I'm really falling behind my stack of papers. Fortunately, life is good and busy, and there are always new, catchy songs to listen to:
The Temper Trap: Fader
That song really puts a spring in my step. Rather like a strong cup of coffee. Full disclosure - more of a tea person, but I've been known to drink a cup of joe every now and again. Maybe I ought to drink a bit more… the evidence is mixed, frankly. And certainly I can't tell you how many times I've had patients complain of insomnia, only to find out they are drinking 6 large iced coffees a day, or 12 Mountain Dews (no matter how much I exercise, I don't seem to be able to take this weight off, doctor…).
But what does the research say about, say, depression and coffee? A brand spanking new piece of epidemiology from the Nurses' Health Study was published in the Archives of Internal Medicine this month - Coffee, Caffeine, and Risk of Depression Among Women.
Some facts from the article - 80% of the caffeine in the world is consumed as coffee. Interesting. Prospective studies of men and caffeine use showed a strong inverse association between coffee drinking and depression, with no association for tea or cola. Three cohort studies showed an inverse relationship between coffee consumption and suicide (though in a Finish study, there was a J-shaped curve with both very high (>7 cups of coffee daily) and low consumption of coffee seemingly less protective than moderate amounts.)
So, in the Nurses' Health Study (following 121,700 American female nurses starting in 1976), women filled out questionnaires every two years. 97,000 filled out questionnaires in 1996, 98, or 2000, and those with no history of depression at that time (50,739 women) (those with unknown history were excluded) were followed over the next decade.
Regular coffee drinkers in this cohort were more likely to be smokers, drinkers, and not go to church! They also tended to have lower rates of diabetes and obesity. Average consumption for the whole group was about 1&1/2 cups of coffee a day.
Among the 51,000 women, about 2600 developed clinical depression in the 10 year period. There was a dose dependent, inverse relationship between the amount of coffee consumed and the risk of developing depression over the years. When covariates (such as age, health, smoking, divorces, etc. etc.) were all adjusted for, the inverse relationship became even stronger! No associations were found between tea consumption, chocolate consumption, decaf coffee, or soda consumption and depression.
So what's up? Is coffee an antidepressant?
I Know What I Am: Band of Skulls
Well, maybe. This is no randomized controlled trial, so causation cannot be determined, but caffeine (1,3,7-trimethylxanthine) antagonizes the adenosine A2A receptor. This is thought to have pro-dopamine effects. By taking out adenosine, we might also be affecting the transmission of norepinephrine and serotonin, both known targets of antidepressant medicines.
Since coffee is known to cause insomnia and anxiety, both features of depression, a weakness of the study is that women prone to insomnia and anxiety might limit their intake of coffee, thus biasing the results so that women who can tolerate a truckload of coffee also happen to be the ones less prone to depression.
But… all told, it seems that this study is another notch in coffee's bedpost. Though less than 8 cups a day seems prudent. And I really can't recommend Mountain Dew :)
Thursday, September 29, 2011
Wednesday, September 28, 2011
"Healthy" Food Options Lead to Unhealthy Food Choices
I mentioned several theories of obesity from low carb and Paleo gurus in a previous post. Today, I want to show some psychological reasons why people make poor food choices, potentially ending up obese. The theory of eating cues is not meant to replace any other theories about obesity, merely to supplement them. External triggers are very real.
Two important studies in the Journal of Consumer Research show why “healthy” choices in a restaurant may lead to unhealthy meal selection. Words like “healthy” are in quotations marks, as the dominant paradigm of these studies is that low fat, high carb is good and high fat is bad. We Paleo and low carb types know better. Still, they make for very interesting reading and offer yet another reason why obesity may be increasing.
Two important studies in the Journal of Consumer Research show why “healthy” choices in a restaurant may lead to unhealthy meal selection. Words like “healthy” are in quotations marks, as the dominant paradigm of these studies is that low fat, high carb is good and high fat is bad. We Paleo and low carb types know better. Still, they make for very interesting reading and offer yet another reason why obesity may be increasing.
In the first study, consumers who went to Subway believed they were eating healthy food. This led to choosing a “healthy” sandwich, but several “unhealthy” sides, such as sugary drinks and cookies. When asked to estimate the number of calories they consumed, they estimated, on average, 35% fewer calories than they actually consumed. They did not make this magnitude of error estimating calories when eating at McDonald’s. Subway is permeated by a “health halo” that implies all of the menu items at Subway are healthy. In reality, some sandwiches have more calories than a Big Mac. At McDonald’s, people are not under the illusion that they are eating healthy foods, so they may actually consume fewer calories than at Subway.
A second study explains why this is happening. Consumers have a goal of eating healthier, and “healthy” items on the menu confirm their goal of healthy eating. The mere presence of a “healthy” menu choice does three things. First, it vicariously fulfills a desire or goal the make more “healthy” eating choices. Second, it focuses the consumer’s attention on the least healthy item in the choice set. And finally, it provides consumers with a license to indulge. Their goal of eating at a “healthy” restaurant is met, so they don’t actually have to eat in a “healthy” manner, just eat at a “healthy” restaurant. This is what focuses their attention on the unhealthy menu options and leads them to indulge, and this study demonstrates convincingly that this is even true with individuals who have a high degree of self-control. The authors of this paper demonstrated this effect in four different studies across different contexts. It also works in vending machines with more “healthy” options (sales of Snickers bars go up).
What does this all mean? In the rush to add “healthier” items to the menus at unhealthy restaurants, the net effect is an increase in sales of unhealthy items. When “healthy” items are not present, consumers make “wiser” decisions about their “healthy” food choices.
Tuesday, September 27, 2011
Why We Get Fat, According to...
Gary Taubes blames carbs, especially the refined carbs like wheat and sugar.
Laura Dolson is generally with Taubes on the refined carbs, but she also blames marketing.
<Rant>
As a marketing professor, I find straw men arguments like this patently ridiculous. Marketing is not all powerful; if it were, I would have created a junk product and marketed it to all of you idiots out there, who would have bought it. You wouldn't have a choice; marketing would have forced you to buy it, and I could retire in style to the French Riviera. Unfortunately, life isn't like that. Consumers have brains and can choose to not purchase marketed products. Up to 95% of new products fail, despite massive amounts of marketing. The influence of the home can swamp any marketing campaign. Massive amounts of food industry marketing do not work on me, for example, or the example I set in my family. I have a brain and I choose differently.
