Low Carb Down Under and carbs…

Second post in a week! What’s going on here? More exciting things to share, that’s what.

I had an opportunity to put my rusty public speaking skills to good use last weekend at the Low Carb Down Under Seminar series “What should we eat?”. I have written about it before and here is Jimmy Moore’s blog on his Aussie adventures. Today I just want to share my impressions on the event.

First off, I am sending my thanks to Dr Rod Tayler and Jamie Hayes for organising the event and inviting some excellent speakers and myself. I could not believe my eyes when I saw a packed conference room with a 200-strong eager crowd. Thank you all for  supporting the event. Here is a snippet of mine and Jamie’s talk courtesy Jimmy Moore. I understand that the full videos of all talks will be available at a later date.

The topic of my talk was somewhat tricky as I attempted to navigate murky waters between low carb and Paleo nutrition strategies. I may or may not have come up with my own definition of Paleo (everyone is hijacking that word, I might as well join the club!) and compromised on discussing the basics of evolutionary approach to health and disease.

BrisbaneTo be completely honest, I do not completely identify myself as “low carb” . On my very “Start here” page (more than 1.5 years ago) I wrote about my “meh” attitude to a rigid macronutrient ratio. I feel even stronger about this now. However, if you plug my diet into fitday.com I will definitely be in the low carb zone of 50-150g of carbohydrate a day. So it’s kinda low carb by default rather than by design.

In spite of the fact that the seminar itself was called LC and had the undisputed king of LC, Jimmy Moore, fronting the line-up, I did not get the impression of the narrow approach that we sometimes see pure low-carbers exhibit. The topics throughout Australia varied from environmental sustainability to oral health, from GAPS diet to the value of sleep. Jimmy himself is starting to turn more towards Paleo diet nowadays and I was delighted to hear of his health gains/weight loss recently (pardon the pun). I am not quite ready to dive into the nutritional ketosis debate just yet but I am wondering how much of his recent success is enhanced by better sleep (8-9 hrs up from 5hrs a night) and lean body mass gains due to his diet and strength training. Either way, Jimmy is a very passionate and genuine guy and I wish him all the best in health!

In fact, it was quite refreshing not to see arguments and petty disputes between various nutritional approaches. At least for now, we seem united in educating Australians in the value of REAL FOOD.

The word on the street is that the seminar may come back next year and I would definitely like to be a part of that. I would like to see a name change (sorry, Rod!) but maybe I am just being picky.

If you have not been able to make it to the Seminars (especially if you had recklessly decided to live in places like, say, Darwin) look out for the videos. On my part, I hope that our Whole9 South Pacific workshops will continue the trend for nutrition education in our region and build on this momentum.

Work, life, updates

It’s been pretty quiet on the blog recently. I have recently started my ED (emergency department) term and it has been quite decent. Most people imagine ED straight out of the episode of ER or Grey’s Anatomy: insanely chaotic with patients bleeding out of every orifice, relatives sobbing in the corridor, gurneys flying at warp speed and scrubs-clad doctors shouting “Epinephrine, STAT!” Errr… No. My small hospital is very civilised with crumbly oldies coming in with exacerbations of chronic conditions (COPD, heart failure, arrhythmia, diabetes), young lads with pub crawl injuries and a very occasional trauma. I feel like I inquired: “any burning or stinging on passing urine?” about a hundred times this last week. Just in case you thought the life of an ED doc was glamourous.

In addition to my ED duties I also share the out of hours cover of hospital wards on a rotating roster with other residents. This involves an occasional weekend shift, an evening cover or an all-night on call for operating theatres. On that note, a plea to women in the local area: please choose a decent time to require an urgent c-section other than 3am! And if you are having acute appendicitis please be so kind as to come to hospital during day hours. So inconsiderate.

Take into account food, sleep, exercise and personal life and I am left with about 15 mins a day for research, reading and blogging.

After experiencing massive nerdfest withdrawals post-AHS12 and Whole9 seminar I am now happily looking forward to another event in the ancestral/evomed community: Low Carb Down Under seminar series. If you are in Australia and reading this, you should definitely try to get involved. The event will bring together the inquisitive minds of doctors, nutritionists, fitness professionals, authors, media personalities and general public, keen to learn more about their bodies, nutrition and health. And then, of course, we’ll have the always galant Jimmy Moore and his wife Christine making a journey across the Pacific to be in all 5 cities.

