FAT REFORM: OBESITY, FOOD POLITICS AND THE PERILS OF DIETARY CARBOHYDRATES

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FAT REFORMOBESITY, FOOD POLITICS AND THE PERILS
OF DIETARY CARBOHYDRATES

• Jeffry N. Gerber, M.D., Denvers Diet Doctor
• Family Physician, Littleton Colorado
• DenversDietDoctor.com
• facebook.com/DenversDietDoctor

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Disclosures

• None

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Outline

• History and Politics
• Science of nutrition the evidence
• Re-write the nutritional guidelines
• Summary and action plan

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Diabesity A Twin Epidemic

• The spectrum of Insulin Resistance

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Obesity Statistics

• The progression of insulin resistance
• 44 obese in 2030
• 33 diabetic in 2050

Sources TFAH, OECD, WHO, CDC, ADA
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Historical Perspective
I am such a glutton and sloth

• Blame behavior and lifestyle choices
• Eating too much and exercising too little
• Obesity is caused by positive energy balance!
• A simple explanation
• Health insurance will not pay for treatment
• Its your fault, your problem, you fix it!
• The Lipid Hypotheses 1950s
• Avoid caloric dense fatty foods

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USDA Dietary Guidelines 1977-1980
Phillip Handler A vast nutritional experiment

• Less saturated fats, less calories
• More poly-unsaturated Vegetable oils
• More carbohydrates, starches, sugars
• More inexpensive food commodities
• Weak evidence, the wrong tools!

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Macronutrient Content

• More refined carbohydrates and less saturated fat
• Total caloric intake increases from sugar
  consumption

-MMWR, Morbidity and Mortality Weekly Report,
February 6, 2004 / Vol. 53 / No. 4
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Does Saturated Fat Cause Heart Disease?
http//www.awlr.org

• Outcomes looking at MI, death from MI and stroke
• Observational - 16 studies - No!
• Observational - 8 studies - Yes but problematic!
• Observational - 2 meta analysis, 350,000 subjects
  - No!
• RCTs - Clinical trials - 2 well done - No!
• RCTs - Clinical trials - 3 meta analysis - No!
• RCTs - Clinical trials - 1 meta analysis - Yes
  but problematic!

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Food Politics Agriculture

• Industrial revolution and the food commodities
• Corn, Wheat, Rice, Potatoes
• Sugars Cane, Beet, HFCS
• Soybean and industrial Vegetable oils
• Whole foods expensive Animals and other Plants
• Farming incentives, increase yields, GMOs

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Food Politics Manufacturing and ales

• To sell refined and processed foods for profit
• Food commodities are the raw materials
• Tasty and addicting foods, eat more
• Deceptive advertising Healthy foods
• Food lobbyists funding politicians
• Selling food not health

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Our Ancestors Before Agriculture

• Hunter gatherers and the Paleolithic era
• Whole foods, some carbs
• Animals including Fish, seasonal Veggies, Fruits
  ,Nuts and Roots
• Use of fire
• Agriculture and the Neolithic era
• Cultivate Grains and domesticate Animals for
  Dairy
• Modern civilization changing nutrition
• For better or worse

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The Cost of Healthcare

• World leader in healthcare spending since 1980
• Treating chronic diseases
• Medicare and Medicaid industry guidelines
• Treatment of illness and disease only
• Obesity not a medical condition
• A reactive and costly approach to healthcare
• Preventive services task force 2012, counseling
• Treating obesity complications is profitable

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Evolution - Are You Kidding?
Nutrition changing humans in our lifetime!
The Food Revolution Andreas Eenfeldt, M.D.
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Fat Reform is Healthcare Reform

• Address obesity
• Save trillions treating complications
• Food industry regulation!
• Healthcare delivery
• Nutrition and center stage
• Re-define healthy nutrition
• Re-educate
• The perils of dietary carbohydrates
• In defense of dietary fat

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Nutrition and Metabolism 101

• Food metabolism
• All macronutrients are not created equal
• Carbohydrates are fattening and inflammatory
• Fats and proteins
• Obesity is a chronic metabolic disease
• Insulin resistance
• Inflammation

