Thursday, August 14, 2008

The rabbit hole: Diabetes

I was looking around for some info on fiber and I came across this statement from the Diabetes Health Center at WebMD:
"Diabetes Diet Myth 1: Eating Too Much Sugar Causes Diabetes."

Their reasoning?

"How does diabetes happen? The causes are not totally understood.  What is known is that simply eating too much sugar is unlikely to cause diabetes. Instead, diabetes begins when something disrupts your body’s ability to turn the food you eat into energy."

In their entire discussion of causality in Diabetes, the words "Insulin resistance" are not used.  There is also the strange term "unlikely" applied to sugar as a risk factor.  They mention Obesity as a risk factor, however, not considering for a moment how obese people become obese.

Then I went on:

"Diabetes Diet Myth 3: Carbohydrates Are Bad."

Let's see their reasoning on this one:

"In fact, carbohydrates are good. They form the foundation of a healthy diabetes diet – or of any healthy diet.
Carbohydrates have the greatest effect on blood glucose levels, which is why you are asked to monitor how much carbohydrate you eat when following a diabetes diet."

Why is this all a problem?  

The answer begins with Hippocrates.  Any diet recommendations fall under the umbrella of "Preventive Medicine".  Preventive medicine is most profoundly beholden to the Hippocratic oath, which is a lovely statement descrying harmful prescription.  Yet the folks at WebMD are doing just that.  
This has been going on for generations.  

The initial argument was that a high percentage carb diet held a lower risk of heart disease.  Which is true only in select studies, and only very slightly when compared to a high percentage fat diet. (The high carb diet holds a higher risk of stroke and cancer in all studies, but these aspects of diet studies are seldom reported.)

The long tumble down the hill of bad science and medical clap-trap began with this correlation.  (high fat = heart disease)

It was assumed that obesity was also correlated with a high fat diet, based not on data or science, but on intuition.  The syllogism would properly read:  If dietary fat is correlated with obesity, and obesity is correlated with heart disease, then dietary fat must be correlated with heart disease.  But this was not their logic.  Their logic links obesity and dietary fat through heart disease.  It would be as if a man were convicted of killing another man, because he happened to be standing next to the actual killer during the act.

To make matters worse, the chain continued, as Diabetes was brought into the mix.  There is absolutely no evidence that a high percentage of natural dietary fats (saturated, or otherwise, anything but trans fats) have any correlation with a higher rate of Diabetes.  Nor is there any evidence that dietary fats have any correlation with obesity.  But, we assumed, because it seemed to make sense.  

Why did it seem to make sense?
Because MD's and biochemists seldom understand the first thing about physics.  When discussing diet many scientists will hearken to the First Law of Thermodynamics. For those of you who are unfamiliar with the law, it states:

"The increase in the internal energy of a system is equal to the amount of energy added by heating the system, minus the amount lost as a result of the work done by the system on its surroundings."

This law is invoked when talking about Calories.  A calorie is a calorie is a calorie - the mantra of bad dietary science.    They suggest that the amount of calories that is consumed in the diet must equal the output of energy.  Food with a higher calorie rating must require more energy to break down, and thus, the less active we are the less calories we break down.  The idea is based on a positive or negative caloric balance.  But it is an oversimplification of human biology.  It ignores the body's fat storage mechanisms, it ignores defecated waste, it ignores water losses through perspiration.  

1.  Fat storage - before fatty acids are converted into energy they have the option of becoming stored fat.  This process was discussed heavily in my post a few days ago.  If they do this then they will not enter the energy output cycle.  This process is heavily influenced by the content of our diet, not the total caloric quantity.  
2.  Defecation - as any raw foodist will tell you, eating more fibrous foods (cellulose particularly) will increase bowel motility.  The problem with their theory of course is that less nutrients are absorbed...but we'll leave them alone for a bit.  The point here is that if we are defecating more thoroughly we will be releasing more food content.  So bowel variation has a part in food absorption.
3.  Perspiration - when I eat Congee with Pork and Thousand Year Egg I sweat.  I sweat a lot.  When I drink Oolong tea I sweat.  This isn't much, it is not going to tip the scales one way or another, but if it is happening then we know ATP is being manufactured, as heat is the bi-product.  If our food can enable or disable this body function then we must consider it as part of overall metabolism.  

So, thermodynamics when applied to human dietary physiology might look a bit circuitous.  A calorie is a calorie in the stomach, but to the duodenum it is a glucose or a fatty acid;  to the pancreas it is a 'make insulin now' and to the gall bladder it is a "bile - GO!".  Then the liver takes some charge of the situation and the calorie becomes one of several possible outcomes, as outlined above.  It could be energy, as glucose usually is directly after consumption, or fatty acids are most of the rest of the time.  Or it could be fat storage, or it could not be assimilated at all, and defecated.  All these factors must be parsed and counted to have an accurate idea of the effect of different diet components on the body.  This is far too complex for a typical prospective diet study.  

The point of all this is that all calories are very likely not created equal.  Because the foods that the "calorie" ratings are applied to have different actions on the internal mechanisms of the body.  These actions have different effects on metabolism.  

What if there were a car factory that could make a fuel efficient compact, a mid-size family sedan, and a 7 seater SUV, all with the same apparatus?  The operators would simply insert a different blueprint when they wanted one or the other, allowing the machines to do the rest.  

This is what our body does naturally.  What a beautiful machine it is!  It is capable, based on input, of producing such a variety of end products, that it boggles the mind.  The input is our dietary contents.  The output is always different, dependent upon the particular ingredients of our diets.  Different inputs can make us fat, thin, strong, weak, healthy or disease-ridden. 

High fat diets, with low carbohydrate content (not percentage, but overall content) are repeatedly among the safest and healthiest diets found in prospective studies, such as those run by the National Center for heatlh statistics.  The recommendation for "lean proteins" constantly bandied about by the AHA or the ADA are based on no science.  

And yet, on both their websites (www.diabetes.org and www.americanheart.org) you find the recommendation for "non-fat dairy" and "lean protein", as well as a foundation of carbohydrates.  

These recommendations have been around for about 30 years.  (or perhaps upwards of 60, but more powerfully the last 30)  In that time we have seen an increased incidence of heart disease, diabetes, obesity, cancer, bowel diseases and dementia.  Thanks to other medical advances, we have seen life expectancy rise amid the deluge of disease.  Americans are living longer with heart disease then they used to.  

So what dietary ingredient has increased since 1970?  According to these USDA statistics, between 1970 and 2005, grain availability increased by 41%, of which 89% went to our diets in refined form; fruits and veggies increased by 19%, and meats by a paltry 7.5%.  This accompanied a growth in US population of 45%.  
If you count sugars and sweeteners you get a further 19% growth in refined carb load.

So, in a period which saw a 45% growth in population, we find a complimentary growth in only one major ingredient:  Refined Carbohydrates.  

If, as many scientists do, we assume that diet has some relationship to disease incidence, we find the only logical culprit for the increased incidence of disease in America to be refined carbs.  All other food types have not been produced and consumed in such quantity as to keep up even with population growth.  

And yet, we are still recommending Carbs as the foundation of a healthy diet.  Sure, they are saying "whole grains" these days, but who actually follows that advice?  

Come on people, wake up and eat your bacon.  Drink your fatty milk, eat your pasture beef, fry those pasture eggs in butter.  

And leave the toast in the bread basket.  You'll thank me when you are 90 and still driving around the neighborhood. 

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