Jamie Scott and I will be speaking at the Brisbane event (if we ever make it through a 7hr road trip without murdering each other).

Here is the outline of my little talk:

Why Paleo is the best low carb diet.

Anastasia will talk about the intersection of Paleolithic diets with low carb approach, point out the common misconceptions about Paleo vs LC and discuss the benefits of the evolutionary approach to LC diet and lifestyle.

Here is Jamie’s talk:

Pillow Talk: Taking low-carb living to the bedroom

When engaging in a low-carb lifestyle, people often meticulously plan every aspect of their diet. Yet rarely do we see this level of planning and regard for an aspect of our life that is absolutely vital to successful appetite regulation, and therefore, low-carb living; Sleep.

Nutritionist, Jamie Scott, will show you why your bed – and vitamin z – is as important to your diet as a well-stocked fridge.

If you can make it, feel free to come up and chat at the event. Otherwise, expect a blog post on my experiences.
There are a few things still brewing in that busy brain of mine so keep your open.

Something to read on your Sunday night:

1. Dr Rod Tayler, one of the organisers of LCDU, talks to 180 nutrition about his journey away from the conventional wisdom.
2. Jamie stupidly bravely takes on a food giant.
3. J. Stanton talks dental health.
4. A must see from Richard Dawkins: a 3 part series on life in an atheist world. Sex, Death and the Meaning of Life.

20121111-215717.jpg

A weekend trip to Elleborough Falls

Insulin: superhero or super villain?

 

OK (mentally rolling up my sleeves). I will try to make this as basic as possible, mainly not to confuse myself. To the biochemistry geeks: don’t pick on me. If you are a visual learner and don’t like reading too many words (good luck tackling “War and Peace”), scroll halfway down the page for the Insulin Action summary diagram.

It can be a revelation to realise that your metabolism (and therefore your weight) is regulated by hormones. Here you are, religiously counting your calories, looking up nutrition charts and calculating your necessary protein portions, and your own body doesn’t care one bit. I am sorry to break it to you but an uneducated old woman in a remote Russian village is doing a better job in controlling her weight than some of us are. I should know, she is my grandmother.

Insulin could be the most important hormone in our body.

How to keep a tight leash on glucose

The first thing you need to understand is that our blood sugar (=blood glucose) is kept in a narrow range. If it gets too low your body will start sweating, hands slightly shaking, heart rate goes up and you might become less pleasant to be around . If you are thinking that this sounds a lot like a first date, you are right. The same forces are at work here: hormones adrenaline and noradrenaline fire up your sympathetic autonomic nervous system, responsible for our ancient “fight or flight response”.

Other players like glucagon, growth hormone and thyroid hormone get involved. Their combined action is to raise your blood glucose back to normal by breaking down glycogen (stored glucose in the liver). Your body switches to preferentially burning fat for energy and ketones, produced from this process, are fed to the brain and to the heart.

Normally this would be the end of your troubles: blood sugar normalises, your body starts happily eating away on all that fat conveniently stored for such purposes. However, things can go wrong if you have injected yourself with a whopping dose of insulin or if your sympathetic nervous system doesn’t work. Blood sugar dips even lower, brain starts to starve without an energy source in the form of glucose or ketones, and you end up in a coma. Not nice.

High blood sugar is toxic

If your blood sugar gets too high, your body doesn’t like it either. To protect your brain and other cells from toxic effects of glucose, your pancreas release insulin. The primary job of insulin is to take glucose out of the blood and dump it into the cells which are prepared to take it. It sort of reminds me of when my boyfriend tries to clean the room. His main concern is only the mess that he can see: clothes get shoved into drawers, papers shuffled into a pile out of the way. (Don’t get me started on not vacuuming around random objects like a shoe box which because they are clearly too heavy for lifting).