Also, does marketing/advertising create food attitudes, or merely reflect already existing attitudes in people? Any competent social scientist will tell you it is very hard to change behavior. While I think marketing can help to create attitudes, it mostly reflects what already exists. Take smoking, for example. Reasons people smoke include parental example/rebellion against parents; peer pressure; stress and anxiety reductions; desire to lose weight, etc. Marketing, though often blamed for smoking (Exhibit A: Joe Camel), is not even mentioned as a factor (I would argue that marketing only informs brand choice, not the decision to smoke). Get real, folks. Marketing is just not as powerful as you would like to believe. It may be a convenient whipping boy, but your belief in the absolute power of marketing is a fantasy.
</Rant>
Kurt Harris blames the Neolithic Agents of Disease, including fructose, wheat, and seed oils.
Stephan Guyenet blames highly palatable food choices for weight gain.
Paul Jaminet blames malnutrition, dietary toxins, and infections for obesity.
Chris Kresser says there is no single cause of or treatment for obesity. Later, he says that modern lifestyle + genetic predisposition = obesity.
What do I believe? I used to believe Gary Taubes, because the solution he proposed worked for me, to a point. Harris, Jaminet, and Kresser are all singing variations of the same tune, so I suppose I am in their camp now. I am following the Perfect Health Diet, though I am stalled at the moment. They seem the most reasonable, the most scientifically based, even though I have criticized science as a justifying principle for belief. But I guess I have to hang my hat somewhere.
Laura Dolson is generally with Taubes on the refined carbs, but she also blames marketing.
<Rant>
As a marketing professor, I find straw men arguments like this patently ridiculous. Marketing is not all powerful; if it were, I would have created a junk product and marketed it to all of you idiots out there, who would have bought it. You wouldn't have a choice; marketing would have forced you to buy it, and I could retire in style to the French Riviera. Unfortunately, life isn't like that. Consumers have brains and can choose to not purchase marketed products. Up to 95% of new products fail, despite massive amounts of marketing. The influence of the home can swamp any marketing campaign. Massive amounts of food industry marketing do not work on me, for example, or the example I set in my family. I have a brain and I choose differently.
Also, does marketing/advertising create food attitudes, or merely reflect already existing attitudes in people? Any competent social scientist will tell you it is very hard to change behavior. While I think marketing can help to create attitudes, it mostly reflects what already exists. Take smoking, for example. Reasons people smoke include parental example/rebellion against parents; peer pressure; stress and anxiety reductions; desire to lose weight, etc. Marketing, though often blamed for smoking (Exhibit A: Joe Camel), is not even mentioned as a factor (I would argue that marketing only informs brand choice, not the decision to smoke). Get real, folks. Marketing is just not as powerful as you would like to believe. It may be a convenient whipping boy, but your belief in the absolute power of marketing is a fantasy.
</Rant>
Kurt Harris blames the Neolithic Agents of Disease, including fructose, wheat, and seed oils.
Stephan Guyenet blames highly palatable food choices for weight gain.
Paul Jaminet blames malnutrition, dietary toxins, and infections for obesity.
Chris Kresser says there is no single cause of or treatment for obesity. Later, he says that modern lifestyle + genetic predisposition = obesity.
What do I believe? I used to believe Gary Taubes, because the solution he proposed worked for me, to a point. Harris, Jaminet, and Kresser are all singing variations of the same tune, so I suppose I am in their camp now. I am following the Perfect Health Diet, though I am stalled at the moment. They seem the most reasonable, the most scientifically based, even though I have criticized science as a justifying principle for belief. But I guess I have to hang my hat somewhere.
Saturday, September 24, 2011
Anger and Serotonin
My buddy Jamie Scott is a research machine. It's all I can do to keep up with the interesting papers and links he emails my direction. Today's article is yet another one we owe to his sharp eye. He also has brand new digs at a wordpress blog (*brief moment of jealousy*) - so edit/add him to your blogroll and check it out:
Some music - I rather adore the Yeah Yeah Yeahs. Here's an oldie but a goodie: Gold Lion (right click to open in new tab). Favorite comment on youtube: "i think I just got whiplash rocking out to this song" [sic].
Want something a bit more classical? How about a Chopin Nocturne played by none other than Rachmaninoff from 1927? (You will not be rocking out, but it is quite lovely).
The paper is in Biological Psychiatry: Effects of Acute Tryptophan Depletion on Prefrontal-Amygdala Connectivity While Viewing Facial Signals of
It's kinda cool. Involves humans, which is always a plus. It is one of those "view angry faces whilst in a functional MRI machine" which has some limitations, but it is pretty much the only way to see what's going on in real time in the old noggin, seeing as how it's rather awkward to test gene expression and neurotransmitter levels other ways without decapitation (not likely to pass the institutional review board any time soon, unless you were unfortunate enough to be born as a research rodent). (Random aside - Andrew tweeted this REAL MIND READING finding yesterday. Wow.)
How many segues is that? Welcome to my left-handed, small child-raising brain. As we know, depletions in serotonin, especially in a particular communication circuit between the frontal lobes (the policeman) and the amygdala (the emotional/rage center of the brain) leads to anger and aggressive behaviors. Now, there are some people who are just aggressive altogether - I'm thinking Drew Barrymore's boyfriend in one of the Charlie's Angels movies. We're not talking about that. We're talking about impulsive aggression. All the sudden, you just want to jump out of your car and strangle the other driver who cut you off (please don't do this). Impulsive aggression can be unexpected and very scary, and can certainly ruin lives.
So what if it happens just because you forgot to eat your banana this morning??? Oh, don't worry, we are likely more resilient than all that… but in an experimental setting, one can pretty much abolish serotonin via a weird laboratory tryptophan-depleting drink. Then you get into an MRI machine. Then you look at pictures of angry faces (if I were running this experiment, I would pipe in some hard core metal, and not one of Chopin's Nocturnes). Of course, I read A Clockwork Orange in high school. The tryptophan-depleting drink significantly reduced both plasma tryptophan levels (remember, tryptophan is the precursor to serotonin) and the ratio of tryptophan to other long-chain neutral amino acids (remember, tryptophan competes with these other amino acids for entrance into the brain).
In the end, the reactions of the tryptophan-depleted individuals to the angry faces vs. controls was statistically significant. Tryptophan-depleted folks had a higher response to the angry faces within the amygdala (the rage/anger part of the brain) compared to controls, and compared to the response to neutral faces. These findings would suggest that, as suspected, serotonin helps you chill out and assess the situation when faced with an angry hoarde.
Between the mind reading and the availability of a rapid acting tryptophan-depleting anger drink that will affect our aggressive reactions, I'm a little worried about the future of our free will. But I'll try to eat some protein, micronutrients, a banana, and put my trust in the incompetence of bureaucracy in order to be less paranoid.
Friday, September 23, 2011
Carbohydrates, Gut and Autism
If you haven't already, go read the latest Psychology Today post about Alzheimer's and High Blood Sugar and Alzheimer's and Omega3s. Page views on my Psychology Today posts help support the paper, toner, textbook, and time that goes into Evolutionary Psychiatry.
