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Healthy Eating Myths

A Dec. 2013 health column in my local paper, The Tennessean, authored by Julian Hayes II, a Nashville fitness and lifestyle coach, was titled: “Nutritional Myths You Can Stop Stressing Over.” Having recently published, What About My Weight? I’m compelled to offer commentary on Mr. Hayes’ myth busting. I’ll take them one at a time, and remember, these are—from the article’s perspective—myths, his position being the opposite of the assertion presented:


Mr. Hayes’ take: Meal timing isn’t important; skipping breakfast is a way to “intermittently fast,” which he cites to be beneficial; feel free to skip it if you want.

My take: There are seeds of truth here but I largely disagree. Let me offer as preface, though, to all my comments—a basic tenet of What About My Weight? is that we are all different. Different weight-loss/control strategies work for different people. So, if whatever you’re doing is working, great! Keep doing it. If it isn’t, try something different: like skipping breakfast or not, depending on where you started.

Anyway, I’m a big believer in breakfast. There is data, at least in diabetics, that blood sugar control and weight loss is aided by eating breakfast, and skipping or limiting supper, in support of the adage, “Eat breakfast like a king, lunch like a prince, and supper like a pauper.” This plan also allows intermittent fasting (little or no intake from lunch to breakfast), and I agree limited fasting is beneficial. It offers an opportunity to lower calorie intake, yes, but there is a more complex aspect. Leptin levels rise (this is a hormone produced by fat tissue) when we eat and store fat. This signals the brain to shut down appetite, so we don’t overeat. Leptin levels fall when we fast, and appetite returns. Modern Western excess-eating habits have created a situation where leptin levels are high all the time (that is, we eat round the clock, never seeing a true fasting state). The brain ignores those constantly high levels and appetite never shuts off; it’s the rising and falling of leptin that is important to appetite control, not absolute levels.

So, Mr. Hayes and I agree that skipping a meal is a good thing. Is breakfast the best one to skip? My own experience is that a big breakfast satisfies to lunch, fueling the most active part of the work day (assuming a tradition 9-to-5-type schedule) without need for snacking. A decent-size lunch does the same for the afternoon, and by the time you’re home relaxing, there isn’t as great a need for all that fuel.

One argument against meal timing is that calorie intake minus output determines body weight—it’s all in the math, and doesn’t matter what hour of the day the calories get consumed. Physiologically, this is true. But I think thoughtful meal-timing can help regulate the appetite, limit snacking as I described above. My strong feeling is that manipulating or “fooling” one’s appetite into eating less is at least as important, perhaps more so, than the math. In other words: if you eat a calorie, it matters not when you ate it, you’ll gain the same weight; meal-timing though might mean you never eat that calorie in the first place. See?


Mr. Hayes’ take: Eating 2000 calories in five meals is the same as eating it in two; quit timing and make your nutrition fit your preferred lifestyle.

My take: We largely agree, and the issues are not dissimilar to the last “myth.” Amongst my pet peeves, though, are experts pontificating about healthy living and healthy nutrition as if there were one set of rules, etched in concrete, for the whole genetically, medically diverse population. Everyone talks up diversity these days, but not so much in this arena. I can’t tell you how many patients I’ve had who are overweight and complaining they can’t lose weight, and in the next breath claim: “I’m eating right,” “I follow a healthy diet,” like any of that mattered. If it isn’t working try something different.

To that end I might say there may be people who for whatever reason get more satisfaction out of frequent small meals and might as a result eat less overall—but I do agree with Mr. Hayes that eating five or six meals a day is not good universal advice. His point about making nutrition fit with one’s preferred lifestyle is good as well, provided that lifestyle isn’t clearly unhealthy, like spending hours in front of the TV curled up with a big bag of Lay’s potato chips. I would add that the best nutritional strategies are ones incorporating one’s dietary preferences, and ethnic food background.


Mr. Hayes’ take: Barring certain health-issues (serious kidney disease would be an example) he advises a high protein intake.

My take: He’s 100 % right on this one. Protein slows absorption of carbs, helping diabetes control and making one feel fuller, longer, and less apt to overeat. Protein, together with resistance training increases muscle mass, and the more muscle you have the more calories you burn at rest. What was that? I said REST. Sure, exercising muscle burns calories, but for most of us—those not out running marathons, for instance—muscle tissue’s greatest contribution to weight control is its contribution to “resting energy expenditure,” which it huge. This point cannot be overemphasized—we all eat more than we need, that is, all mammals do. Overeating is natural, and if the metabolic engine is tuned correctly, resting muscle burns up much of the excess so we don’t gain weight.


Mr. Hayes take: Carbohydrates are necessary.

My take: Again, he’s right—carbs are the body’s major preferred fuel and it doesn’t take a medical degree to know we all need fuel as much as a car does. Furthermore, the brain—the body’s most important organ bar none, burns glucose (the major carb) exclusively. Except under very unusual circumstances, the brain must have glucose. So, no carbs is not an option. However, everybody is different and the devil is in the details. Many people overindulge in carbs and have been, wrongly encouraged to by all the haranguing about the evils of fat for the last 40 years.

One of our biggest nutritional problems, one of the major causes of the obesity and diabetes epidemics is the overconsumption of sugars, especially in the form of sweetened liquids, like sodas, juices, sweet teas. We simply must stop that, must get over our collective sweet tooth. It’s killing us.

