ACCRAC: The Obesity Code Book Review

This podcast episode was so good and free in knowledge, I decided to listen again and write notes to share. Jed Wolpaw decides to review a book authored by nephrologist Jason Fung. The author also manages the diet of obese patients in a special program and thus has hands-on knowledge/experience to what he's doing (along with access and reviews of various literature).

Interesting points of the author highlighted by Jed (that may or may not be true as research slowly progresses on, as nutrition is difficult to make really good strong studies and the higher authorities have a a knack of making literally wrong recommendations):

1. The low-fat, low-cholesterol, high-grain diet is unscientific and mostly just wrong. The problem is that when it's incorporated in guidelines, it takes time to reverse the wrong advice.
2. Not all calories are the same. Sugar calories are most problematic as they cause high insulin and insulin resistance, which is the crux of the problem; insulin is the main culprit
3. Exercise is important, but the diet is what counts. The body can conserve energy very well, and therefore you'll burn less calories than you think, especially at rest.
4. Persistently high insulin levels from constant eating (including even calorie free sugar substitutes) leads to eventual resistance, leading to a feed-forward spiral of higher insulin levels yet higher resistance. Apparently insulin levels determine the body's "set weight"; with higher insulin levels, the body tries to keep it's set weight higher. The key to weight loss is to keep insulin levels low to reset the set weight lower.
5. Apparently intermittent fasting lowers insulin levels, insulin resistance and thus facilitates weight loss.
6. As fructose is only metabolized by the liver, it eventually leads to fatty liver which itself leads to insulin resistance
7. The book disagrees with constant small meals due to the aforementioned persistently high insulin levels even with the same number of calories
8. Anti-diabetic drugs that increase insulin all cause weight gain, and ditto for other drugs that may have the same effect
9. Sleep deprivation (via cortisol) also causes increased insulin
10. Protective foods to lower insulin: fibers, vinegar
11. The glycemic index is misleading. For example, fructose and Stevia have lower GI's but increases insulin resistance
12. Highly processed oils except olive oil are worse than saturated fats, e.g. butter (which may actually protect than harm), and "full" food options are better than skimmed.
13. Don't skip and make breakfast optional (as the body is adapted to not eat breakfast). Studies on breakfast and mental performance need to be taken with a pinch of salt.
14. No to sweetened beverages. Reduce refined grains
15. Moderate protein intake (it does increase insulin somewhat)
16. Increase natural fats
17. Fast. Muscle is not wasted until you reach low body fats (via increased GH). Your brain can use more than just glucose (ketones too). The BMR does not fall with fasting (apparently adaptive to supply energy for food hunting in times of low food). Hunger usually abates after a few days of acclimatization. Rebound binging rarely occurs with regular fasting. With a good diet, there is no shortage of nutrients. Hypoglycemia does not occur unless in type 1 diabetics as the body adapts to the utilization of fats. Many of these points are a part of established science for anesthesia. Fasting counterintuitively causes a sense of well-being. Muslims and others who practice regular fasting may attest to it.
18. Simply cutting calories overall does not work well as it drops the BMR.
19. This does not apply well to the critically ill, who have different nutritional needs.

I'm sure that I can/should incorporate some of this into my own daily life. It's always good to talk about primary prevention rather than expensive secondary/tertiary prevention of threats to health.

Random Thoughts (28/3/18)

1) Thinking of deleting Facebook? Here's some accounts of people managing a life less dominated by it. And if you really want to see how creepy Facebook is (I'm sure Google is just the same), go ahead and download how much it knows about you.

“You’ll see a detailed history of chats, phone numbers (wonder how it managed to get those because we don’t remember sharing ours) and much more – it’s like having your very own FB page, but offline.”

2) Medical schools should definitely prioritize nutrition and lifestyle education. Preventive medicine is a key tenet in achieving health. The only problem is that nutrition and exercise science does not have a robust research culture as clinical medicine. Low fat or no to low fat (I believe personally that intentional low fat causes more harm)? How much should we reduce salt (everyone agrees that we take too much sodium in general)? Are we facilitating a more active lifestyle? Cardio vs strength (both are good)? The dietary cholesterol debate (no correlation)? Pharma companies won't sponsor such studies, but they must be done nonetheless as they are intuitively effective and cost-saving. We have so many questions that need to be answered. And just in time, my friend shared this, which really encapsulates the problem with evidence-based health promotion.

“This movie displays all the great characteristics of really bad thinking. Confusing causation with correlation in clinical trials? Check. Cherry picking data to support your view while ignoring data to the contrary (i.e., “confirmation bias)? Check. Relying on “experts” who are selling books and seminars but have nothing to do with real science, as evidenced by their fundamental misunderstand of basic physiology (carbs can’t make you fat? diabetes is caused by chicken consumption?) –> Chickity check.”

3) People in Vietnam are publishing critical research on severe dengue, characterizing features (including serial echocardiography) that predict the risk of shock and pulmonary edema among such patients. How about us?

4) After so long not playing on the competitive Street Fighter 5 scene, Infiltration has been totally dominating out of nowhere.

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Random Thoughts (27/3/18)

1) Doctors really cannot treat their own family members: you must have that ability to emotionally disconnect from the patients (and only empathize, not sympathize; understand but not necessarily react emotionally) and make proper assessments, give proper advice and manage the case.  Let someone else professionally handle it. Even if your job involves the management of critically ill or terminally ill patients, it is not the same when it involves your own family member. Do you really want to be the one who will put in the lines, perform CPR, or terminally disconnect the ventilator? Do you want to be the one burdened with making a wrong diagnosis and decision? Disregard that this is coming from someone who did put in his own lines, gave emergency neb, applied a noninvasive ventilator to his own son and readily agreed to physically and chemically restrain him to facilitate therapy; I'm not normal. May those who are in such a situation be given peace with their situation.

2) When pursuing one’s goals there will always be competition and obstacles (both personal and interpersonal). So I sometimes think of surfing and bulldozing when it comes to investing into your goals will such issues. Surfing is when you work in line with whatever else is happening. Don’t fight the waves and follow the flow. If you’re always on the move, find a way to study while on the move. I'll bring my gym bag if going directly from work is at the end easier than going home first. It’s a friendly “manner” of ensuring that your priorities are attended to, in the sense that your goals are not the priority but are multitasked into the flow of things. Sometimes it’s difficult to get things done other than by bulldozing: forcing your way through (yourself and others) to work on your goals. Sometimes you have to grind during the odd hours or sacrifice social "obligations". There will be victims, but sometimes it’s needed. An optimum balance is what it takes between optimal performance and preservation of self and interpersonal relationships. And if possible, change the direction of the waves so that you’ll surf in the direction you wanted to. But if the goals don’t align, and you have to get your shit down, hunker down and bulldoze through.

3) After the MPA tourney last Nov, I made it a goal to get my weight below 90 kg without manipulation. So far I haven’t seen much success in achieving that goal; I'm weighing heavier around 92.5 kg, a 1 kg increase from my steady-state weight pre-competition. One problem I have is that my sleepiness (from poor sleep hygiene) causes increased hunger; this makes it difficult to maintain discipline and really control the carb intake on the non-lifting days. And I think I've been eating too much carbs anyways on those lifting days.

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