Jamie sent me this link from PLOS1 (which, admittedly, is not the Rolls Royce of journals, but does have some interesting stuff every now and again):
Hmm. The text is very large and doesn't seem amenable to editing. One more reason to move over to wordpress…
So y'all have heard of the GAPS diet, right? Natasha Campbell-Mcbride is a doctor who had a kid with autism. I haven't read her book yet, but the general theory is that folks with certain issues with gut microbiota and carbohydrate malabsorption will end up with psychological/psychiatric symptoms, including autism. Dr. Campbell-McBride had great success with this approach, as, apparently, do many others.
In this PLOS1 paper, patients with autism and patients with GI disturbances were examined for different carbohydrate malabsorption.
Kids with autism often have gastrointestinal problems (survey studies report comorbidities of 9-91%, which isn't all that useful a percentage spread, but certainly given clinical experience and thinking about autistic kids I know in the community, higher seems more likely than lower). Pathologic findings of gut issues in autistic kids include gastritis, esophagitis, inflammatory markers at the gut lining, gut lymphatic system hyperplasia, increased intestinal permeability, abnormal gut microbiota findings, increased enzyme secretion, and carbohydrate malabsorption. Indeed, autistic children with severe gastrointestinal symptoms are more likely to have severe autistic symptoms (1).
So what happens if you don't have efficient digestion of disaccharides, for example, for whatever reason (damage to gut, unlucky genes, other illness)? Well, any carbohydrate that goes undigested will float down and feed the hungry masses of gut bacteria. This feeding can result in bloating, discomfort, diarrhea, and proliferation of pathogenic bacteria, which can presumably affect both inflammation and behavior.
The researchers from the latest studies biopsied the intestines of autistic children with gastrointestinal symptoms (AUT-GI), finding the following (among other things:)
When there is a devastating illness with only supportive treatment, a harmless intervention, such as adjusting the types of carbohydrates in the diet (this will not be a completely "paleo" intervention - sweet potatoes, for example, are off limits on GAPS I believe - I will post some more when I get the book), seems to be an approach that ought to be supported and attempted. Sure, it might not help everyone, but what is there to lose?
Jamie sent me this link from PLOS1 (which, admittedly, is not the Rolls Royce of journals, but does have some interesting stuff every now and again):
Impaired Carbohydrate Digestion and Transport and Mucosal Dysbiosis in the Intestines of Children with Autism and Gastrointestinal Disturbances
Hmm. The text is very large and doesn't seem amenable to editing. One more reason to move over to wordpress…
So y'all have heard of the GAPS diet, right? Natasha Campbell-Mcbride is a doctor who had a kid with autism. I haven't read her book yet, but the general theory is that folks with certain issues with gut microbiota and carbohydrate malabsorption will end up with psychological/psychiatric symptoms, including autism. Dr. Campbell-McBride had great success with this approach, as, apparently, do many others.
In this PLOS1 paper, patients with autism and patients with GI disturbances were examined for different carbohydrate malabsorption.
Kids with autism often have gastrointestinal problems (survey studies report comorbidities of 9-91%, which isn't all that useful a percentage spread, but certainly given clinical experience and thinking about autistic kids I know in the community, higher seems more likely than lower). Pathologic findings of gut issues in autistic kids include gastritis, esophagitis, inflammatory markers at the gut lining, gut lymphatic system hyperplasia, increased intestinal permeability, abnormal gut microbiota findings, increased enzyme secretion, and carbohydrate malabsorption. Indeed, autistic children with severe gastrointestinal symptoms are more likely to have severe autistic symptoms (1).
So what happens if you don't have efficient digestion of disaccharides, for example, for whatever reason (damage to gut, unlucky genes, other illness)? Well, any carbohydrate that goes undigested will float down and feed the hungry masses of gut bacteria. This feeding can result in bloating, discomfort, diarrhea, and proliferation of pathogenic bacteria, which can presumably affect both inflammation and behavior.
The researchers from the latest studies biopsied the intestines of autistic children with gastrointestinal symptoms (AUT-GI), finding the following (among other things:)
Pyrosequencing analysis of mucoepithelial bacteria revealed significant multicomponent dysbiosis in AUT-GI children, including decreased levels of Bacteroidetes, an increase in the Firmicute/Bacteroidete ratio, increased cumulative levels of Firmicutes and Proteobacteria, and increased levels of bacteria in the class Betaproteobacteria...
Metabolic interactions between intestinal microflora and their hosts are only beginning to be understood. Nonetheless, there is already abundant evidence that microflora can have system-wide effects and influence immune responses, brain development and behavior.
When there is a devastating illness with only supportive treatment, a harmless intervention, such as adjusting the types of carbohydrates in the diet (this will not be a completely "paleo" intervention - sweet potatoes, for example, are off limits on GAPS I believe - I will post some more when I get the book), seems to be an approach that ought to be supported and attempted. Sure, it might not help everyone, but what is there to lose?
Large Containers, Large Plates
Yesterday, I wrote about research on chronic dieters and small package size. Today, I want to report on some research about large container size and its impact on eating.
Apparently, chronic dieters and their small packages aside, the larger the container, the more people will consume. This article reports on container size and palatability, and is one of Brian Wansink's infamous popcorn studies. Popcorn was given away during an early afternoon movie screening (just after lunch, so consumers would not be hungry) in either medium or large buckets. The popcorn was either freshly popped or stale (14 days old). But whether or not the popcorn was palatable was not the issue; consumers ate 45% more fresh popcorn from the big buckets and 33.6% more stale popcorn from the big buckets than from the medium buckets. The conclusion: container size is a powerful cue to how much you eat. There is another version of this popcorn study. In this second study, people who reported they disliked the stale popcorn still ate 61% more popcorn from a large rather than the medium container. Those who reported they liked the fresh popcorn ate 49% more popcorn from the large rather than the medium container. The conclusion: container size is a powerful cue for consumption. The bigger the container, the more will be consumed, whether the food is palatable or not.
Another, similar study was conducted to demonstrate the effects of plate size on portions. This video (select the menu button on the player and scroll to the last segment) explains the study. Basically, participants scoop pasta on to a small plate. Before they can take the plate to the table, they are distracted. During the distraction, the plate and food are surreptitiously weighed. The server then "accidentally" coughs or sneezes on the plate and offers the participant a second plate and has them scoop up more pasta. The catch: the second plate is much larger. Once again, the plate is surreptitiously weighed before the plate is taken away. The results: the same person scoops up 25% more pasta on to the larger plate rather than the smaller plate. The takeaway from the study: we are cued into how much to eat by plate size.
