal.

Marvellous

David Healy:

Companies don’t engage in conspiracies, we are being told, they are masters of the cock-up, and if given a choice of feet to shoot themselves in will opt for both feet.

Truly marvellous.

More Animal Fat & Less Seed Oils = Longevity!

Stan the Heretic has the details:

1. New study on the topics of mono-unsaturated and saturated versus polyunsaturated fats:

"Lipidomics of Familial Longevity.", by Gonzalez-Covarrubias V, et al.
Aging Cell. 2013 Mar 2. doi: 10.1111/acel.12064. [Epub ahead of print]

Quote:

In addition, the longevity-associated lipid profile was characterized by a higher ratio of monounsaturated (MUFA) over polyunsaturated (PUFA) lipid species suggesting that female offspring have a plasma lipidome less prone to oxidative stress. Ether PC and SM species were identified as novel longevity markers in females, independent of total triglycerides levels. Several longevity-associated lipids correlated with a lower risk of hypertension and diabetes in the Leiden Longevity Study cohort.

2. Longevity marker = MUFA/PUFA ratio in cellullar membranes:

"Fatty acid profile of erythrocyte membranes as possible biomarker of longevity.", Puca AA, et al., Rejuvenation Res. 2008 Feb;11(1):63-72.

Quote:

Erythrocyte membranes from nonagenarian offspring had significantly higher content of C16:1 n-7, trans C18:1 n-9,[mono-unsaturated] and total trans-fatty acids, and reduced content of C18:2 n-6 and C20:4 n-6 [polyunsaturated fats].

(comments in brackets added by me)
 

It Is The PUFA Overconsumption, Not The n-6/n-3 Ratio, Stupid!

Science – do an experiment, find out things:

Metabolic markers in Ossabaw pigs fed high fat diets enriched in regular or low α-linolenic acid soy oil

Ramesh B Potu, Hang Lu, Olayiwola Adeola and Kolapo M Ajuwon*

Abstract

Background
Soy oil is a major vegetable oil consumed in the US. A recently developed soybean variety produces oil with a lower concentration of α-linolenic acid, hence a higher (n-6)/(n-3) ratio, than regular soy oil. The study was conducted to determine the metabolic impact of the low α-linolenic acid containing soy oil.
Methods

Ossabaw pigs were fed diets supplemented with either 13% regular soybean oil (SBO), or 13% of the low α-linolenic soybean oil (LLO) or a control diet (CON) without extra oil supplementation, for 8 weeks.

Results
Serum and adipose tissue α-linolenic acid concentration was higher in pigs fed the SBO diet than those on the CON and LLO diets. In the serum, the concentration of saturated fatty acids (SFA) was lower in the LLO group than in CON and SBO groups polyunsaturated fatty acid (PUFA) concentration was higher in the LLO group compared to CON and SBO groups. Glucose, insulin, triglycerides and LDL-cholesterol were higher in pigs fed the SBO diet than those fed the CON and LLO diets. HDL-cholesterol was lower in pigs on the SBO diet than those on the CON and LLO diets. Pigs fed SBO and LLO diets had lower CRP concentration than those on the CON diet. Adipose tissue expression of Interleukin 6 (IL-6) was higher in the SBO and LLO diets than the CON. Expression of ECM genes, COLVIA and fibronectin, was significantly reduced in the SBO diet relative to the CON and LLO diets whereas expression of inflammation-related genes, cluster of differentiation 68 (CD68) and monocyte chemoattractant protein 1 (MCP-1), was not different across treatments.

Conclusions
Results suggest that lowering the content of α-linolenic acid in the context of a high fat diet could lead to mitigation of development of hyperinsulinemia and dyslipidemia without significant effects on adipose tissue inflammation.

For those of you who don't know right of the back of their heads, α-linolenic acid is an Omega-3 fatty acid (n-3). So a lower consumption of it makes the n-6/n-3 ratio higher – with a higher n-6/n-3 ratio usually considered (erroneously) to be the main problems with seed oils. Yet a lower consumption of only this fatty acid decreases the absolute amount of PUFAs consumed – and that seems to be beneficial (if you are an mammal).

Let me put this in other words: Lower PUFA consumption (even Omega-3!), means better health. 

If you are not an mammal, or if your livelihood depends on selling PUFA supplements in the form of fish oil or seed oil (I'm looking at you USDA, ADA and AHA), then go ahead and advertise an increased PUFA consumption. I just hope that in everybody's interest that you die of natural causes before people start to pick up pitchforks.

If Pharma made cars…

David Healy:

If Pharma made cars..

Companies are legally obliged to answer the question “Can cars kill?” with a “Yes”. They can usually evade this by answering instead the question “Will this car kill me?” or “Did it kill him?” with a “No – absolutely not – if things went wrong it was the Dr’s fault”. But ultimately they depend on their professors (who are carefully managed independent contractors under no legal obligation) to deliver the message “Cars Cannot Kill”.

