The Paleolithic diet presumes that foods eaten during the stone-age (Paleolithic era from 2.5 million years ago to 10 thousand years ago) are optimal foods for humans. The Paleolithic (Paleo) diet includes grass fed beef and other lean meats, fish, shellfish, fruits, vegetables,  eggs, nuts, but no grains, no dairy, no salt, no refined fats (butter or margarine) and no sugar or high fructose corn syrup.

Fanatical Diet (Lifestyle types)
There are three things one should never discuss in polite company, religion, politics, and diet. Getting into an argument with proponents of diets is like a democrat trying to convince a republican that Obama is ok. Each side will quote their own studies, statistics, and population studies. But the key to scientific study of the various diets is not what we presume from correlation, but from what we learn when that diet is placed into patients – in this case, the laboratory values of those who have the diet.

Diet proponents become fanatical about their diet (lifestyle) to the point of religious fervor. Seeking to prove that their diet is backed by science, proponents use population studies with associations that are only suggestive and not proof of causation. These associations become propaganda as the associations are repeated over and over, morphing from a suggestion to “proof.”

The Flaws of population studies or Correlation does not equal causation
The foundation of many diets are based on the correlation of what a population eats and what diseases they suffer from. In the Paleo diet the assumption about what they ate and the diseases they suffered from is a spurious correlation at best, and far from causation.

Population studies are flawed, as often we find that we don’t know as much about the population as the data might suggest. Take the Pima Indians of the Southwest. In 1990 a paper came out stating that the Pima Indians had a low incidence of fatal coronary heart attacks in spite of having a high rate of diabetes. The Pima Indians were called among the most studied populations, with an NIH post in Phoenix, and lots of studies showing the highest rate of diabetes in the world. When the population was examined more carefully, the Pima Indians had plenty of heart disease.

Step back from the most studied group in the United States with great statistics and physicians trained in modern medicine and then imagine making conclusions about what Chinese eat, or Mediterranean’s, or French. Those assumptions are more flawed, as are the statements about what diseases they do or do not have. Now step back further trying to determine what people of the Stone Age ate, what diseases they had, and we leave the tenuous role of suggestion and enter the role of outright guessing. Even if we have reasonable data (and often we don’t – even for the best studied people in the United States) the correlation between what people eat as a cause for what diseases they have is a fundamental flaw. Correlation does not equal causation.

The Best Diet or Lifestyle is?
When it comes to the best diet plan for a person – we just don’t know enough to say that one is better than another. There isn’t enough evidence to state that the Paleolithic (also called Paleo) diet is better than the Ornish, Southbeach, Pritiken, or pick one, or better than how you currently live your life.

We cannot broadly say that any given diet will prevent heart disease, cancer, arthritis, or even obesity. When someone tells you a diet can prevent such, they have gone from the realm of science to the realm of bs.

The Paleo Diet Premise:
The Paleo diet premise is that we should avoid certain foods because our body is not evolved to process those foods, and if it does process them it will lead to the chronic diseases of modern man – heart disease, strokes, cancer. Cavemen didn’t have those diseases, so we should eat like cave men. Of course, we don’t know about what diseases that cavemen had – especially when it comes to organ and soft tissue diseases, we just have a few fossils that we examine and look for evidence of known diseases. Would coronary artery disease show up in a fossil – nope? Would cancer show up in the fossil – bone cancer would (kind of a rare cancer) or cancer that went to the bone might – but it would be hard to tell if the fossil evidence.

We do know, from many hunter-gathering societies, that they live a short life, and not long enough to develop the diseases we associate with aging. All a person has to do to pass on their genes is make it into puberty, and to be effective to nurture the young, into the 30′s, and to see grandchildren and help child raising – into the early 40′s. That is what a simple civilization needs. After that, in any primitive society, the elderly become a burden – perhaps to be placed on an ice flow. People who live into their 40′s and 50′s may die of cancer, heart disease, or obesity- but they will have passed on their genetic code.