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Insulin and Insulin Receptors

• One of several hormones
• Regulate energy and energy storage
• Dietary carbohydrates, the primary fuel
• Turn on the insulin switch
• Dietary proteins and fats, secondary fuels
• Minimal effect on insulin, essential
• Insulin receptors normal function
• Cells, muscle, tissue absorb energy and nutrients
• Excess food energy converted to fat and stored
• Normally insulin will suppress appetite
• ? insulin promotes the release of stored energy
• Basic physiology

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Insulin Resistance

• Years of carbohydrate overload
• More insulin is required
• Excess energy, stored as body fat
• Receptors become strained and resistant
• Beta cells strained, abnormal response
• A disease of insulin overload
• Insulin resistance makes us hungry
• Fat cells literally starve lean body tissues
• Hypothalamus, Nucleus Accumbens
• Eventual loss of central signals

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Regulation of Food Intake

• Leptin Insulin Amylin PP - Ghrelin - PYY -
  GLP-1
• Resistance changes signaling
• Promotes inflammation and mitochondrial
  dysfunction

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Inflammation and Adiposity
Inflammation
Dyslipidemia
Premature Ageing
? Lipoprotein lipase
Hypertension
? Angiotensinogen
? IL-6
? Insulin
? CRP
? FFA
Liver Gut
Insulin Resistance
? IGF-1
? Resistin
? TNFa
? Leptin
Type II Diabetes
Cancer
? Adipsin(Complement D)
? Lactate
? Plasminogenactivator inhibitor-1
? Adiponectin
Atherosclerosis
Dementia
Thrombosis
Fertility
Lyon CJ et al. Endocrinology 20031442195-200
Trayhurn P et al. Br J Nutr 200492347-55 Eckel
RH et al. Lancet 20053651415-28.
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Insulin Resistance Evaluation
Overweight
Obesity
Pre-diabetes (Metabolic Syndrome)
Type II Diabetes

• Anthropometric measurements
• Medical and family history, physical
• 2hr OGT, GTT
• Metabolic markers of inflammation
• HgA1c, c-peptide, Insulin, CRP, Thyroid, etc
• Cholesterol testing as a marker for
  atherosclerosis

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Insulin Resistance Treatment

• The food is the medicine
• Remove the optional fuel
• Less dietary carbohydrates
• Turn off the insulin switch
• Control hunger and appetite

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Insulin Resistance Treatment

• Dietary proteins
• Essential, healthy
• Dietary fats and cholesterol
• Essential, healthy
• Caloric dense and filling
• NOT inflammatory or atherogenic
• One exception
• Carbs and fats together
• Standard American diet (SAD)
• Carbs are the catalyst

http//deliciouslyorganic.net
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Insulin Resistance Treatment

• Medication
• Physiologic drugs
• Metformin, Byetta, Victoza, Bydureon, Symlin
• Rx appetite suppressants
• New and future drugs
• OTC market
• Treat co-morbidities
• Nutrition center stage
• Gastric bypass surgery

http//peaceloveandlowcarb.blogspot.com
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Eat Real foods

• Focus on the carbohydrate content of food
• Avoid high glycemic foods, processed foods
• Eat low glycemic foods, whole and unprocessed
• Healthy natural fats
• Butter, Animal fat, Coconut oil, Olive oil,
  Avocado, Fish oil
• Low-Carb High Fat (LCHF), Ancestral diets
• Control of appetite and promote weight loss
• Enhanced fat burning during exercise
• Quantity, calories and portions not the focus

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Comparing Diets Head to Head

• Compare the macronutrient content
• of calories from carbs, protein and fat
• Very low fat lt10, high carb, low calorie
• Very low carb lt10, high fat, LCHF, 1860s
• LCHF vs. Ancestral diets
• Food quality important
• What diets are healthy and safe?
• Low carb high fat (LCHF) diets improve health!
• Greater weight loss, improved lipids and blood
  sugar
• Dozens of RCTs, Stanford 2007, Duke 2004, Penn
  2003, 2011
• Meta analysis , Santos 2012

