Chris Kresser, Danny Roddy, and I recorded a podcast yesterday, and it should be up at TheHealthySkeptic.org or ChrisKresser.com on Tuesday. Chris and Danny are great hosts and we had some fascinating questions to play with, so it was a lot of fun.
Here’s what interested me this week:
[1] Interesting posts: JS Stanton of gnolls.org has been doing a great series on satiety, hunger, and obesity. Part IV went up this week. JS points out that the obese have damaged mitochondria and reduced ability to oxidize fat. These defects often persist after weight has been lost:
Normal subjects are burning 7% carbs and 78% fat at rest, whereas formerly obese subjects are burning 49% carbs and 34% fat at rest!
Don’t miss JS’s ongoing exploration of the implications.
Jamie Scott looks at the question: do high-fat diets cause intestinal inflammation?
Barry Groves finds a paper showing via functional MRI that fatty meals improve mood.
Melissa McEwen shows that a diet that includes some carbs, fiber or butyrate, and omega-3 fats is very good for the gut, whereas a high-protein low-carb low-fiber diet is harmful. She has a cool picture:
In another post, Melissa informs us that Lierre Keith has become an advocate of terrorism. Eeek! I regret that we mentioned The Vegetarian Myth in our appendix for vegetarians.
Seth Roberts also linked to a paper showing that high-protein diets are bad for the colon, due to toxic protein metabolites.
Emily Deans informs us that a substantial fraction of people develop hypoglycemia when they eat a small amount of carbs following a fast; and that hypoglycemia is associated with violent behavior.
Mike the Mad Biologist advises: “WASH YOUR DAMN HANDS!”
The Scientist notes that vinegar can do us a lot of good: it helps resolve inflammation and tightens the intestinal barrier. These are among the reasons we include beneficial acids, like lemon juice and vinegar, in our Food Plate.
Chris Masterjohn notes that history affects how you’ll respond to a diet:
[I]f I eat a diet very low in muscle meats and rich in organ meats for a few months, I can go two months on a practically vegan diet, with maybe some oysters and clams here and there, and feel terrific. How we feel right now is not just influenced by what we ate today, but how we ate the last week, three months ago, six months ago, three years ago, and so on.
Nutritional deficiencies can take months or years to show an effect.
Stephan Guyenet added a section on genetic defects that produce obesity to his contra Taubes post. These experiments show that leptin pathways, not insulin pathways, are crucial; Stephan also quotes two papers arguing that since the genes in question are highly expressed in the brain, the brain is likely a crucial organ in obesity.
In another post, Stephan summarizes two early papers indicating the existence of a fat mass setpoint that regulates appetite. One of the papers says:
In the present experiment, the subjects reduced their intake voluntarily and were always in good spirits, while in the previous experiment, the subjects had to continually fight off their hunger and would spend the night dreaming of food.
And Stephan comments:
That, ladies and gents, is the difference between someone who is at his setpoint and someone who is not.
This may be the most informative sentence Stephan has written so far. If hunger is the manifestation of a setpoint above current body weight, and lack of hunger the manifestation of a setpoint below current body weight, then the Perfect Health Diet seems to immediately reduce the setpoint to something close to normal weight for many people, because so many have reported hunger-free weight loss on our diet. As a result of this experience, Stephan’s post actually convinces me more than ever that the body’s nutritional status is a central influence upon appetite, and that being well nourished may be the key to weight loss. It also gives us easier experiments with which to test these theories: what reduces hunger better, a highly nourishing diet that is high in food reward, or a less nourishing diet that is bland and low in reward?
[2] Everything’s just ducky:
[3] Hospital epidemics: Hospitals are great places for microbes – lots of sick people eating bad food – and I expect we’ll see more stories like this one:
A strain of Klebsiella pneumoniae bacteria is sweeping a Dutch hospital, killing 28 people so far. The Dutch National Institute for Public Health and the Environment (RIVM) yesterday announced a set of genes for specific diagnosis of the strain, developed by scientists who mined the bacterium’s genome.
Dutch media reports that Maasstad hospital in Rotterdam has been reporting K. pneumoniae infections since late 2010. Since then, at least 80 patients have been infected and the hospital estimates that more than 2,000 may have been exposed to the bacteria.
The strain is resistant to many antibiotics, and also contains the gene for Oxa-48, an enzyme that allows it to resist the carpabenem antibiotics typically used to treat broad-spectrum antibiotic resistant Klebsiella.