The Evolution of Homo Sapiens:
When Homo Erectus came out of Africa, they encountered a world that was much more varied in food sources than Africa. The brain of the human (H. sapiens) evolved, becoming much larger, and utilizing far more energy than the brains of the Australopithecus – about 10 percent more. More than any other species, humans evolved a brain that required more calories- and our brain metabolism accounts for up to 25% of our energy needs. Bigger brains and its increased requirements mean a richer diet- and modern hunter gathering species derive about half of the energy from animal foods – in contrast with other primates that have far fewer animal foods. While our ancestors the Australopithecus dined on plant foods, and had large mouths to grind up fibrous plants – humans are built, with smaller faces and jaws, to dine on energy rich animal foods.

The reconstructed skull of Lucy, Australopithecus- large jar and muscles for eating plants

The Human skull is larger, larger brain- and jaws for more energy rich foods

Humans were successful, as the fossil record shows, because they were “flexible” eaters, using a wide variety of dietary strategies. If there were a lot of Elk, then we ate elk- berries, we picked berries. To state that our digestive system evolved only to eat some few items found in the Stone Age – has been disproven on the face of it. Our ancestors in Africa didn’t encounter Arctic char, whales, seals, salmon – and yet when they moved from that warm climate to the frozen north, they adapted quite well to a very high fat diet of primarily animal based diet that was clearly not available in Africa. The findings of starch grains from wild plants in grinding tools from sites in Italy, Russia, and the Czech Republic from the mid-upper Paleolithic era suggest that the production of flour was present 30,000 years ago.

Contrary to what Paleo proponents state: people made flour 30,000 years ago

How to eat like a caveman
There are some things about the Paleo diet that people avoid:

Excess sugars including fructose
Excess Omega 6 oils – including soy
Processed wheat, grains, and gluten
Dairy

What is the scientific evidence for this? It’s the simple premise that modern man has lifestyle illness from altering food, taking in too many calories, and if we would return to our ancestors roots (pun intended) we would avoid these highly processed foods and not suffer from the holy trinity of diabetes, obesity, heart disease, and maybe even cancer. There is not a single shred of evidence to support the premise of this diet.

An entire dietary regimen has been formed with plenty of books and websites to guide you through this. It has become so popular that the question becomes not the flawed premise for the diet, but rather how the diet would compare to other diets. If you want to eat like a caveman, then shop on the outside of your grocery store.  Everything on the inside of your grocery store is generally processed foods, and everything on the periphery of the grocery store is generally not processed.  On the periphery you will find the vegetables, fruits, meat counter, fish counter – although you might get in trouble with dairy, and before you check out they might have a cookie or two – or there might be a bakery (a big no no among the non-Geico types). But lets be clear- whatever the caveman could get that they could eat- they would eat, and if a caveman were to be around today- wait, we have them – well, they eat Poptarts.

In one real scientific study patients with known heart disease who were randomized to either the Mediterranean-like diet (based on whole grains, low fat dairy products, fish, fruit, and vegetables) or the Paleolithic diet (no grains or dairy but plenty of lean meat, fish, fruits, vegetables, root vegetables, eggs, and nuts) and those who undertook the Paleolithic diet were satisfied with less food. There was also a decrease in leptin in the Paleolithic group by 31% and by 18% in the Mediterranean group.

There have been other studies that show that people who go with this diet have improved laboratory values – less triglycerides, lower blood pressure, some weight loss, that the diet has a better glycemic index (the food doesn’t increase blood glucose levels as much). This diet compared to a standard diabetic diet did better. Those studies are short term, with small numbers of individuals, and hints of laboratory values.

So before one assumes I am putting this diet plan into the trash bit along with Ornish- there is clearly some data here that shows good nutritional sense in the food.

While highly processed carbohydrates transiently increases blood glucose levels more than whole grains – it does not mean that bread is bad for a person. At least we don’t know enough about this to state that today. Clearly, people who eat a lot of flour based products can get fat quickly, and getting off the bread and bakery products will help reduce weight, decrease hemoglobin A1C levels, decrease triglycerides, and overall be healthy.  Some people need to be told to never eat them again – as some alcoholics must never drink again- and some people are able to moderate them so they do minimal damage to the body.

