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Physicist, Startup Founder, Blogger, Dad

Monday, March 28, 2011

We're different on the inside

Hmm... I wonder how many pounds of gooey visceral fat are encasing my internal organs? Good thing I just got back from the gym :-)

I'm quasi-paleo and refuse to take statins. Any advice?

NPR: ... The Afghan soldiers, police and civilians he treated in Kandahar had radically different bodies from those of the Canadians he took care of back home.

"Typical Afghan civilians and soldiers would have been 140 pounds or so as adults. And when we operated on them, what we were aware of was the absence of any fat or any adipose tissue underneath the skin," Patterson says. "Of course, when we operated on Canadians or Americans or Europeans, what was normal was to have most of the organs encased in fat. It had a visceral potency to it when you could see it directly there."

... "Type 2 diabetes historically didn't exist, only 70 or 80 years ago," says Patterson. "And what's driven it, of course, is this rise in obesity, especially the accumulation of abdominal fat. That fat induces changes in our receptors that cells have for insulin. Basically, it makes them numb to the effect of insulin."

For a long time, the human body can compensate — the pancreas secretes even larger amounts of insulin, which regulates blood sugar levels. But over time, the pancreas begins to fail to secrete enough insulin, and that is when diabetes develops.

He explains that the increase in abdominal fat has driven the epidemic of diabetes over the last 40 years in the developed world — and that he's now seeing similar patterns in undeveloped regions that have adapted Western eating patterns.

See also the essay below.

Maisonneuve: ... Excessive fattiness is precisely why, when caring for the critically ill in North America, glucose levels are tightly controlled with insulin—a procedure necessary even for those not thought to be diabetic. Stressed by the infection, or the operation that has brought us to the intensive care unit, our sugar levels rise, paralyzing our white blood cells and nourishing the bacteria chewing upon them. But it was never necessary to give the Afghans insulin, no matter how shattered they were.

Among North American adults, 40 percent of us maintain normal glucose levels only by secreting larger than normal quantities of insulin from our pancreas. So we wander in and out of our family doctors’ offices and, if some blood work is done, we are reassured that our glucose levels are normal, that we don’t have diabetes. Mostly, they are and mostly, we don’t. But our bodies are not normal. The Afghans’ bodies are normal. We are so commonly ill we take it to be normal.

Here is our normal: 40 percent of North American adults have metabolic syndrome. The syndrome is caused by being fat, even at levels North Americans would not recognize as abnormal. Obesity prompts the receptors that insulin acts upon to become numb to its effects. As we grow fatter, and insulin resistance proceeds, higher and higher levels of insulin are necessary to get the sugar out of the blood. Eventually, overt diabetes may supervene, as it has for 8 percent of North American adults, a tenfold increase since the turn of the last century. But even prior to the development of diabetes, metabolic syndrome insidiously eats away at the bodies of those it affects.

Metabolic syndrome’s elevated insulin level is why we order a second Whopper; getting fatter, cruelly, stimulates our appetite. It is also why high blood pressure is more common among Westerners, too, and why our cholesterol panels are more alarming. Ultimately and especially, it is why heart attacks are almost unknown among traditional peoples like the Pashtun, while half of us will spend our last minutes with the impression that a large kitchen appliance is sitting on our chests.

55 comments:

Catperson said...

Type II diabetes can be reversed

Patrick White said...

Why do you refuse to take statins?

Nobie Redmon said...

Advice?
Eat anti-inflammatory foods and maintain good insulin sensitivity and gut health.

What do you mean by quasi-paleo?

Guest said...

Live expectancy in Afghanistan is 45 years for both men and women. In the US the average is 78. I don't want to be normal.

Frankly, giving stories like this without context or controls is senseless.

Sam said...

You seem to be aware that the conventional wisdom (?) about nutrition is pretty much complete, total crap.

But you clearly need more focused information. Google these terms and go thru as much of these blogs as you can stand - done correctly, you will spend at least 2 weeks of fulltime work. Even a genius level physics professor will have to spend this much time to fully understand...