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Calories consumed equal, Atkins LCHF diet better
controls insulin, weight and appetite
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(No Transcript)
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Lipid profile improved on Atkins LCHF
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Advanced Lipids and LCHF Diets

• Favorable LDL subclasses or particle sizes
• Triglycerides decrease, healthy HDL-C increases
• Other markers
• Apo-B, LDL particles
• Lpa, genetic markers
• Advanced labs
• Berkeley Heart Lab
• NMR Liposcience
• VAP Cholesterol

Effects of LCHF diet on emerging plasma markers,
Richard J. Wood, et al. J. Nutrition.
136384-389, February 2006
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• Marcia at 262 lbs, BMI 41
• lost 70 lbs, now 192 lbs, 27 loss TBW, BMI 30

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Dr Gerber Patient Marcia

• Female age 45, 57, 262 lbs, BMI 41
• OGT performed, FBS96, 1HR180, 2Hr129
• HgA1C6.4, c-peptide4.7
• TRG221, HDL36, TC148, LDL69, NON-HDL112,
  TC/HDL4.2, LDL Pattern A/B
• 8 months later lost 70 lbs, 192 lbs, BMI 30, 27
  loss of body weight
• FBS 76
• HgA1C5.1, ?c-peptide
• TRG147, HDL40, TC186, LDL121, NON-HDL151,
  TC/HDL5.2, ?particle size

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• David at 312 lbs, BMI 40
• http//mendosa.com
• lost 153 lbs, now 159 lbs, 49 loss TBW, BMI 20

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Dr Gerber Patient David

• Male, age 71, 63, 312 lbs, BMI 40
• OGT FBS105, 1HR219, 2HR201
• HgA1C6.8
• TRG193, HDL28, TC225, LDL158 , NON-HDL197
• 2 years later, lost 153 lbs, 159 lbs, BMI 20, 49
  loss of body weight
• OGT pending, FBS normal
• HgA1C4.6
• TRG109, HDL40, TC155, LDL93, NON-HDL115

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• Patrick at 220 lbs, BMI 32
• Lost 45 lbs, now 175 lbs, 20 loss TBW, BMI 24

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Dr Gerber Patient Patrick

• Male, age 53, 6, 220 lbs, BMI 32
• OGT performed, FBS86, 1HR148, 2HR103
• HgA1C5.4, c-peptide4.1
• TRG133, HDL47, TC238, LDL164 , NON-HDL191,
  TC/HDL5.1
• 7 moths later lost 45 lbs, 175 lbs, BMI 24, 20
  loss of body weight
• FBS77
• HgA1C5.1, c-peptide0.9
• TRG75, HDL78, TC200, LDL75 , NON-HDL122,
  TC/HDL2.6

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Dr Gerber Patient Eric

• Age 43, lost 10 pounds on a Paleo diet, 183 lbs,
  BMI 25
• Berkeley Heart Lab
• Triglycerides and HDL-C improved, LDL-C, Apo-B
  unchanged
• LDL subclasses (particle size) remained
  favorable, 9p21 genetic markers at risk
• Carotid IMT, 39 yrs., heterogeneous plaque lt20

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Author Gary Taubes
Nutrition and the history of weak scientific
evidence

• 2002 New York Times Magazine What If Its All
  Been a Big Fat Lie
• 2008 Good Calories Bad Calories
• 2010 Why We Get Fat And What To Do About It
• 2011 New York Times Magazine Is Sugar Toxic
• 2012 Newsweek Why the Obesity Campaign is
  failing

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Nutrition for the New Millennium

• Re-defining healthy nutrition
• Less refined and processed foods
• More whole foods including natural fats
• New federal dietary guidelines
• Food industry regulation
• Re-define healthcare delivery
• Nutrition centerstage
• Control the cost of healthcare

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Good Food is Good Medicine!

• Jeffry N. Gerber, M.D.
• DenversDietDoctor.com
• facebook.com/DenversDietDoctor