Only a few studies have examined the effects of the Paleolithic diet on laboratory values that we associate as increased risk for disease – but again, those were laboratory values, not a long-term follow up for disease.

The premise for the Paleo diet may be flawed, but here are the parts of the Paleo diet that most would agree with:

(a) Highly processed grains – white flour, rolled oats- do cause a rapid increase in blood glucose levels and the body responds to that by increasing triglycerides and ultimately fat.
(b) Fish – as long as it is not contaminated with mercury, is a protein source that is high in Omega 3 fatty acids, which have been shown to be beneficial. If you have some great fish three or four meals a week it works out well.
(c) Vegetables and fruits are the basis for most diets- thus a vegetarian could participate in a Paleo diet easily. Too many people do not eat enough fruits or vegetables or look to them as snacks.
(d) The trend away from cattle feedlots and desire to have grass fed rather than grain fed beef. Grain fed beef is fatter and more prone to being infected with Salmonella or E.Coli than grass fed beef.  There is a wider variety of taste with grass fed beef, and most who find grass fed beef end up preferring its flavor. Grass fed beef is best cooked with Sous Vide cooking.
(e) If you eat more calories than you burn you will gain weight. But it is more than just calories – it is also the types of calories. Eating high glycemic index foods mean you will spike glucose pushing it into cells, where it will be quickly transformed and stored as fat. Low glycemic index foods will be slowly burned  - thus, calorie for calorie with the Paleo diet plan you will tend to burn the fuel from the food as opposed to store it.
(f) If you eat a majority of your food with highly processed grains instead of whole grains you will have a faster rise in blood sugar. Some attribute this rise to increased obesity and an increased load on the pancreas.

Overall- this is not a bad diet program. Nothing in it would appear to cause nutrient deficiencies and there is some preliminary evidence that this diet keeps a person more satisfied with less food. It is a low-carbohydrate diet, and those diets, in comparison to other diets, tend to produce faster and longer weigh loss.

Here are a few scientific references- I’m sure we will add more as time goes on

Low incidence of fatal coronary heart disease in Pima Indians despite high prevalence of non-insulin-dependent diabetes. RG Nelson, ML Sievers, WC Knowler, BA Swinburn, DJ Pettitt, MF Saad, IM Liebow, BV Howard, and PH Bennett
Circulation. 1990;81:987-995

Food for Thought: Dietary change was a driving force in human evolution. Wm R Leonard. Scientific American. December 2002: 107-114.

A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in inviduals with ischemic heart disease. Jonsson, et. Al. Nutrition & Metabolism 2010, 7:85

Thirty thousand-year-old evidence of plant food processing. A Revedin, et al Proc. Nat. Acad. Sci, November 2010: 107:18815-18819

At the start of the study, 11.6 percent of the participants reported having acid reflux weekly, and by the end of the study, 17.1 percent of the people reported weekly symptoms — a 47 percent increase. While the study does not explain why this increase has occurred, the researchers point out that it is most likely because of the increasing rates of obesity in industrialized countries.

A troubling consequence of suffering with acid reflux for a long period of time is that it is a risk factor for esophageal cancer, a dangerous and once rare form of cancer that is now becoming more common. It is estimated by the American Cancer Society that nearly 17,000 new cases of esophageal cancer were diagnosed in the U.S. in 2011 and nearly 15,000 Americans died from it.

Interestingly, the study found that 1 in 5 participants had their acid reflux symptoms resolve on their own. Whether these people lost weight or were carefully watching what they ate is beyond the scope of this study. Experts advise that in addition to weight loss, there are lifestyle changes that can improve symptoms of acid reflux. Some of these changes include not eating large meals before bed time, avoiding alcohol and cigarettes, and eating 4 or 5 small meals daily instead of larger meals.

Research has shown that weight and age seem to play a role in the occurrence of acid reflux in women. The study found that new cases of acid reflux symptoms rose with age for women, and women under 40 were the least likely to report symptoms. Additionally, a  few years ago, a study found that GERD is linked to obesity in women.