Insulin sweeps the blood with the same nonchalant efficiency. It acts on specific receptors on the surface of muscle and fat cells, effectively opening the door and letting glucose into the cell. In a muscle cell, glucose can be used for energy or stored as muscle glycogen for later. In a fat cell, you guessed it, it is used for forming triglycerides, a.k.a fat. Insulin does not care that the “drawers” are full and you would prefer NOT to store any fat. All it cares about is neutralising the sugary sweet wave of glucose. If insulin did not do its job (like if you have type I or advanced type II diabetes), any high carbohydrate meal would leave you nauseated, confused, delirious and end up in a coma. All roads lead to Rome.

So to re-cap (biochemical terms in brackets).
High insulin =>blood sugar pushed into liver, muscle and fat cells (↑ glucose uptake)
=>blood sugar converted into its storage form the liver and muscle (↑ glycogen synthesis)
=>liver makes fatty acids and releases them as triglycerides (↑ fatty acid synthesis in the liver)
=>fat cells get fatter (↑ triglycerides synthesis in adipose tissue)

Insulin action summary

Incidentally, does anybody else think it’s interesting that we have a whole gang of hormones dealing with hypoglycemia (=low blood sugar) and only one dealing with hyperglycemia (=high blood sugar)? Could this mean that sky high glucose was a rare event from the evolutionary point of view and we didn’t need much back up? Hmmmmm…

So it’s actually quite simple. Let’s say you are a healthy 20-something with bulging biceps and metabolism buzzing like an Energizer bunny. You start your day with 7 weat-bix (because a paid athlete said so) with low-fat milk (because your girlfriend follows nutrition advice from Cleo magazine), washed down with a glass of orange juice. Almost 100g of carbohydrates makes your blood glucose go up, insulin rushes into the blood like a knight in shining armour. Blood glucose gets swept into the cells, and blood sugar levels settle back down. Insulin sticks around for a few more hours though. It tries to keep fat locked inside the fat cells and glycogen stored safely away in the liver and muscles. You have your protein shake “to prevent muscle breakdown” at 10.30am, raise your blood glucose again, your insulin is still up. You conscientiously top your blood glucose up every 2-3 hours because it is the healthy thing to do. Your pancreas happily spits out insulin necessary to cover this continuous influx of carbohydrate-rich food.

If you are young, fit and healthy, it doesn’t seem like a big deal.  Multiply this scenario by 365 in a year, add a few spikes of glucose around Christmas parties, birthdays, a huge sugar tsunami for your mate’s wedding, reduce physical activity, add liver inflammation from alcohol, fructose, vegetable oils. Then continue for the next 15, 20, 25 years. (Any of this reminds you of a family member or a friend?)
How long would it take your cells to develop resistance to these massive doses of insulin?
How long before your pancreas runs out of steam to push more insulin out?
How long before your knight-in-shining-armor-insulin becomes your worst enemy?

Medical degree = nutrition knowledge??

You are tired of diet contradictions in the media. You have had enough of celebrities who are “half their size! Learn how they did it!”. You have done your own research and now you are going to your family doctor, because you want answers. So, Doctor, is 1.5 g of protein per kilo enough for me if I am doing intervals and strength training 3 times a week? What do you think of Omega-3 composition of grass-fed meat vs grain-fed? How do I reduce my body fat while maintaining muscle mass and strength? You are getting a blank look. The eyes are glazing over. A hesitant hand reaches for a referral pad to a dietician…

Hey, they are doctors! They wear white coats and have stethoscopes around their necks! Don’t they learn this stuff? Let me tell you how much education on nutrition we ACTUALLY get in medical school.

Year 1. The age of innocence
- a lecture on triglycerides in diet. It details the cholesterol transport in all its chemical formulaic glory and exciting medications like statins which we can use to disrupt this process.
- one of the cardiology lectures briefly mentions that saturated fat and cholesterol cause coronary heart disease. A graph from Framingham heart study is flashed on screen. We are assured that it shows a relationship between blood cholesterol levels and heart attacks.