If Philip Morris made drugs..

If Philip Morris made medicines, all available drugs would come with prominent Black Box warnings that this product can kill consistent with the traditional medical view that Every Drug is a Poison, and the Art of Medicine lies in finding the right dose.

There would be a ban on all advertising including Direct to Consumer Adverts. The use of drugs for children would be severely restricted, and exceptional rather than common.

As company products are available over-the-counter rather than on prescription-only, doctors would be openly skeptical of the claimed benefits and would fully support ongoing research to demonstrate the risks. Somewhat more puritanically perhaps some doctors might be expected to attempt to get Philip Morris sponsorship of university activities banned.
…

The Strange Case Of Postpartum Psychoses

Interesting, disease that get worse, diseases that vanish. David Healy:

… when we set about entering North West Wales records from the asylum in 1896 to compare with admissions in 1996, something more startling became apparent – we admit 15 times more people with serious mental illness now, and compulsorily detain 3 times more people (Healy et al 2001). This prompted a quixotic adventure – why not enter all records from North West Wales between 1875 and 1924 and build a modern database covering admissions from 1994 to 2010?

This was quixotic because no-one wanted to fund us. Grant-giving bodies in history were not able to see the value in quantifying records or in having modern data. Modern epidemiologists could not see the value in historical records. So over 15 years and without support we put together easily the largest body of historical epidemiology in existence – we had no competition, no-one else thought this made sense.

…
Hergest was the first of these general hospital units to open but within 3 years of opening, the mother-and-baby unit closed. There were no cases. The Ablett mother and baby unit had just opened up and this is where Cora went (see Cora’s Story)– and going there may have partly caused her loss of life. All 3 mother-and-baby units have now closed.

Our historical and contemporary databases bring this out perfectly. De novo onset postpartum psychoses have vanished – the manic-depressive type remains (see Tschinkel et al 2007). These are not disorders you can treat in the community. They are the most high risk in all psychiatry.

But when we came to report the findings we were in for a surprise. No-one it seems wanted to hear about a disorder vanishing – not the postpartum experts whose careers depend on it and are still busy portraying it as commoner than ever. Not the health service managers whom one might have thought would have an interest because of the budgetary implications. Nor the researchers you might have thought would be interested in the implications for theories of mental illness. Not the historians specializing in postpartum psychoses or women’s mental health. It was difficult to get published.

Psychiatry Kills – Just Say No

David Healy:

Patients with psychosis, just as they were 100 years ago, are now 4 times more likely to be dead after 5 years of treatment than the rest of us. Patients with schizophrenia are 11 times more likely to be dead – this is much worse than 100 years ago.

Patients with schizophrenia are 10 times more likely to be dead at the end of the first year of treatment than they were 100 years ago. There is no other illness in medicine where such a statement could be made.

Death in the early years of schizophrenia does not come from heart attacks or strokes – it comes from suicide. In their first year of treatment, patients with schizophrenia are over a hundred times more likely to commit suicide than the rest of us.

This is shocking. When I have written about the social function of psychology, I seriously underestimated what harm these psycho*s from the psychiatry department are doing.

Drugs To Take, Drugs To Avoid?

I was thinking in general what I would take and what I wouldn't take with regards to pharmaceuticals. There are a few (hypothetical) situations were I would definitely take pharmaceuticals/medications, vaccines and treatments in general:

• Anti-retrovirals, when faced with an persistent (and clearly identified) infection that causes problems
• Same with antibiotics for bacterial infections
• Same with anti-fungals for fungal infections
• Depending on the cancer – and carefully considering the options – I would be willing to take anti-cancer
• I will take any recommended vaccines against deadly child disease like the usual suspects (MMR, Polio, and the like)
• I would take vaccines against "new" diseases if there is an outbreak (or real risk of an outbreak) in my country, and if the disease has severe health outcomes (e.g. SARS)
• I would take insulin if I had type 1 diabetes (T1DM)

On the other hand, there a few instances where I would definitely not take stuff from pharma or other kinds of treatments:

• I will not take heart disease or vascular medication, especially "preventive" disasters like statins (I'm already fatigued from dairy, I don't need pharma to help with that. And anyway what is wrong with trying out Paleo?)
• I will not take any medicals against diabetes, hypertension, obesity or the like (do Paleo instead, duh!)
• I will not take vaccines against the latest hyped virus (e.g. a repeat of the bird flu disaster)
• I will not take anti-depressives (cf. David Healy)

Furthermore I would try to avoid some forms of surgery (e.g. prostate cancer surgery, which seems to be a result of overhyping prostate cancer – not every "cancer" poses a danger). As a child I was subjected to a unnecessary tonsillectomy which by all means did more harm than good – were I a parent today, I would say no to such surgeries (and in addition the doctor suggesting this would run the risk of needing surgery himself).