** This post is also featured on www.DoctorsofWeightLoss.com **

Yesterday I heard that a dear patient died. Virginia was 65 years old, and had her Lap-Band placed in 2007. She took this task seriously, and she came to every support group we had. Over the course of her weight loss journey, she lost about 100 pounds, and kept it off.   Struggling sometimes, but always bouncing back, always coming to the office with a smile, and always making it to our monthly support group.

From a weight loss surgeon’s perspective you can’t ask more from a patient. Changing a lifestyle is difficult, especially difficult when you do it at 61 years old. But she set her mind that “I don’t know how long I have, but I am tired of carrying this weight.” Even when I told her that it is very difficult to change as you get older she said, “Dr. Simpson, I am going to prove to you that I will do this. I am going to be your model patient.” And she was.

Virginia Abner - Always smiling

We often see people come to the monthly support group pre surgery, and maybe a few visits after surgery- then they fall away. But there are those few who come on a regular basis- and funny thing- those are the ones that get to their goal and stay there. Virginia was a regular at our support group meeting- and people would ask her for advice, and she always said the same thing: “Never give up, measure your food, never be too full, and never be too hungry.”

From Virginia we have learned – never give up, never give in. There is always more to learn about weight loss – and she did everything she could – right up to the end.

We will miss Virginia. For those who were fortunate enough to call her a friend, a memorial service will be at the Heritage Funeral Chapel on 6830 W. Thunderbird, Peoria, AZ on December 18th at 1 pm.

Who would have imagined that my patient, Evo, would have lost 14 pounds on the “beer and sausage” diet (now called the Evo diet).

From the medical side there are two other benefits — his triglyceride level dropped by half, his cholesterol dropped by a third, and his “good” cholesterol increased.  There was never an increase or a blip in any of the liver enzymes.  His fat mass dropped, the only non-fat mass of his that decreased was that tissue associated with and supporting the fat mass (I know, sounds complicated).  His muscle mass maintained itself.

One important lesson learned: we do not know enough about science and medicine and diets to be able to say anything to anyone about which diet is healthy and which is not. But let me give you an example – we had more data points for this one month of the Evo diet than Ornish had for his diet program.

The famous Ornish line is that his data showed a decrease in “Plaques” of patients who had heart disease. This was based on less than 20 patients, including the control group.  He has since gone on to show poor data with prostate cancer, as well as aging. The data that Ornish has isn’t good, and when you look at the data we generated in one month from the Evo diet, one could assume that we would find people would do better not doing the Ornish diet and following the Evo diet.  This is said with a smile, because never has a “lifestyle” and diet – such as Ornish, been propagated with less data and more press.  Ok- there is also the China Project (a single misuse of data to say the same thing).

The second important part of Evo’s diet was this: there was a simple and yet profound control of the portion sizes that he had. It was measured, it was regulated to around 1500 calories per day.  Based on that,  Evo lost more than we would expect him to have lost. Why? No clue.

What can you take away from this: First, if you want to have a diet begin by strictly regulating portions. Portion control is a key for any weight loss, including weight loss surgery.  Limit your portions, and thus your calories, and you should lose weight.  The advantage of beer and sausages is that they come in nice units that you can measure.

Processed meats appear to increase risk of colo-rectal cancer

What you should NOT take away from this: beer and sausage are not “diet foods.” Beer and sausage were, in this case, a tool for great portion control. And Evo ate more than just sausage. He ate what came with it.  When I cooked for him he had the peppers and onions that went with my famous recipe (recipe will be on terrysimpson.com later). He had bread (yes, I know some of you think bread is the devil’s tool) – if it came with the sausage.

The final message is most important- We don’t understand food as well as Ornish, Atkins, or pick some diet guru would have you believe.

Since my friend Evo has started his fun diet- seemed like a good idea to show why diets work – and why they don’t. What is real and what is not. Hope you enjoy this– and my humor –TLS

A number of my patients, when deciding to get to their goal, ask, “Should I go back on Atkins or go to Weight- Watchers?” The answer is no, and the reason is simple:

Those are diets, not lifestyle changes. Sure, some of those do proclaim that they offer changes in lifestyle, in their own way, but they are really a diet. If diets worked, would we need weight loss surgery? Ask the famous question, “How does that work for ya?”