"Peter Hyperlipid"
"Stephan whole health source"
"Kurt Harris paleonu panu"'
"Chris Masterjohn daily lipid"
"Mike Eades protein power"

You don't get rid of visceral fat by going to the gym. You don't get rid of any fat by doing that.

If you have visceral fat, which the overwhelming majority of adult Americans have - and a distressing number of children, too - you have some degree of liver damage. This is caused by (in no particular order) transfats, omega-6 pufa, fructose and various micronutrient deficiencies.

St_Anselm said...

Steve is apparently aware that there is ONE prevailing environment in developed countries and the US especially that causes metabolic syndrome, type II diabetes, atherosclerosis, etc. He must be aware that BMI, body fat percentage, blood pressure, etc. are as heritable as IQ.

YET he is unable to make the very simple observation that IQ's heritability, the seeming irrelevance of family environment, etc. may be because IQ is measuring suitability to ONE prevailing environment.

Just as Somoans are fat and "stupid" it may be there are a few who synecdochally speaking thrive on McDonald's and crowded public schools.

Steve may simply say in professor speak, "It's qualitatively different." Is it really?

THINK.

St_Anselm said...

The Afghans don't follow a paleo diet.

DK said...

Maybe Afghans don't have much visceral fat but they sure as hell don't follow any kind of paleo diet and meat is most definitely not the main source of their caloric intake. Grains and dairy, the evil products of agriculture, are their staples. Of which the evilest--wheat--totally dominates. So maybe you should revise your argument.

To me, it seems more and more likely that it is only simple sugars (maybe even only fructose) that are responsible for the whole epidemic of the metabolic syndrome. Try finding an ice cream without HFCS. Next to impossible.

steve hsu said...

I've read bad things about statins and I'm only borderline high so I'm resisting for now.

steve hsu said...

I try to cut down on carbs and eat a lot of fruits and vegetables and protein. But I don't necessarily buy the whole ideology. I just find it's easier to restrict calories by restricting carbs.

Jordan Ezz Fisher said...

No agricultural society does, but they most likely consume much less polyunsaturated fatty acid, much less fructose, and less processed foods. They also probably prepare their grains differently (soaking and maybe fermenting). Some parts of the paleo community are coming around and accepting grains as potentially healthy, if prepared properly.

steve hsu said...

A lot of that difference is probably early mortality due to disease. Primitive people (even more primitive than Afghans) who live to adulthood can often have very long lives. So the statistic you quoted doesn't necessarily imply their diet is worse.

steve hsu said...

Thanks for the references! I have friends (some are physicists) who endorse the ideas you mention, so I've heard them before. But even they would admit the confidence level in most of this science is not that high. One friend characterizes nutritional theories as analogous to religion ;-)

steve hsu said...

Anon, we've discussed this before. I acknowledge that heritability is defined wrt a specific range of environments. In the case of IQ I am specifically interested the effect of genes in the "prevailing environment", which I expect to prevail, insofar as producing scientists, for some time.

steve hsu said...

I strongly expect that people vary in terms of which diets work for them. I find it funny that the subset of paleo people who are also HBDers often haven't figured this out.

DK said...

100% agreed. Doubtless genotype determines a lot. Trouble is, we are still nowhere near understanding where a useful practical advice can be given. Although there is never a shortage of prophets giving such advice.

DK said...

These references are all as total crap as "conventional wisdom" though. I've read these guys for a while until I realized that they all contradict each other at least half if not most of the time. The only things they have in common is rallying against the "consensus". They do have a lot in common with the nutritional orthodoxy in that they make up stuff and bend the evidence all the time to fit their beliefs.

esmith said...

It's simple. Don't eat anything over 2 calories per gram. Your body was never meant to handle that kind of density in unlimited quantities. Shoot for 1 calorie/gram average across all your solid food.

Paleo is good, but there are many different versions of paleo, and at least some of them are crackpotty. For example, there's one guy who advocates heavy reliance on dried meat aka pemmican/jerky. More generally, original paleo was associated with the school of thought that humans relied heavily on big game hunting throughout the Paleolithic and may have even evolved big brains as a result. This is a fairly dubious claim (not only because it's hard to kill big game with sharpened sticks, but also because you can't eat raw meat, you need fire to cook it, and fire is a relatively recent invention.) But it still seems to be very popular because 90% of all scholarly research into the matter comes from the same two or three scientists, who happen to be pro-meat.