Are people in the low carb/paleo communities susceptible to these cues? You betcha. But as Brian Wansink, the author of the above studies, wrote in his book Mindless Eating, you can use these cues to your advantage. Serve your meals on smaller plates and "mindlessly" consume less. As I have mentioned previously, I have stalled on my low carb journey and need to cut calories. An easy way to do this is by using smaller containers and plates.
Apparently, chronic dieters and their small packages aside, the larger the container, the more people will consume. This article reports on container size and palatability, and is one of Brian Wansink's infamous popcorn studies. Popcorn was given away during an early afternoon movie screening (just after lunch, so consumers would not be hungry) in either medium or large buckets. The popcorn was either freshly popped or stale (14 days old). But whether or not the popcorn was palatable was not the issue; consumers ate 45% more fresh popcorn from the big buckets and 33.6% more stale popcorn from the big buckets than from the medium buckets. The conclusion: container size is a powerful cue to how much you eat. There is another version of this popcorn study. In this second study, people who reported they disliked the stale popcorn still ate 61% more popcorn from a large rather than the medium container. Those who reported they liked the fresh popcorn ate 49% more popcorn from the large rather than the medium container. The conclusion: container size is a powerful cue for consumption. The bigger the container, the more will be consumed, whether the food is palatable or not.
Another, similar study was conducted to demonstrate the effects of plate size on portions. This video (select the menu button on the player and scroll to the last segment) explains the study. Basically, participants scoop pasta on to a small plate. Before they can take the plate to the table, they are distracted. During the distraction, the plate and food are surreptitiously weighed. The server then "accidentally" coughs or sneezes on the plate and offers the participant a second plate and has them scoop up more pasta. The catch: the second plate is much larger. Once again, the plate is surreptitiously weighed before the plate is taken away. The results: the same person scoops up 25% more pasta on to the larger plate rather than the smaller plate. The takeaway from the study: we are cued into how much to eat by plate size.
Are people in the low carb/paleo communities susceptible to these cues? You betcha. But as Brian Wansink, the author of the above studies, wrote in his book Mindless Eating, you can use these cues to your advantage. Serve your meals on smaller plates and "mindlessly" consume less. As I have mentioned previously, I have stalled on my low carb journey and need to cut calories. An easy way to do this is by using smaller containers and plates.
Thursday, September 22, 2011
100-Calorie Food Packages and Low Carb
As my cousin Cathy once said, "When I think of all the reasons I eat, hunger has very little to do with it." How true. There is more psychology involved in eating than one may think, and there is a lot of interesting food research out there to report on. Not all of it is low carb or Paleo, but it is interesting nonetheless.
Since I am a marketing professor, I have decided to report on some of the interesting food research that I stumble across in the academic marketing literature. I will link to abstracts and full text articles whenever possible, though if you don't have academic access, you may not be able to pull up the full article. But fear not: I will summarize them in plain English and avoid the statistics and academic-speak.
Today's topic: diet "food" in 100-calorie packages. According to this article published in the Journal of Consumer Research, chronic dieters perceive that if a food, such as M&Ms, comes in a 100-calorie pack, it is a diet food. This perception can prompt chronic dieters to overeat the "diet food" contained in the 100-calorie pack. The authors caution dieters to be wary of "foods" contained in 100-calorie packs.
In a second study about small packages of food, this article, also in the same issue of the Journal of Consumer Research, shows that large packages trigger concerns of overeating in chronic dieters, but small packages do not trigger the same concerns. In fact, small packages actually encourage chronic dieters to eat more.
In this clever study, one group of participants had their dietary concerns "activated" by taking surveys about dieting and thinness and by being weighed and measured in front of mirrors. They were then asked to evaluate commercials during an episode of Friends. Another group was given the same task, but did not take the dieting surveys and were not weighed and measured prior to watching Friends. The research participants thought they would be evaluating TV advertisements, but that was really a distraction from the true purpose of the study. The researchers actually monitored how many potato chips participants consumed during the TV show.
The catch: the chips came in large bags and small bags. The group whose dietary concerns were activated by the survey and the weigh in did not consumer very many chips from the large bags, but ate a lot of chips from the small bags. The control group ate roughly the same amount of chips from large or small bags.
The takeaway: dieters actually consume more high-calorie snacks when they are in small packages rather than large packages.
So, combining the results from the two studies, dieters perceive food in 100-calorie packages to be diet food, and they will eat more of them, even if they are, in reality, high calorie snacks.
Do we in the low carb/Paleo communities fall prey to this, too? I know I have, in the past. For example, these 10 gram, 70% dark chocolate mignonettes each have three grams of carbs, one gram of fiber (for two net grams of carbs), 3 grams of saturated fat in the healthy cocoa butter, and 59 calories. Isn't that a perfect, low carb food? Yes--if you eat one piece. But if you perceive it to be "diet" food and overeat it, then no, it is not good for you and is in reality a high-calorie snack.
Since I am a marketing professor, I have decided to report on some of the interesting food research that I stumble across in the academic marketing literature. I will link to abstracts and full text articles whenever possible, though if you don't have academic access, you may not be able to pull up the full article. But fear not: I will summarize them in plain English and avoid the statistics and academic-speak.
Today's topic: diet "food" in 100-calorie packages. According to this article published in the Journal of Consumer Research, chronic dieters perceive that if a food, such as M&Ms, comes in a 100-calorie pack, it is a diet food. This perception can prompt chronic dieters to overeat the "diet food" contained in the 100-calorie pack. The authors caution dieters to be wary of "foods" contained in 100-calorie packs.
In a second study about small packages of food, this article, also in the same issue of the Journal of Consumer Research, shows that large packages trigger concerns of overeating in chronic dieters, but small packages do not trigger the same concerns. In fact, small packages actually encourage chronic dieters to eat more.
In this clever study, one group of participants had their dietary concerns "activated" by taking surveys about dieting and thinness and by being weighed and measured in front of mirrors. They were then asked to evaluate commercials during an episode of Friends. Another group was given the same task, but did not take the dieting surveys and were not weighed and measured prior to watching Friends. The research participants thought they would be evaluating TV advertisements, but that was really a distraction from the true purpose of the study. The researchers actually monitored how many potato chips participants consumed during the TV show.
The catch: the chips came in large bags and small bags. The group whose dietary concerns were activated by the survey and the weigh in did not consumer very many chips from the large bags, but ate a lot of chips from the small bags. The control group ate roughly the same amount of chips from large or small bags.
The takeaway: dieters actually consume more high-calorie snacks when they are in small packages rather than large packages.
So, combining the results from the two studies, dieters perceive food in 100-calorie packages to be diet food, and they will eat more of them, even if they are, in reality, high calorie snacks.
