So, lets get an idea of what we’ll be going over and some basic ideas and principles. And to put things in perspective, I am tackling this from an MD’s point of view. I am not in the business of making people lose weight, I’m not a personal trainer, I don’t have a healthy recipe book to sell, and I don’t run a lucrative organic farm (not sure those exist). I am doing this because I think it is important to look at medicine and health care from the ground up, and make sure we are doing things right. The steady rise in chronic disease and the epidemic of obesity tells us that clearly, we are not doing so.
The principles that apply to sick humans should also apply to those who are well and wanting to remain so. The idea of optimal nutrition ties in to healing injuries and optimal performance as well.
This is an exceedingly complex field, I do not pretend to have completely understood it, but I have seen a lot of consistent signals in media, literature and among trusted friends and colleagues in the last years, and mostly in the last months when I have focused a fair bit of my reading of medical literature on the topic. There is something there that is largely being ignored both by the general public and the health care professionals.
So let’s get started…with some ideas, some starting points:
- Nutrition as is generally discussed in the developed world, including most medical practice, has very little true scientific basis. It is more historic and cultural-based. It is time to review this.
- Certain paradigms need to be challenged and re-thought. In the ICU and in acute care, in the outpatient world and in that of the healthy humans. We are all healthy until we get sick.
- In chronic disease, the importance of nutrition and the therapeutic impact is much, much undervalued and under-appreciated, and the truth is that most professionals in the health care system – doctors included – have no more than a rudimentary understanding of nutrition, and the little that was taught to them was, as stated above, shoddy from a scientific standpoint.
- Our digestive system and body is so much more complex than we think and know. It isn’t just what goes in and what is used, but the individual’s particular genetic traits, current state of health, his or her microbiome (the billions of microbes in our intestines), and the time and frequency of what goes in.
- Physiology is controlled by hormones and neurotransmitters.
So first, ditch the whole calorie concept. It is utter nonsense. Indeed, as Jason Fung says, we do not have calorie receptors. Calories are a measure of thermodynamic energy, which we are utterly unable to handle, store, collect, etc. The human body simply does not work that way. There are a lot of calories in wood, but we are unable to extract anything from it at all. We absorb glucose, fructose, fatty acids, amino acids, water, vitamins and minerals. So the calories in-calories out is irrelevant from a physiology standpoint. Can it work for people trying to lose weight? To some degree, as it will likely bring on a state of being more mindful of what one eats. But if you truly want to understand nutrition, you have to look elsewhere.
In the case of metabolic syndrome, which has become the scourge of developed countries, the real evildoer is insulin.
Wait, but isn’t insulin something important? Required to control blood glucose, etc? If you don’t have any or enough, aren’t you diabetic? Yup. All true. For those who develop the metabolic syndrome, a strong driving force is insulin. How? Chronically elevated insulin levels required to control blood glucose levels will have two main effects over time:
- increased adipose tissue – insulin is a storage/growth hormone. Turned on by excess glucose, it shifts metabolism towards the synthesis of glycogen (short term energy stores), and when this is maximized, the liver makes fatty acids, in turn taken in by adipocytes (fat cells) and used to synthesize triglycerides. The breakdown of fats is also inhibited by insulin.
- a progressive development of insulin resistance. Why is this important? Because over time, this will cause increased serum insulin levels, as the body will need to make more insulin for the same level of blood glucose control.
We can see how this sets up a vicious cycle that ends up in weight gain and, more importantly, the metabolic syndrome… And we all know the far-reaching and myriad of clinical consequences this will have.
Love to hear comments and ideas!
Next post: understanding the hormonal modes involved in nutrition, and some podcats discussions!
Some interesting stuff by some actually smart people:
Jason Fung’s The Obesity Code and The Complete Guide to Fasting
Tim Ferriss’s The Four Hour Body