And sometimes it's not emphasized enough that paleo requires _lean_ meat. It's quite hard to find truly lean meat nowadays. Even "lean" beef has a lot more fat than your garden-variety antelope or wild rabbit, and that fat is usually the wrong kind (for example, omega-6 to omega-3 ratios are way off). I'd avoid all red meat and stick with fish.

esmith said...

The problem is that simple sugars have been consumed in the Westerd world in large quantities for over a century. Americans consume only slightly more sugar (including HFCS) per capita today, than Britons consumed back in the year 1900. Not to mention all the simple sugars in fruit. Back on the subject of paleo, if you assume a 50% meat / 50% fruit paleo diet, that's 50% of calories from simple sugars, or over 100 kg of simple sugars per capita per year, way more than what we consume today. And yet preagricultural people somehow didn't have problems with the metabolic syndrome.

So I'm not saying that simple sugars everywhere are good (I've even seen sausages with HFCS!), but maybe they are not the culprit by themselves.

St_Anselm said...

It's quite hard to find truly lean meat nowadays.

That's the US. In Argentina all the beef is grass fed and cheap. Here it's $20 /lb.

2 kcals/gram? It's just CR. Primitive peoples today eat lots of starch like yams, taro root, casava, plaintains, sago palm, ... Definitely more than 2 kcals/gram.

esmith said...

Grass fed beef is better, but it's still not not the same as wild antelope. Yams is 1.1 calories/gram. Plantains are 1.2 calories/gram. Raw cassava is 1.6 calories/gram.

St_Anselm said...

We haven't discussed it. You still don't get it.

The prevailing environment varies significantly within the developed world and within the developing world not just between the two, yet twin studies are always for twins without significant geographic dispersion.

It's also clear by the above and elsewhere that you've confused IQ and ability as a scientist, and you've remarked that non-physicists aren't really scientists at all.

A different sort of person with different genes becomes a scientist in different places Steve.

Thank goodness that's the last time I'll try. If you can't get it by now you can't ever get it.

steve hsu said...

>Thank goodness that's the last time I'll try.<

If only that were true!

Sam said...

By physics standards, all biology is low-confidence science... Nutrition is even below that.

All of the references I gave above are the best quality around - and contrary to DK's assertion, they do not contradict each other. At worst they emphasize different things. None of those listed, for example, thinks carbs are causal of metabolic syndrome - but all endorse highly restricting them in the presence of liver and other metabolic dysfunction.

Luckily, implementing a good diet is pretty straightforward. Dr. Harris has a convenient approach on his blog completely consistent with the others.

St_Anselm said...

Steve Hsu, MD:

I'm sorry Mr Tatupu but the only food on the island is spam and potato chips. I expect that to be the case for some time. I can do nothing for you except tell you that the reason you're so sick is in your genes.

steve hsu said...

>Thank goodness that's the last time I'll try.<

If only that were true!

esmith said...

http://www.nature.com/oby/journal/v9/n11s/full/oby2001124a.html

"A series of detailed experimental studies on the effects of high-fat diets conducted within our own laboratory helped to resolve this issue. Figure 2 shows the 7-day changes in fat balance in a group of lean men allowed to eat freely from seemingly identical diets that had been covertly manipulated to contain 20%, 40%, or 60% energy from fat (11). Under such experiments, subjects eat the same bulk of food irrespective of its fat content. The energy overload consumed on the 60% fat diet, therefore, is an accidental phenomenon caused by the greater energy density of the high-fat diet (therefore, the term passive overconsumption). Numerous other studies have replicated this finding using different experimental approaches (12) (13). If such studies are repeated using energy diluents to equalize the energy density of the high- and low-fat diets, then the high-fat hyperphagia is eliminated, indicating that energy density is the key variable rather than any other specific attributes of dietary fat."

http://www.nature.com/oby/journal/v9/n11s/images/oby2001124f2.jpg

esmith said...