We urgently need to relax the regulatory burdens on antibiotic development: see The FDA Is On The Side of the Microbes, Aug 11, 2010.
[4] Some beautiful photos: Taken by a Wisconsin law professor while hiking the Gaspé peninsula in Canada. Photos here. We’ve never hiked there, perhaps it’s time for a trip.
[5] Shou-Ching’s photo art:
[6] Not the weekly video: This lady, the dancer Lunga, must be one of Todd Hargrove’s better pupils:
[7] Video of the week: Stories of human-animal friendship can circulate for years on the Internet. A few years ago there was a story, published on April Fool’s Day in the French magazine Le magazine des voyages de pêche, claiming that a great white shark who had been freed from a net by a fisherman had then followed him for years making displays of affection.
The magazine photos may be seen in this video and the story of the hoax here.
But occasionally, there is a true story of human-animal cooperation and goodwill. Here’s one:
via this link:
So many good blog posts lately. I think that some bloggers are experiencing the positive effects of perceived peer scrutiny after Ancestral Health Symposium. I’m also glad that the body composition thing is getting more attention. Sweet deal.
You write hunger and setpoint: “It also gives us easier experiments with which to test these theories: what reduces hunger better, a highly nourishing diet that is high in food reward, or a less nourishing diet that is bland and low in reward?”
Of course, there are two other diets … a less nourishing diet that is high in food reward (aka the Western diet) and a highly nourishing diet that is bland/low in reward.
We know that on the first, people tend to gain weight. Presumably people might lose weight on the second, but that sure doesn’t sound like a good setup for lifetime compliance in our obesogenic environment.
On that point, did you see Kurt Harris’ comment on Stephan’s site?
“People in our culture of continuous serial entertainment hate the idea that food be demoted from entertainment to the moderate pleasure of satisfaction of hunger and refueling….
They LIKE thinking about food all the time.
Food Reward theory is really a much more deeply subversive idea idea than either carbohydrate or fat as the black monolith of obesity and disease.”
Sorry to read that about Lierre Keith.
Paul, I’m trying for a highly nourishing diet that is somewhat boring. I think the food I eat tastes good, and is nourishing, but I tend to eat a lot of the same things over and over and it gets a bit boring. But boring in a good way, for my health.
Hi Stabby,
I agree – the summer was quiet for a while, but a lot of good posts the last few weeks. Body composition is a key part of the obesity issue. Where does excess energy go? That’s also key.
Hi Beth,
Yes, the Western diet has already been tested and found wanting. Low food reward may work but have compliance issues.
So it does seem that a moderately rewarding, highly nourishing diet is worth a test, no?
I think a direct comparison would be of considerable scientific interest. We need to decrease the number of variables in play.
Can’t wait to hear your podcast! And I did enjoy that post of Stephan’s – I’m rather glad Gary prodded it out of him.
Hi Michelle,
I haven’t gotten bored yet, but I can see why some people would.
Boredom may not be the right word, but I do go through periods when food seems less attractive. Then I just eat less for a while, and eventually food becomes more attractive. I haven’t noticed a strong correlation to my weight.
Hi Emily,
I really liked Stephan’s post … the literature is so vast, it’s nice to get pointers to key papers from a specialist.
Hi Paul: have you read this paper? It would be great to get your take.
http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.2414.html#/access
Stan has a great post: http://stan-heretic.blogspot.com/2011/08/fat-disrupts-sugar-sensors-in-pancreas.html
Paul, I think the trick re the diet is “naturally” rewarding … not the hyper-reward that is introduced by what Stephan calls the “professionally designed industrial foods.” That said, I’m somewhat surprised that for Stephan, the issue is primarily (only?) about palatability and not about the downstream reward concerns (e.g., opiod peptides in wheat & dairy, linoleic acid and the endocannabinoids etc).
I’ve been following a program that’s very close to your PHD; I’ve been struck by the lack of hunger I experience (and that’s despite eating meals with fairly strong spices — I love Penzeys!).
Hi Scott,
I haven’t read that paper and I would probably have to read many other papers too to form a view about what it means for diet.
I do think it’s clear that lipotoxicity plays a role in the transition from obesity to diabetes, and they are showing that lipotoxicity in beta cells leads to a loss of ability to import glucose, properly glycosylate proteins, and sense glucose levels; and that these defects are actually present in diabetics.
Stan’s post is optimistic but as far as I can tell the research hasn’t progressed far enough to give any real indication about which diet minimizes danger (or which maximizes it). Still a lot of work to show which diets have which effects at which stages of the disease.