Do we in the low carb/Paleo communities fall prey to this, too? I know I have, in the past. For example, these 10 gram, 70% dark chocolate mignonettes each have three grams of carbs, one gram of fiber (for two net grams of carbs), 3 grams of saturated fat in the healthy cocoa butter, and 59 calories. Isn't that a perfect, low carb food? Yes--if you eat one piece. But if you perceive it to be "diet" food and overeat it, then no, it is not good for you and is in reality a high-calorie snack.
Wednesday, September 21, 2011
Justifying Principles
An epistemological question: why do people believe what they believe about low carb/paleo/ancestral ways of living? What are your justifying principles? I have written before about how tough it is to justify dietary dogmas. But I think I would like to revisit that question in more detail.
It seems to me that in the low carb world, the overarching belief is that "carbs are bad." Gary Taubes, at least as interpreted by his adherents, seems to be a big proponent of this philosophy. According to this view, carbs are fattening, and therefore, cutting carbs causes people to lose weight. But I have actually read Taubes' two main books, and while he is certainly down on carbs, he does seem to be especially down on fructose and refined carbs, not all carbs. Also, this theory is under attack, with many paleo and primal types rejecting it. As Chris Kresser pointed out, just because cutting carbs is a cure to obesity, it doesn't logically follow that carbs cause obesity. We are confusing a cure with a cause.
Yet, as I peruse the Internet, it seems to me the belief that carbs are fattening is widely held. I don't believe this and I personally think that we lose weight on a low carb diet because when we cut out sugar and refined carb products, we spontaneously consume fewer calories, as fat and protein (the foods with which we replace all those carbs we cut) are much more satiating. And limiting your intake of carbs cuts out an awful lot of food choices. That said, if you eat too much low carb food, you will gain weight, especially if you consume too much fat. Calories do matter.
What is the justifying principle for Paleo? Paleo types try to eat what they guess our Paleolithic ancestors ate. For example, J. Stanton of Gnolls.org suggests, "Eat like a predator, not like prey." Unlike low carb dieters, many Paleo adherents don't do dairy, because have you ever tried to milk a wild buffalo? But do we really know what our ancestors ate? It seems to me that a lot of Paleo adherents have a romanticized view of what our ancestors ate. Some Paleo adherents (e.g., Jaminet, Harris) advocate eating "safe" carbs, such as potatoes, rice, tapioca, etc., in addition to adding dairy. Apparently, Harris is currently eating 40% of his calories as carbs, including a lot of Rice Krispies and half and half (you'll have to listen to a rather long [but interesting!] podcast to hear him admit this).
My main problem with Paleo: its justifying principles are rather shaky. I can find all varieties of people who follow the "Paleo" lifestyle: those who do low carb Paleo; those who eat fruit, since not all ancient fruits were small, bitter, and low in sugar; those who will add some dairy to the previous list; those who will add dark chocolate; those who will add rice or potatoes; those who do vegetarian variants of the Paleo lifestyle; those who do low fat Paleo; and those who try to do some version of Paleo, but who cheat, a little or a lot. There have also been some high profile people quit the Paleo lifestyle, such as Don Matesz. Since there is so much argument about what our Paleolithic ancestors ate, it seems to me that members of the "Paleo" community are more united by what they avoid than by what they eat. They avoid things that make modern man sick, such as refined carbs, dairy, seed oils, processed foods, etc.
I actually appreciate all of the discussions within the Paleo community. As General George Patton once said, "If everyone's thinking the same thing, nobody is thinking." At least some thinking and progressing is going on in the Paleo community. Sometimes, it doesn't seem to me like as much thinking is going on in the low carb community. There does seem to be a lot of agreement in most Paleo camps that modern wheat, seed oils, refined carbs, and processed foods are not healthy to consume. The debate about dairy (fermented, cheese, cream), fruit, potatoes, rice, dark chocolate, etc., is actually very healthy. I know it has helped me change my mind on some topics. And at least they avoid nonsensical arguments like, "All carbs are fattening."
It seems to me that in the low carb world, the overarching belief is that "carbs are bad." Gary Taubes, at least as interpreted by his adherents, seems to be a big proponent of this philosophy. According to this view, carbs are fattening, and therefore, cutting carbs causes people to lose weight. But I have actually read Taubes' two main books, and while he is certainly down on carbs, he does seem to be especially down on fructose and refined carbs, not all carbs. Also, this theory is under attack, with many paleo and primal types rejecting it. As Chris Kresser pointed out, just because cutting carbs is a cure to obesity, it doesn't logically follow that carbs cause obesity. We are confusing a cure with a cause.
Yet, as I peruse the Internet, it seems to me the belief that carbs are fattening is widely held. I don't believe this and I personally think that we lose weight on a low carb diet because when we cut out sugar and refined carb products, we spontaneously consume fewer calories, as fat and protein (the foods with which we replace all those carbs we cut) are much more satiating. And limiting your intake of carbs cuts out an awful lot of food choices. That said, if you eat too much low carb food, you will gain weight, especially if you consume too much fat. Calories do matter.
What is the justifying principle for Paleo? Paleo types try to eat what they guess our Paleolithic ancestors ate. For example, J. Stanton of Gnolls.org suggests, "Eat like a predator, not like prey." Unlike low carb dieters, many Paleo adherents don't do dairy, because have you ever tried to milk a wild buffalo? But do we really know what our ancestors ate? It seems to me that a lot of Paleo adherents have a romanticized view of what our ancestors ate. Some Paleo adherents (e.g., Jaminet, Harris) advocate eating "safe" carbs, such as potatoes, rice, tapioca, etc., in addition to adding dairy. Apparently, Harris is currently eating 40% of his calories as carbs, including a lot of Rice Krispies and half and half (you'll have to listen to a rather long [but interesting!] podcast to hear him admit this).
My main problem with Paleo: its justifying principles are rather shaky. I can find all varieties of people who follow the "Paleo" lifestyle: those who do low carb Paleo; those who eat fruit, since not all ancient fruits were small, bitter, and low in sugar; those who will add some dairy to the previous list; those who will add dark chocolate; those who will add rice or potatoes; those who do vegetarian variants of the Paleo lifestyle; those who do low fat Paleo; and those who try to do some version of Paleo, but who cheat, a little or a lot. There have also been some high profile people quit the Paleo lifestyle, such as Don Matesz. Since there is so much argument about what our Paleolithic ancestors ate, it seems to me that members of the "Paleo" community are more united by what they avoid than by what they eat. They avoid things that make modern man sick, such as refined carbs, dairy, seed oils, processed foods, etc.