Year 2. Depth of lecture boredom
- endocrinology block introduces hormonal regulation of metabolism. A very dry and boring biochemistry lecture describes the relationship between insulin and glucagon.
- a couple of lectures by an obesity specialist. She talks about different strategies used for obese populations: high vs low carb diets, very low calorie diets, lap band surgery, behavioural strategies, more drugs. At the end she pessimistically concludes that none of the above work in the long term
- a very exciting lecture by Jennie Brand-Miller. She concedes that obesity is probably related to metabolic syndrome, mentions the role of carbs in developing insulin resistance. Then she enthusiastically talks about her research in glycemic index. We are told that to reduce the incidence and severity of diabetes we should recommend low GI diets. The lecture concludes with the slide of her book.
- a few lectures on diabetes management with a focus on medical (=drug) treatment.

Years 3-4 Unleashed onto unsuspecting public
Ahem. Nothing.
Oh, I got presented with a free patient and doctor information booklet on diabetes during my general practice rotation. It is written in a very clear, easy to understand language, colourful pictures, graphs and all. It is written by Pfizer, the pharmaceutical developer of Lipitor, the cholesterol-reducing medication which brought its happy executives $12.2bn in 2005.

 Does anybody else think that this is a bit like a car mechanic who blindly swears that he found a mechanical fault with your car and now you have to pay him $x to fix it? (I normally pay just in case because I don’t understand half of what he is saying and I am a little scared of all this stuff under the bonnet).

 Other than these delightful handouts from pharmaceutical companies, we are encouraged to visit websites like the Heart Foundation, the organisation which has just given its tick of approval to Milo cereal. ‘Nuff said.

Yes, there are others, who study nutrition in order to help their increasing (in size) patient population. But their knowledge is the result of a conscious effort, not an automatic consequence of a medical degree. They are worth their weight in gold when you find them. Because apart from being diet-savvy, they clearly possess humility to acknowledge what they don’t know.

 So what does your doctor know about nutrition?

 Disclaimer: other medical schools might provide more teaching on lifestyle modification. Also, I might have had a microsleep in one of these lectures and missed some pearls of nutritional wisdom. This is not intended as a personal attack on any individual physicians. This is merely an illustration that unless doctors are interested enough to search for truth themselves, you are getting second-hand information.

Consider yourself a nutrition expert? Take a quiz and find out!

When it comes to nutrition and weight loss, we are all experts. Thanks to Women’s Day, Men’s Health, body building sites and your Sunday paper, everyone has an opinion. Now is your chance to find out how much you actually know. The questions are based on basic biochemistry of human metabolism and therefore are not somebody’s point of view. They are simple hard facts you can find in any biochemistry or endocrinology textbook. Good luck!

1. The predominant fat in lard (pork fat) is:
A. Saturated
B. Monounsaturated
C. Polyunsaturated
D. I only buy margarine

2. Saturated fat consumption in the 20th century has:
A. Increased
B. Decreased
C. Unchanged
D. I haven’t seen saturated fat since I was 5

3. What component of the diet raises blood triglycerides the most?
A. Carbohydrates
B. Fat
C. Protein
D. I have never had a cholesterol/lipid blood test and have no idea what you are talking about

4. What is the effect of low-carb diet on HDL (“good cholesterol”)?
A. Increases HDL
B. Decreases HDL
C. No change
D. Low-carb diets are a fad and I will never try one

5. Estimate the glycemic index of the following foods (guess to the nearest 10 or choose low/medium/high):
A. “Frosties” breakfast cereal
B. Boiled potato
C. Eggs
D. Peanut M&M’s
E. Muesli bar with dried fruit
F. Super supreme pan pizza

6. Most of the blood cholesterol comes from your diet:
True
False

7. What is the preferred fuel for the heart?
A. Carbohydrates
B. Fat
C. Protein
D. Love

8. Which foods contain the most Vitamin A:
A. Carrots
B. Milk
C. Eggs
D. Liver

9. What happens in your body if you don’t get a carbohydrate fix 4 hours after your last meal? (in a healthy individual)
A. You go delirious and slip into a coma
B. You start burning your hard-earned muscle undoing all the work in the gym
C. Your body activates hormones which start burning body fat for energy sparing muscle proteins
D. This travesty has never occurred since you always carry a cereal bar for such occasions

10. What is the difference between saturated and trans fats?
A. There is no difference, they both cause heart attacks
B. There is no difference as they are both solid
C. Trans fats are man-made by hydrogenation, saturated fats are abundant in nature
D. I don’t know but this quiz has made me hungry

Answers in the next post!