But then there quite a few "gray areas". The influenza vaccine? If I knew.

That all got me thinking, would it possible to have a sort of guidance for this? Well, I came up with this, were I would more readly trust pharma:

• The disease needs to have clearly defined adverse outcomes (e.g. like HIV/AIDS), so doctors can not substitute the reality of a disease with their narrative
• The disease has to affect clearly many who are diagnosed with it, and not be some "risk number"
• The drug has to have clearly visible efficiency (e.g. like insulin for T1DM), that does not does not rely on statistical analysis to show efficiency (e.g. definitely not like statins)

So if it is a disease that clearly kills or maims many, and if the treatment does not have to rely on statistical manipulations analysis to show that it does something, then yes, I would take that treatment. In all other cases I'd be careful. Patient discretion is advised.

When Patients Do Lobby-Work For Pharma

David Healy:

… Quite innocently some decades ago a network was set up by Silvio Garattini among others to investigate rare diseases. This later gave rise to Eurordis, an organization to speak on behalf of patients with rare diseases.

An organization of patients and by patients and for patients sounds like a wonderful thing but far from being a sanetocracy it has turned out to be an insanetocracy.

As it happens as of 2011 Eurordis took funds from 38 different pharmaceutical companies. These only amounted however to 22% of their income. Financial conflicts are not really the issue – they could survive without the money. It’s something else that keeps them tied to the Corporation. This is the patient group for whom pharmaceutical solutions are a lifeline. They are more committed to the interests of the pharmaceutical industry than are any of the employees of any of the pharmaceutical companies.

They can be absolutely depended upon to read the runes right and come out with a strong industry position, making it possible for industry representatives to sound relatively accommodating to others in contrast …

The ME/CFS community should take notice – especially those lobbying for Ampligen – not to become unpaid pharma shills.

I Guess "Case Studies" and Anecdotes *CAN* Be Usefull Afterall

1 Boring Old Man:

The scheme boxed above [about RCTs, randomized controlled trials], while initiated as a protective maneuver, is actually designed to detect smaller differences – differences that might not even be apparent without the statistical rigor described. One would hardly need more than my one case of terminal congestive heart failure treated with Ethacrinic Acid to know that drug was a powerhouse diuretic – dangerously powerful. The same is true of Digitalis, Insulin, and Prednisone. They don’t work statistically. They just work. The same would be true of Thorazine which is closer to a sledge-hammer than something subtle requiring statistical proof. The issue with all of these drugs is about their safety, not their efficacy. So the coming of the clinical trial technology greatly expanded the ability to detect much more subtle levels of efficacy.

What frustrates me is that medical science (in the form of pharma-trials) is chasing ever smaller effect sizes (Statins, anyone?) while at the same time ignoring what could be gained be removing evolutionary novel foods from nutrition – something like the Paleo Diet, that "just worked" for me. It did not work "statistically", but it "just worked", just like flipping a switch.

Why can't they take MS patients (for example) and put them on elimination diets, where you remove one component from the diet and see what it does? Have one arm of the study where you remove dairy, one arm where you remove grains, one arm where you remove dairy and grains, and so on – there are other possibilities. Or do this with Behçet's and dairy?

I feel like medical science is stuck, unable to ask the right questions anymore, unable to question what is right and what is wrong with all that knowledge they have gathered. The only way to get themselves "unstuck" would to question everything. Are (whole) grains actually healthy? Is dairy actually healthy? Is an increased consumption of PUFAs actually healthy? If not, for which groups of patients with what diseases? Or are there even problems with these foods that affect everybody negatively?

Until the medical science starts questioning whether the foundation of nutrition is really what the medical mainstream thinks it is, until then medical science will remain stuck.

A Diagnosis Is For The Patient, Not For The Doctor

1 Boring Old Man:

… The hostility towards psychiatrists about diagnostic labeling is actually in sympathy to the mentally ill who can be actually harmed by being diagnosed – in all kinds of ways. Saying a person has a DSM diagnosis isn’t like coding appendicitis – it may make a person uninsurable or unemployable for life. That’s a big hurt. And there are other subtle consequences. These days, there’s a big suspicion that diagnostic inflation is partially motivated by people drumming up business. With the DSM-5 diagnostic inflation, that’s hard to refute.

In this reaction to the reaction Dr. Pies makes what I consider a weak point – that doctors need to make diagnoses. Of course they do, but not in the Managed Care/DSM-5 way it’s done these days. I didn’t deal with insurance companies as a practitioner and was on no panels. When patients wanted to file insurance themselves, I producing bills with the diagnosis [ICD-9-CM] and session [CPT] codes. And I often saw it important to discuss this topic with the naive, as informed consent [do no harm has lots of meanings]. Diagnosis is something one does for a patient, not to or with a patient. Our diagnoses are more in the range of opinion than anyone would like to admit, at least the ones used for outpatients.