I actually appreciate all of the discussions within the Paleo community. As General George Patton once said, "If everyone's thinking the same thing, nobody is thinking." At least some thinking and progressing is going on in the Paleo community. Sometimes, it doesn't seem to me like as much thinking is going on in the low carb community. There does seem to be a lot of agreement in most Paleo camps that modern wheat, seed oils, refined carbs, and processed foods are not healthy to consume. The debate about dairy (fermented, cheese, cream), fruit, potatoes, rice, dark chocolate, etc., is actually very healthy. I know it has helped me change my mind on some topics. And at least they avoid nonsensical arguments like, "All carbs are fattening."
Tuesday, September 20, 2011
Stalled Again
I think I have officially stalled again. For one month now, I have been hanging around the 242-243 pound range. The good news is that almost without effort, my weight has stabilized in a range that is sixty pounds lower than when I started. The bad news is, I am still about 25 pounds away from goal.
Weight Watchers took me all the way down to goal, but it was a miserable experience. Low carb/paleo/Perfect Health Diet has been a much better, overall way to lose weight. I am healthier, I am not hungry, and my type II diabetes is effectively in remission. Yet, I cannot seem to get down to where I want to be. And this is a rather common problem when low carb dieting. What to do? I don't really know yet.
Weight Watchers took me all the way down to goal, but it was a miserable experience. Low carb/paleo/Perfect Health Diet has been a much better, overall way to lose weight. I am healthier, I am not hungry, and my type II diabetes is effectively in remission. Yet, I cannot seem to get down to where I want to be. And this is a rather common problem when low carb dieting. What to do? I don't really know yet.
Saturday, September 17, 2011
Why I Love Belgium, Part I
Belgium is a coastal country, with lots of seafood available, fresh. It is a land of French cuisine in the restaurants, without the French wait staff or attitude. And it is very, very easy for me as a low carb adherent to eat, even when I am on the road and have to eat out all the time. But it is even better when I can cook on my own.
The supermarkets sell all sorts of things, such as lamb, rabbit, duck, wild boar, and on the shelves it is easy to find offal (kidneys, heart, liver, brains, etc.). The eggs are almost all from free range chickens and some say, even on the box, that they don't throw your omega 3s and 6s out of balance. You can buy cheeses made from raw, unpasteurized milk, as well as yogurt, which is simply divine. And the selection of cheeses is enormous! The dark chocolate here is better, and a whole lot less expensive, than what we have to make do with in the states. But even better are the fresh food markets on the weekend.
The one in Antwerp is simply not to be missed. The quality of the vegetables, fruit, cheeses, butter, fish, meats, olives, olive oil, etc. is just amazing. I enjoy wandering around the market on Saturday morning and seeing all of the high quality food. Serious cooks know to get the best produce, fruits, and meat at the markets.
The supermarkets sell all sorts of things, such as lamb, rabbit, duck, wild boar, and on the shelves it is easy to find offal (kidneys, heart, liver, brains, etc.). The eggs are almost all from free range chickens and some say, even on the box, that they don't throw your omega 3s and 6s out of balance. You can buy cheeses made from raw, unpasteurized milk, as well as yogurt, which is simply divine. And the selection of cheeses is enormous! The dark chocolate here is better, and a whole lot less expensive, than what we have to make do with in the states. But even better are the fresh food markets on the weekend.
The one in Antwerp is simply not to be missed. The quality of the vegetables, fruit, cheeses, butter, fish, meats, olives, olive oil, etc. is just amazing. I enjoy wandering around the market on Saturday morning and seeing all of the high quality food. Serious cooks know to get the best produce, fruits, and meat at the markets.
Interesting Findings in Eating Disorders and Alzheimer's
First off, everyone take a couple of hours and hop on over to Robb Wolf's blog and listen to his podcast with Dr. Kurt Harris. As usual, Kurt pulls it all together with fun and flair and a hefty serving of common sense. He gives me and my blog a few mentions, which is very much appreciated, as always :)
I've been anticipating excitement hunting down a couple of papers that came out in the last couple of weeks - the first one: An Update on Hospitalizations for Eating Disorders, 1999-2009. As expected from a statistical brief, there is little there besides the numbers - so it is not all that exciting. Overall, eating disorders as a primary or secondary diagnoses have increased 24% in that period, cost of hospitalizations have increased 29%, and hospitalizations for children under 12 have increased 72%, and for people 45-65 88%, and for men 53%. Weirdly, hospitalizations for pica (compulsively eating non-food items, such as dirt or soap or whatever) have increased 93% but are still rather unusual. If you look at eating disorders as a "principal" diagnosis only, the number has actually fallen 1.8%, and I've seen some funny headlines as a result - "eating disorder hospitalizations fall, but pica hospitalizations double."
An important caveat is that these numbers are generated from billing codes. If someone comes to see me at the office, I am obligated (if I want to be paid by the insurance company) to generate a code based on a DSMIV diagnosis that I put on a billing form. The same is true for inpatient hospitalizations. And in the past 13 years, a number of states and the federal government have issued rules to prevent insurance companies from rejecting paying for psychiatric diagnoses that are so-called "biologic." This change is a part of the mental health parity act. "Biologic" diagnoses vary from state to state depending upon the laws, and even depending upon the insurance company, but generally include major depressive disorder, bipolar disorder, schizophrenia, etc. Sometimes anxiety disorders are not included. Addiction used to be not included, now it is I believe, and often autism and eating disorders are not included. Therefore if I am a doctor who would like to get paid and not have patients stuck with bills when they pay their insurance premiums, and someone meets criteria for major depressive disorder (MDD) AND an eating disorder (which in the inpatient world will very often be the case), the MDD will always be the "principal" diagnosis to avoid issues down the line. I know that anorexia is often more likely to be covered for inpatient care than bulimia, depending upon the medical status of the patient… in short, the overall trend of primary and secondary diagnoses and increase in men and children and older people I find very interesting more than the drop in "principal" diagnosis.
It is actually rather difficult and getting more difficult all the time to be hospitalized for psychiatric disorders in general. For the most part you must be an obvious imminent risk to self or others or completely unable to care for yourself in order to get a bed, which are in scarce supply. In 1999 it was easier to get the slightly less ill hospitalized. So with this background, I find it rather remarkable the eating disorder hospitalizations have increased to such a degree. Binge eating rarely results in psychiatric hospitalization, and outpatient rates of binge eating and bulimia are rising also (though inpatient bulimia hospitalization dropped - the severe cases are often readily managed in intensive outpatient day programs nowadays, however.) As obesity has also increased over the same period of time, I can't help but suspect the two trends are related, but I can't prove it.
The second article I was excited to hear about is probably a watershed paper in the treatment of Alzheimer's dementia: Intranasal Insulin Therapy for Alzheimer Disease and Amnestic Mild Cognitive Impairment. This paper discusses a pilot trial of 104 adults with amnestic mild cognitive impairment or Alzheimer's disease vs controls with a couple of doses of intranasal insulin.