And under the category, everybody’s different—some have diabetes, some don’t. A great many more are insulin resistant and at risk of diabetes (most people with a family history of diabetes fall in that category). If you are insulin resistant and/or have type 2 diabetes, the more carbs you eat or drink the higher your blood sugars and insulin levels will be, and high insulin levels begat weight gain. So, for that group, limiting (but not eliminating) carbs may be an important health habit, helping prevent obesity and diabetes. If you’re not one of those people, you can eat more carbs, but I’d still say everybody should limit the sweet beverages.


Mr. Hayes take: This sounds good for people with no social life, yet dinner is a popular time to get together with friends and family.

My take: I’ve indicated already that incorporating one’s preferred lifestyle into a nutritional plan is a good strategy for success. I’ve also pointed out the benefits—for those with diabetes at least, and perhaps others—of eating little or no supper. And while it is true that dinner is a popular time for socializing, that doesn’t make it healthy. On the other hand, I state in my book that were I to eat a substantial meal in the evening, I might want it to be higher in carbs/glycemic index. My rationale being that higher protein/fat meals during the day will be more satisfying and lessen the urge to snack—while at night those more filling meals might promote acid reflux and abdominal fullness that might interfere with sleep.

So, I agree with Mr. Hayes that there is no specific need to avoid carbs at night, but except for certain special occasions out, I do think the notion of limiting any type of calorie intake at night (not just carbs) has merit.


Mr. Hayes take: No one-size-fits-all diet; the best diet is one fitting your schedule, causes little stress, and you can stick to.

My take: I agree. Any attempt to give universal healthy-eating advice is complete folly and a major flaw with much nutritional pontification, including by doctors.

I disagree that schedule, stress inducement, and ease of adherence are absolute definers of the best diet. My definition of the “perfect diet” for a given individual is the one that works—the proof is in the pudding. If one starts with a diet that fits schedules, is unstressful, is easy to stick with, and that diet achieves one’s health and weight goals—great! If that diet doesn’t work, though, move on from there. The solution might not be easy—many worthwhile things aren’t.

My conclusions: We disagree in a few details, but overall Mr. Hayes’ view of nutrition is very insightful, nay, revolutionary, because, to quote his preamble to the column: “The image of getting in shape and eating healthy has become rigid and narrow minded.” And, “The tunnel-vision approach is outdated. You have options.” There is way too much posturing and pontificating by everyone—physicians, nutritionists, semi-quackish alternative-medicine providers, the government, the media, the public. I had a patient tell me she was following some diet plan and very successfully was losing weight. Then her friend told her, no, no, no, you have to cut carbs, or something or other. My patient listened and started regaining her weight. I told her, go back to what you were doing that was working and stop listening to oversimplified advice. One of the biggest challenges, I think, we have to overcome in the skillful practice of the art and science of medicine and healing, is our tendency toward hubris. Toward thinking we, any of us, can master the awesome complexity of human physiology. We can scratch the surface and often help our fellow man, but we mustn’t think any of this is simple, or completely manipulatable. Read More 
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New Guidelines Call for Wider Use of Weight Loss Drugs


As Interim Medical Director of NexSlim at MMC, I wanted to take this opportunity to update you on the just-published AACE (Amer. Assn. of Clinical Endocrinologists) Comprehensive Diabetes Algorithm, which includes sections on prediabetes management, glycemic control in T2DM, and dyslipidemia—each of which begins, no surprise, with lifestyle modification. But, in each case that recommendation expressly includes “medically assisted weight loss.” Further, a separate algorithm for overweight and obesity calls for “medical therapy” if BMI is greater than 27 with cardiometabolic or biomechanical complications of either low, medium, or high severity, if lifestyle modification fails to achieve goals. They specify this medical therapy can include phentermine, orlistat, lorcaserin, or phentermine/topiramate ER—the latter two being Belviq and Qsymia, both approved by the FDA in 2012.

I find these recommendations groundbreaking, and no doubt will be controversial. Use of anorectic drugs has a historically poor reputation, and has been fraught with toxicity issues—in fact, every drug introduced prior to 2012 for long-term use for weight loss has had to be withdrawn from the market for that purpose, starting with thyroid extracts 120 years ago. My own experience with anorectics is admittedly limited, nor have I been impressed with their efficacy to the extent that I have used them. To be sure, there are genuine concerns about a lack of long-term maintenance of any weight loss that is achieved, but lifestyle interventions have the same failing.

All that said, we need to sit up and take notice that a major mainstream medical organization is strongly calling for the use of these drugs as part of a comprehensive, multifaceted effort. This is a recognition, and a call to action, that mainstream clinicians need to be managing overweight/obesity seriously, and specifically, and with every tool in the box, not just with vague advice, if we are to curb the epidemic of obesity and obesity-related diseases.

In light of the new AACE guidelines, I ask you to give consideration to the use of medically supervised weight loss, to include anorectic drugs when appropriate. Perhaps if we all used these drugs more, and smartly, as part of a comprehensive effort, we might see better results from them. Too often patients use them in a vacuum and street-corner weight-loss clinics dispense them that way, such that their failure is inevitable—perhaps we can do better.

Additionally, the prediabetes portion of the AACE algorithm called for metformin or acarbose use in mild prediabetes not resolving with lifestyle change, and consideration of adding pioglitazone and/or a GLP-1 receptor agonist, like exenatide, if needed, in more severe cases (high fasting and post-meal glucoses, for example).

jkr  Read More 
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