Since a glucose deficiency in beta cells is behind the problem, it’s not obvious to me that the Optimal Diet is a good solution. But further research is needed …
Hi Beth,
Our diet does seem very effective at minimizing hunger. I’m glad you’re having success.
I do think the body-brain interactions are crucial. Stephan has been very focused on the brain, but I expect he’ll expand his scope in the future. It’s naturally that he’d blog from his research specialty a bit.
Best, Paul
I find Stephan’s posts very interesting and it really has changed a lot of my previous beliefs about obesity, but I agree with Beth here that some questions should be answered on other factors of reward.
For example, people get addicted to narcotics because they are very “rewarding”, not because of flavor but due to effects on neurotransmitters in the brain.
Isn’t it a possibility too that there is something in the modern diet that can get in to the brain to cause a chemical reward, one that is not associated with flavor?
Hi Kris,
Yes, I think it’s not only possible but certain … something from the diet or from infections interacts with the brain to produce distorted reward signals.
Hi, the link to ‘The Scientist’ article on vinegar goes to an article about gut bacteria. It happened to be one of the most interesting and informative articles I’ve ever read about gut bacteria so I’m definitely not complaining but it would it be possible to get the vinegar link up as well? As a vinegarholic it would be good to see some science rather than just apple cider vinegar folklore.
Hi Josh,
The link is correct. Acetate is a byproduct of bacterial metabolism in the gut, they can’t metabolize it in the absence of oxygen. It’s also what acetic acid — the main component of vinegar — becomes in the body. So you can get acetate from either vinegar or gut bacteria. The story discusses the benefits of acetate.
Sorry if the logic wasn’t clear.
Best, Paul
Regarding Melissa McEwen’s blog on colon mucosa: The statement is made that. . . “a high-protein low-carb low-fiber diet is harmful.” Butyrate is apparently available in such things as butter and parmesan cheese. So a low-fiber diet wouldn’t necessarily be harmful if butyrate is consumed in food?
Hi Marilyn,
Butyrate in butter and cheese is helpful, so the anti-dairy low-carb crowd is worse off than the pro-dairy low-carbers. But butyrate is only ~3% of butter and butter is probably less than 10% of calories; fiber can easily generate more butyrate than you would get from butter. So I’m not sure a low-fiber diet is adequate even if dairy is consumed.
It looks like the end of this sentence fell off:
“Jamie Scott looks at the question: do high-fat diets cause intestinal inflammation? This is an”
It is great to have you blogging again after your vacation… thanks for all the interesting material.
I have another explanation why the people reacted to the sweet liquid test as they did in Stephan’s Ponderostat-post:
When they dieted with restricted calories on the first test, the restricted carbs as well and that’s why they craved the sweet liquid more after the diet.
When they dieted with the bland liquid (Renutryl) their glycogen stores where full and that’s why they didn’t want the sweet liquid for a second round.
Renutryl has 72g of carbs per serving(300ml!): http://www.fatsecret.com/Diary.aspx?pa=fjrd&rid=1688514
Interesting. I bought The Vegetarian Myth when it first came out, but soon got fed up with the political agenda and didn’t finish it. Most of my used books go into book sales. VM went into a wastebasket.
Hi Rich,
Thanks! I fixed the last fragment. I had thought about saying more about Jamie’s post, then decided to just direct readers there.
Hi Franco,
It’s very possible … I think being well nourished in all nutrients including glucose is desirable on a weight loss diet.
Hi Paul,
I always look forward to PHD Around the Web.
I’m also curious of your thoughts re:
“Jamie Scott looks at the question: do high-fat diets cause intestinal inflammation?”
Thanks,
Mark
Something odd just happened to me which kind of fits in with all this, I just went through a period where food became a lot less attractive- first I was just having trouble thinking of what I wanted to eat, then I just wasn’t very hungry, and finally I lost all interest in food for a few weeks and had to force myself to gag down 800 calories or so each day. (This coincided with a bout of extreme anxiety and stress.)
Anyway I am coming out of it now and you would think my body would be famished for nutrient dense foods like what I normally eat- egg yolks, meat, raw milk, veggies, etc. BUT I am famished for junk food, the junkier the better, stuff I almost never eat. Like I am craving a coke (ok, I gave in and had a coke.) Tortilla chips fried in soybean oil. Crackers. Popcorn chicken from Sonic. I mean the worst stuff, that normally would just disgust me, is looking SO GOOD.