Why intranasal? None of the subjects had diabetes, and obviously systemic insulin could cause dangerous hypoglycemia. The intranasal dose goes pretty much straight to the central nervous system via the olfactory and trigeminal nerve perivascular channels, and none of the subjects had hypoglycemia during the trial.
Why insulin? Well, as I've discussed at great length (I really ought to repost some of those dementia articles up on Psychology Today…), there are very clear issues with the ability of a dementing brain to metabolize glucose (the example in that article is Parkinson's disease, but the principle is very similar for Alzheimer's). This problem results in inefficient use of energy, free radical generation, and neuronal toxicity and death. There are several ways to (theoretically) improve this issue - one of them is to use a therapeutic ketogenic diet. The other way is to jack up insulin in the central nervous system to improve the ability of the cells to pull in and utilize glucose, theoretically. In addition, insulin seems to have an effect on amyloid-beta peptides that may protect the neurons, and insulin and insulin activity are generally low in the CNS of folks with dementia (though hyperinsulinemia with insulin resistance seems to be a long-term risk factor for developing Alzheimer's dementia eventually).
My question is - and this is highly speculative - without improving the energetics, does jacking up the insulin help in the short term but hasten the problems in the long term? No long term studies have been done. In the absence of insulin resistance and with insulin in the CNS low already, perhaps not? I'll have to think a little more on that one.
I've been anticipating excitement hunting down a couple of papers that came out in the last couple of weeks - the first one: An Update on Hospitalizations for Eating Disorders, 1999-2009. As expected from a statistical brief, there is little there besides the numbers - so it is not all that exciting. Overall, eating disorders as a primary or secondary diagnoses have increased 24% in that period, cost of hospitalizations have increased 29%, and hospitalizations for children under 12 have increased 72%, and for people 45-65 88%, and for men 53%. Weirdly, hospitalizations for pica (compulsively eating non-food items, such as dirt or soap or whatever) have increased 93% but are still rather unusual. If you look at eating disorders as a "principal" diagnosis only, the number has actually fallen 1.8%, and I've seen some funny headlines as a result - "eating disorder hospitalizations fall, but pica hospitalizations double."
An important caveat is that these numbers are generated from billing codes. If someone comes to see me at the office, I am obligated (if I want to be paid by the insurance company) to generate a code based on a DSMIV diagnosis that I put on a billing form. The same is true for inpatient hospitalizations. And in the past 13 years, a number of states and the federal government have issued rules to prevent insurance companies from rejecting paying for psychiatric diagnoses that are so-called "biologic." This change is a part of the mental health parity act. "Biologic" diagnoses vary from state to state depending upon the laws, and even depending upon the insurance company, but generally include major depressive disorder, bipolar disorder, schizophrenia, etc. Sometimes anxiety disorders are not included. Addiction used to be not included, now it is I believe, and often autism and eating disorders are not included. Therefore if I am a doctor who would like to get paid and not have patients stuck with bills when they pay their insurance premiums, and someone meets criteria for major depressive disorder (MDD) AND an eating disorder (which in the inpatient world will very often be the case), the MDD will always be the "principal" diagnosis to avoid issues down the line. I know that anorexia is often more likely to be covered for inpatient care than bulimia, depending upon the medical status of the patient… in short, the overall trend of primary and secondary diagnoses and increase in men and children and older people I find very interesting more than the drop in "principal" diagnosis.
It is actually rather difficult and getting more difficult all the time to be hospitalized for psychiatric disorders in general. For the most part you must be an obvious imminent risk to self or others or completely unable to care for yourself in order to get a bed, which are in scarce supply. In 1999 it was easier to get the slightly less ill hospitalized. So with this background, I find it rather remarkable the eating disorder hospitalizations have increased to such a degree. Binge eating rarely results in psychiatric hospitalization, and outpatient rates of binge eating and bulimia are rising also (though inpatient bulimia hospitalization dropped - the severe cases are often readily managed in intensive outpatient day programs nowadays, however.) As obesity has also increased over the same period of time, I can't help but suspect the two trends are related, but I can't prove it.
The second article I was excited to hear about is probably a watershed paper in the treatment of Alzheimer's dementia: Intranasal Insulin Therapy for Alzheimer Disease and Amnestic Mild Cognitive Impairment. This paper discusses a pilot trial of 104 adults with amnestic mild cognitive impairment or Alzheimer's disease vs controls with a couple of doses of intranasal insulin.
Why intranasal? None of the subjects had diabetes, and obviously systemic insulin could cause dangerous hypoglycemia. The intranasal dose goes pretty much straight to the central nervous system via the olfactory and trigeminal nerve perivascular channels, and none of the subjects had hypoglycemia during the trial.
Why insulin? Well, as I've discussed at great length (I really ought to repost some of those dementia articles up on Psychology Today…), there are very clear issues with the ability of a dementing brain to metabolize glucose (the example in that article is Parkinson's disease, but the principle is very similar for Alzheimer's). This problem results in inefficient use of energy, free radical generation, and neuronal toxicity and death. There are several ways to (theoretically) improve this issue - one of them is to use a therapeutic ketogenic diet. The other way is to jack up insulin in the central nervous system to improve the ability of the cells to pull in and utilize glucose, theoretically. In addition, insulin seems to have an effect on amyloid-beta peptides that may protect the neurons, and insulin and insulin activity are generally low in the CNS of folks with dementia (though hyperinsulinemia with insulin resistance seems to be a long-term risk factor for developing Alzheimer's dementia eventually).
My question is - and this is highly speculative - without improving the energetics, does jacking up the insulin help in the short term but hasten the problems in the long term? No long term studies have been done. In the absence of insulin resistance and with insulin in the CNS low already, perhaps not? I'll have to think a little more on that one.
Thursday, September 15, 2011
Back to School Again
I've started teaching my small section of the introduction to psychiatry class for the medical students again, which has added a measure of increased chaos to the week. Not always a bad thing. However, blogging frequency may diminish for the fall (but who knows - depends upon what I see that interests me, and the class time for the lectures I don't teach does give me time to catch up on some journals, as I'm not taking a test at the end of the semester, I don't always need to pay attention…)
A few weeks ago I recorded a podcast with Superhuman Armi Legge and Bulletproof Exec Dave Asprey. Here is the podcast, so enjoy! I'm not entirely certain I am a paleo "brain hacker" - I'm more into emulating the evolutionary milieu(™)* than throwing MCT oil and butter into coffee for a kickin' breakfast, but that could be my likely dairy intolerance talking. We all share enthusiasm and interest in human health - the search for optimization of human health and performance is preliminary but intriguing. Thanks for the opportunity, Armi and Dave! Very happy to be on your podcast.
I also have another post up on Psychology Today about vitamin D, birth weight, and schizophrenia. All clicks are very helpful and help me finance my textbook addiction.