Often times we don't know we gained the weight

Diets are a set of rules imposed on you by someone else. How do you respond to someone telling you what to do? I was in a restaurant a number of years ago while on the Atkins diet when they offered me some of their fresh bread.  My response was, “No thanks, I am on Atkins.” It felt good to say that because I was following a rule-bound diet and doing a good job—but I missed the bread. I was following someone else’s rule for a diet that makes no sense. It is far better to adopt a healthy lifestyle with healthy choices.Those choices are not strange, they are simple.

The one food or one food group diet

The most famous diet, at least today, is the Atkins diet. It has been almost universally tried by all of my patients and misunderstood, perhaps even by the Atkins folks themselves. Robert Atkins made a great deal out of the body going into “ketosis” where it burns fat instead of turning food into fat. He had a complicated set of theories. None was ever proven, in fact, the reason you lose weight on that, or any low carbohydrate diet is fairly simple: you eat less. The Journal of the American Medical Association published a study showing that the average consumption of calories in low-carbohydrate diets is much less than other diets, and hence they are successful at losing the weight.

I gained weight on Atkins

—or, biology does not overcome the laws of physics

How can you gain weight on a diet that promises that you will lose weight if you avoid carbohydrates and eat meat? Because if you eat enough calories you will gain weight. Meat—or protein—contains calories, and your body is perfect at counting calories. Your body doesn’t care where the calorie come from, it will count every calorie even better than you will, and if you eat enough protein or fat, or drink enough alcohol, or eat enough carbohydrates, you will gain weight.

Most weight loss surgery patients have been on this dietor a variation of it and they know—given their pre-operative anatomy—that they really did gain weight on a diet, without cheating. After all, when you have a stomach that can hold a small mammal, you know you can eat your way into ketosis and weight gain on the Atkins diet. Simply put, a calorie is a calorie is a calorie. It doesn’t matter if you get the calorie from meat, from figs, from bread, or from alcohol. If you get a bunch of calories together you will store them, and if you store them, you will store them as fat. Eat enough steak and you will gain weight.

The Cavemen

The famous caveman diet- life wasn't so simple

Then there is the old “when we were cavemen” theories. They show how back in the old days when men hunted the wooly mammoths, lived in caves, and didn’t shower, that they were thin (now how do they know we were thin?). Back in those days, as this theory goes, we ate meat (lots of it), and didn’t gain weight. Well, there were a few other things in “the good old days” that we might want to think about—the cavemen hunted to get their meat, which meant exercise. The cavemen had famines and for long periods couldn’t eat, and the cavemen didn’t have refrigerators to store the meat so when it went bad, it went bad. If you want to go on a caveman diet, or think that eating one thing will make you lose weight, think again. The body is designed to store excess food as fat, and the body doesn’t care if those excess calories come from donuts, wooly mammoths, prime rib, tofu, or corn—the body was built to withstand a famine.

Our biology was not designed to eat just meat or just vegetables but to eat a variety of food types. So were our taste buds. Give us a single food and we will get sick of it. Sure, we might have to eat the Wooly Mammoth to survive, but can you imagine the kids in the cave, “Ah come on, dad, Wooly Mammoth again? Can’t you go get a Saber tooth tiger?”

Okay, imagine living in a cave:

Husband comes home proudly dragging the dead Wooly Mammoth, “Honey, I am home, and brought dinner. Barbecue tonight.”

“Don’t drag that thing in here, I just cleaned the cave.”

“Okay, but help me cut these ribs.”

“Cut your own ribs, I have to feed the children their ribs first.”

Days later.

”Get that old carcass out of here, it smells, and while you are at it stop drawing on the cave wall and get us some more dinner.”

“But honey, that was the biggest one I got, I want to paint this on the cave wall for all to know what a great hunter I am.”

“You will be a hunter without a cave if you don’t get that smelly carcass out of here. Why can’t you stay home and plant like the other cavemen? Why do you have to go out and bring these dead animals home? Grog stays home, he plants, their family eats, and it is easier to throw out grain that is bad than that large ugly animal.”