I’m not sure what happened. Does my body just want easy calories to make up for not eating for a while? Or did my reward pathways suddenly reset somehow? I hope it passes quickly.
Hi Mark,
My question/thoughts were well put by Victoria / vlprince in the comments.
Hi Tierney,
Very interesting. I think you have more or less the right questions. It seems plain the appetite/stress suppressed your appetite. Now, setpoint theory would say either there was weight loss which put you below your setpoint or there were changes to the brain that increased the setpoint … and once the stress was over and appetite returned, your brain considered itself way below the setpoint and wanted food reward NOW.
Presumably eating nutritious food will restore equilibrium.
Paul,
Do I run any risks of further colonization or resistant infection at a dosage of 50mg of fluconazole daily for 4 weeks? Do you recommend a higher dose? I have read alot of scary side effects from the drug… but I am guessing most of these come from endotoxins?
Bill
Hi Bill,
Well, more standard doses are 100 mg or 200 mg, but 50 mg should help. Even if some become resistant, the genetic changes will still tend to impair virulence and help you recover a bit.
Fungal cell wall components cause nasty toxicity effects and are the likely cause of any early, acute reaction. Fluconazole toxicity is generally much slower to develop. I personally haven’t noticed anything.
Hi Paul,
I just got your book a few days ago and I’ve been doing the PHD for about ten days now. A few days after I started including all the supplements, I started feeling sick with a headache and a stiff neck, and began running a fever of 100-101 for a few days. This is very unusual for me, I don’t remember the last time I had a fever. Do you think this is significant? I have been doing a more or less paleo diet for about six months now, so really what has changed is the aggressive supplementation.
I have severe psoriasis, which I have seen you mention can be linked to fungal infections. I know that you recommend not taking antibiotics until 3-4 months on the diet, do you think that I should wait a similar amount of time before taking any antifungals? Which of the therapeutic supplements would you recommend I take?
Thank you in advance for any advice you can give me.
Hi Matt,
I’d recommend stepping back for a moment and introducing supplements gradually. This will help you diagnose what may be causing the problem.
If supplements are at fault, the most likely candidate would probably be taking high doses of iodine too quickly; or some mix of other minerals (copper, selenium) that affected the thyroid. Increasing iodine too quickly can cause hyperthyroid symptoms which include feverish temperatures. Start with iodine at 500 mcg/day and wait a month before increasing.
If you know you have a fungal infection, then I would recommend taking antifungals right away. The waiting 3-4 months recommendation is for diseases of unknown cause; the symptoms often clarify as nutritional status improves.
Of the therapeutic supplements, NAC is good in most diseases; thiamin, riboflavin, B6, and biotin are the most likely B vitamins to help.
Hi Paul,
Thanks for your reply. The fever did roughly correspond to me taking iodine supplements, but I was and am only taking 450 micrograms. I’m feeling much better now, and have felt better each day since Sunday, my worst day, so I guess I’ll continue taking this level of iodine for another month or so then maybe double it.
I don’t know that I have a fungal infection, I just read your comment that psoriasis is often associated with fungal infections. Should I do tests or self-experiments to help clarify the situation? Or is having psoriasis enough of a clue that taking an antifungal is warranted? If so, do you recommend a specific antifungal or class of antifungal?
Thanks again for taking the time to answer.
Hi Matt,
It could have been a transient adaptation to the higher iodine intake. I had similar symptoms each time I increased the dose through 3 mg, after that dose increases gave no symptoms. The thyroid is especially sensitive to iodine in deficiency conditions.
Re the psoriasis, the simplest thing to try is topical antifungals. In my experience about 50% of topical antifungals don’t work at all even on a known fungal infection, and so you have to try a number of different ones, but there are several kinds available over the counter in any pharmacy, and you can get other prescription varieties. Also, topical iodine (eg Betadine in your pharmacy) is likely to work, you might try this in test spots that are hidden by clothing.
Systemic antifungals can also help, but you may wish to test the topicals and progress in the diet first.
Vitamin D is crucial for fungal immunity so make sure 25OHD levels are normal.
Best, Paul
Hi Matt, Paul
Going from 4*150mcg Iodine from kelp to 4*225mcg Iodine from Potassium-Iodine gives me similar symptoms as Matt: Stiff Neck, headaches and probably a light fever.
Both supplements are from the brand “Now foods”.
The headaches start about 2-3 hours after taking the supplements.
It has been like this for 3 days now. I will try another day or two and if the headaches have not subsided I will reduce the dosage.