Another article, all the way back from 1983. This was all known 30 years ago, and yet people still fighting over optimal diets and causes of obesity:

http://www.ajcn.org/content/37/5/763.short

"The present study compared the effects of diets low in energy density and high in energy density on satiety, energy intake, and eating time among 20 obese and nonobese subjects. Each diet was served over a 5-day period, and subjects were allowed to eat to satiety. With equal acceptance ratings of the diets, satiety was reached on the diet low in energy density at a mean daily energy intake one-half that of the diet high in energy density (1570 versus 3000 kcal)."

JG said...

Ditto that. In the US it's hard to find lean meat. Other parts of the world it's the other way round: hard to find fat meat. But also they tend to simply eat less meat. In my case, we go down to the city's open-air market and get meat cut off half pig or cow. It's mostly lean to begin with but it gets trimmed as you want it. The US problem is partly an artifact of factory food and the lack of control and information you get with that.

JG said...

Genotype, yes. But expression more. Genotype is like program on your hard disk. Expression is like the programs you are actually running. It's the expression there determines actualities - genotype is only about potentialities.

steve hsu said...

Thanks for the nice comment. Can you provide any links on statins (particularly your 2nd and 3rd points)?

esmith said...

It is quite possible that meat in other parts of the world is less fatty, on average, than meat in the US. And that would be a contributor to the obesity problem over here, because someone needs to eat all that fat. (And that would disproportionally be people who regularly shop at McD, KFC & Co., who also disproportionally happen to be poor.)

The point I wanted to make originally was that farm-raised red meat is ALWAYS fattier than lean game that's supposed to be the cornerstone of paleo. Even if it appears to be mostly lean to begin with and you make sure to remove all visible fat. In my book 'lean' means 1 gram of fat or less per 10 grams of protein. You can reach that level of leanness with turkey and skinless chicken breast. Farm-raised, grain-fed beef without visible fat can sometimes get below 2/10. Pork rarely gets below 5/10.

St_Anselm said...

I was wrong, AS USUAL. Yams are only about 1 kcal/gram, but potatoes are close to 4 kcal/g depending on the potato.

St_Anselm said...

I know. I assumed all tubers were like potatoes. I'm an idiot.

St_Anselm said...

The last time I'll try for you, as you're obviously too stupid to get it. Of course it may be a characteristic of your tribe. Never produced ANY thought AT ALL, etc.

St_Anselm said...

I expect to prevail, insofar as producing scientists, for some time.

Before 1900 to be a scientist was to be a white male gentile. Could that be, I don't know, hmmmm, a change in the prevailing environment in the last century? Apparently Steve's "for some time" isn't very long.

In the last 50 years the environment in NL has changed enough for a 20 pt increase in the Ravens.

ccc said...

I'm working on a cholesterol metabolism model right now.

Sam said...

I'm not JG, but much of the content of the references I provided above addresses JG's 2nd and 3rd points. For example, the overwhelming bulk of Peter's Hyperlipid blog annihilates whatever nutritional studies catches his eye. And there are lot of them...

I_am_Chewbacca said...

I do no exercise. I eat all my meals at McDonald's. I try to get at least 3000 kcals/day in HFCS. I also sniff glue and box without head gear, and in my leisure hours I watch nothing but country music videos and professional wrestling.

Here are my numbers:

cholesterol 90/60
blood pressure 100/60
body fat % 6%
Elo rating 2800

How do I do it? It's genetic.

KenC said...

That's excellent Chewy. And I've got an old bridge I'm trying to unload:

http://www.youtube.com/watch?v=j-zczJXSxnw

esmith said...

Sorry, but you're STILL wrong :)
http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2550/2

You can push french fries above 3 kcal/g if you fry them to extract moisture and soak them in vegetable oil (aka pure fat, 9 kcal/g), but fresh potatoes are much lower in density than that.

Anon said...

is it food or exercise? american high school and college athletes don't seem to me to be carrying a lot of visible excess fat around and eat not so differently on average from the non-athletes. are their insides goo'd-up because of diet or not goo'd-up because of exercise? i'm guessing the latter.

esmith said...