A few interesting articles in the queue - stay tuned for brand new posts. In the mean time, here's a boppin' rock tune (can't get enough of it):
Brooklyn is Burning by Head Automatica
*lovin' Kurt Harris's new picture.
A few weeks ago I recorded a podcast with Superhuman Armi Legge and Bulletproof Exec Dave Asprey. Here is the podcast, so enjoy! I'm not entirely certain I am a paleo "brain hacker" - I'm more into emulating the evolutionary milieu(™)* than throwing MCT oil and butter into coffee for a kickin' breakfast, but that could be my likely dairy intolerance talking. We all share enthusiasm and interest in human health - the search for optimization of human health and performance is preliminary but intriguing. Thanks for the opportunity, Armi and Dave! Very happy to be on your podcast.
I also have another post up on Psychology Today about vitamin D, birth weight, and schizophrenia. All clicks are very helpful and help me finance my textbook addiction.
A few interesting articles in the queue - stay tuned for brand new posts. In the mean time, here's a boppin' rock tune (can't get enough of it):
Brooklyn is Burning by Head Automatica
*lovin' Kurt Harris's new picture.
Tuesday, September 13, 2011
Wheat Belly
I just completed Wheat Belly by William Davis, M.D., and wanted to give my two cents about it. Many reviews have already been written in the low carb blogosphere about the book, but I do believe I have something to add. I very much enjoyed the book and learned a lot about why we should avoid wheat.
The basic premise is that wheat has been genetically modified in the past 50 years into something very unhealthy. Dr. Davis lays out the case that consumption of this genetically modified franken-wheat leads to celiac disease, skin rashes, neurological disorders, diabetes, weight gain, etc. He calls it a "super carbohydrate" and singles it out for special attention because of how it spikes blood sugars and causes a lot of other problems. This part of the book was perhaps the most interesting to me, as I did not know a lot about modern wheat, even though it has been in the scientific literature for more than 30 years. Dr. Davis also recounts experiences from his practice as a cardiologist to back up what the literature is saying.
He goes on to describe what I considered to be a rather conventional low carb diet: cut the wheat and other things that spike your blood sugar, plus avoid vegetable oils. Eat meats, nuts, cheese, vegetables, berries, etc., but avoid processed foods. But I did find myself disagreeing with some of his low carb recommendations.
Though I didn't quite realize just how bad modern wheat is, I have realized that wheat is bad and have cut it from my diet for the past seven months. But I have also cut out sugar and vegetable oils and have been convinced about the dangers of the Neolithic Agents of Disease, as Kurt Harris likes to describe the harmful parts of our diet (e.g., wheat, sugar, vegetable oils).
Many people advocate a similar philosophy of eating. Davis condemns all forms of wheat, Taubes condemns sugar, and Enig condemns seed oils and the vilification of tropical and animal fats. Most low carb/paleo types would agree with avoiding these three categories. But there are variations in Davis' low carb diet recommendation.
For example, Davis permits chocolate; Sally Fallon says we should not eat it. Davis is okay with a bit of soy products in the diet, but others suggest avoiding all forms of soy, except some fermented soy products. Like the Perfect Health and the All Vegan Archevore (!) diets, Davis is okay with a small amount of potatoes and rice, if you can handle them, while others totally avoid (and even mock the concept of) "safe starches." Davis says certain legumes, like peanuts and natural peanut butter are okay; the Jaminets counsel us to avoid peanuts. Davis says don't eat wheat but Sally Fallon tells us we can consume properly prepared wheat. Mark Sisson says properly prepared wheat is probably okay to eat, but too much trouble to bother with. It's simply easier to avoid. Davis' arguments themselves focus more on modern wheat than ancient wheat, and he does not address at all the techniques Fallon and other advocate for properly preparing wheat for consumption.
I actually found myself saying, "I wouldn't eat that!" in response to some of the foods Davis says are okay in his version of a low carb diet (e.g., soy products, artificial sweeteners). So rather than adding clarity to my search for low carb wisdom (I already knew wheat was bad and avoided it), he actually ended up by muddling the already murky waters.
The basic premise is that wheat has been genetically modified in the past 50 years into something very unhealthy. Dr. Davis lays out the case that consumption of this genetically modified franken-wheat leads to celiac disease, skin rashes, neurological disorders, diabetes, weight gain, etc. He calls it a "super carbohydrate" and singles it out for special attention because of how it spikes blood sugars and causes a lot of other problems. This part of the book was perhaps the most interesting to me, as I did not know a lot about modern wheat, even though it has been in the scientific literature for more than 30 years. Dr. Davis also recounts experiences from his practice as a cardiologist to back up what the literature is saying.
He goes on to describe what I considered to be a rather conventional low carb diet: cut the wheat and other things that spike your blood sugar, plus avoid vegetable oils. Eat meats, nuts, cheese, vegetables, berries, etc., but avoid processed foods. But I did find myself disagreeing with some of his low carb recommendations.
Though I didn't quite realize just how bad modern wheat is, I have realized that wheat is bad and have cut it from my diet for the past seven months. But I have also cut out sugar and vegetable oils and have been convinced about the dangers of the Neolithic Agents of Disease, as Kurt Harris likes to describe the harmful parts of our diet (e.g., wheat, sugar, vegetable oils).
Many people advocate a similar philosophy of eating. Davis condemns all forms of wheat, Taubes condemns sugar, and Enig condemns seed oils and the vilification of tropical and animal fats. Most low carb/paleo types would agree with avoiding these three categories. But there are variations in Davis' low carb diet recommendation.
For example, Davis permits chocolate; Sally Fallon says we should not eat it. Davis is okay with a bit of soy products in the diet, but others suggest avoiding all forms of soy, except some fermented soy products. Like the Perfect Health and the All Vegan Archevore (!) diets, Davis is okay with a small amount of potatoes and rice, if you can handle them, while others totally avoid (and even mock the concept of) "safe starches." Davis says certain legumes, like peanuts and natural peanut butter are okay; the Jaminets counsel us to avoid peanuts. Davis says don't eat wheat but Sally Fallon tells us we can consume properly prepared wheat. Mark Sisson says properly prepared wheat is probably okay to eat, but too much trouble to bother with. It's simply easier to avoid. Davis' arguments themselves focus more on modern wheat than ancient wheat, and he does not address at all the techniques Fallon and other advocate for properly preparing wheat for consumption.
I actually found myself saying, "I wouldn't eat that!" in response to some of the foods Davis says are okay in his version of a low carb diet (e.g., soy products, artificial sweeteners). So rather than adding clarity to my search for low carb wisdom (I already knew wheat was bad and avoided it), he actually ended up by muddling the already murky waters.