It's both. Lack of exercise predisposes you to gain weight, unlimited access to cheap energy-dense foods makes you overeat from time to time, and when these factors are combined, they reinforce each other.

Even American college athletes have some visceral fat. Mean body fat percentage among male college athletes is 13%.

steve hsu said...

Sam, thanks!

esmith said...

Authors do seem biased to me.

It takes all of ten minutes and Google to find dozens of randomized control trials and meta-analyses done everywhere from Japan to Norway, going all the way back to 1980, showing statistically significant reductions in cardiovascular morbidity/mortality (typically on the order of 20-30%) correlated with reductions in blood cholesterol. Throwing all that out requires some serious evidence to the contrary.

With regard to ENHANCE specifically, one possible interpretation of the result is that the patients in the trial had familial hypercholesterolemia, and therefore, histories of treatment with assorted cholesterol-lowering drugs going back one or two decades, had very low IMTs to begin with, and may have been less likely to benefit from treatment.

rz said...

It may be worth your while to also cut down on fruit when you are trying to lose weight. I've been seeing some good results by eating fruit only ~20 mins before a workout and on "binge day" which happens once a week.

I, too, find the whole ideology a little crazy, but it does seem that cutting on grains and fruit helps weight loss and maybe enhances performance.

steve hsu said...

The paleo ideology is hilarious: e.g., primitive man had no access to clean water, so clean water must be bad for you! :-)

steve hsu said...

They claim that post 2005 the ethics and disclosure requirements for medical studies have become much stricter, and not coincidentally it is the later studies that show no benefit from statins. But maybe they are nuts...

esmith said...

The official response of the JUPITER team:

http://www.canibaisereis.com/download/The%20JUPITER%20Trial_%20Responding%20to%20the%20Critics.pdf

It's instructive that the term "95% CI" occurs 9 times in the response, but not once in the critical article.

steve hsu said...

Response to this response is linked to in the post above.

esmith said...

JUPITER was the only large study I know of since 2005 that targeted general population and compared statins against placebo. Such studies are expensive and it generally does not make sense to run them over and over, especially when there is already a scientific consensus on the matter built up by study after study over the previous 20 years. Most other studies done during this period of time targeted people with some kind of preexisting condition. There was a study called SPARCL that found a 20% reduction in the incidence of strokes on 80 mg/d of atorvastatin among patients with history of stroke. A study of 10 mg/day of rosuvastatin in patients with history of systolic heart failure (CORONA) found a 8% reduction in the rate of cardiovascular events, but it wasn't statistically significant, given the size of their test group. Your article mentions SEAS and GISSI-HF. SEAS tested statins in patients with preexisting aortic valve stenosis: there was a substantial (percent-wise) reduction in the rate of major cardiovascular events, as long as they were unrelated to aortic stenosis, but again the size of the group was too small for that reduction to be statistically significant. Statins weren't effective in treatment of aortic valve stenosis. GISSI-HF looked at patients with preexisting chronic heart failure. Here statins proved to be completely useless (almost a third of all patients died during the study period, both on rosuvastatin and on placebo).

The general conclusion from the studies done since 2005, as long as you accept that JUPITER wasn't rigged, is that statins do help prevent stroke and AMI, but they aren't a miracle drug and they won't help if there's something else wrong with your heart.

willw2 said...

Hey ... so I'm paleo too and I have this advice... First off, exercise. Lift weights, cardio. Do it a lot. Second, have good fats. This means wild salmon and fish. Third, don't eat meat unless it's grass fed and even then limit it. 4th eat lots of fruits and veggies and no sodium. Avocado is also good fat. Coconut too. Nuts are also good fats, but I have some concerns due to phytate content and lack of phytase.

Contemplationist said...

Go full paleo!

St_Anselm said...

Sorry, but you're wrong. 3.93 kcals/g for white potato cooked. Sorry, I'm not sorry. Sorry, I'm not sorry for not being sorry. Sorry,....

Zhengzheng Zhou said...

Steve, you may be interested in the NYT article on the likely connection between paleo diet, red meat, carnitine, gut bacteria, TMAO, and cardiovascular disease.

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