“But we can keep warm with the skin, and it shows my skill as a hunter, and I can provide for the whole village. We grow fat on the wooly creature but their crops fail.”

“Speaking of fat, I think it is time you stop eating all that meat and go hunt some gazelles. At least you will get some exercise. You must have put on five pounds this week. And brush your teeth, all four of them.”

Variety can lead to excess

If you are given only a single food, even if it is a food that you like, you can eat only so much of it before you don’t want anymore. I love steak—put a 16-ounce steak in front of me and I will consume 10 ounces of it and bring the rest home for my dogs. After 10 ounces I am done with the steak, can’t eat anymore. So, if I am on a low carbohydrate diet, you can bet that I am done with dinner. But, if

I am not on that diet and you put a bunch of French fries with the steak, not only will I have my 10 ounces of steak, but also I will have eight ounces of fries and maybe even think about dessert. Let us not forget the glass of wine before dinner, the glass of wine during dinner, and the after-dinner drink (since we just called a cab).

Another example of getting sick is eating ice cream. There use to be an ice cream restaurant that had a dish called “the zoo.” If you could eat it, they would not charge you for it. Try to eat twenty scoops of ice cream, it isn’t easy. But you can do it if you eat a few saltine crackers with it. The variety of flavor (salt contrasting with the sweet) allows you to eat more. Again, variety can lead to excess.

Here is the problem—if with a single food diet you lose weight, when you add variety you are less likely to moderate the food that allowed you to lose that weight. In other words, you might think of steak as being “okay” because It is a diet food. You might be under the impression if you eat this food and expand your diet that this food won’t count for calories. Most of us know that too much red meat, with its fat, is not a healthy choice. However, seeing weight loss by eating steak leads one to think it is okay to have as much as you want because one incorrectly believes it is the carbohydrates, not the steak, which causes weight gain. But let’s just put that little theory to the calorie test:

One Steak—Porterhouse of course, 442 calories

French Fries, 154 calories

Salad with blue cheese dressing, 339 calories

One big slice of bread, 80 calories

One cup of broccoli, 77 calories

One real glass of wine, 127 calories

Fat is the most dense of all macronutrients

This meal was 1219 calories—and the majority came from things allowed on the Atkins diet (Steak and salad were 781 of the calories). Of the non-allowed items—the French fries, the bread, and the broccoli—you have just over 300 calories. Now, we are not advocating white bread or French fries at all—just pointing out the majority of calories from this meal come from the meat and the fat, not from the carbohydrates.

An Atkins lover would be inclined to add more fat, more meat, and less white bread. We like the less white bread, less fat, less processed foods, but adding red meat with fat is just not a great option. The point is simple: variety can lead to excess, or variety can lead to good flavors. However, single-food diets, while controlling calories, can lead to a false sense that these foods are “okay,” that they are “diet” foods. Fat is not a diet food.

Here is another example: If you get a cheeseburger and you substitute lettuce leaves for of the bun, you have a meal of 330 calories instead of 400 calories. The bun is just 70 calories! Yet so many people think they are helping themselves by eating something that is filled with fat (about 18 grams) and avoiding a bun. It is the calories that the body counts, not where they come from.

Single-food or food-group diets are simply a complex way to control portions. If you control portions then you will consume fewer calories. If you consume fewer calories then you will lose weight.

Surgery is the most radical of portion controls. Whether you had surgery and stretched your pouch, or your stomach has grown, if you limit portions, which is not difficult, you will lose weight. How much you lose is determined by the number of calories that you eat.

We do not like single-food diets for our patients because, more than anything, we want our patients to have a variety: you deserve a lot of fine tasting food and a variety of foods tends to have a variety of nutrients. Single-group diets are probably not going to work in the long run. They become a burden even if you like the food group you try. After a year on the Atkins diet, I couldn’t look at a steak, which was good, because I stopped the Atkins diet before I went to Europe at the height of the Mad Cow infestation.

Artificial sweeteners are either the saving grace of America, or the devil. The first issue with artificial sweeteners came to light when cyclamates (the first marketed artificial sweeteners) were found to cause cancer in rats. So in 1969 cyclamates were taken off the market. Saccharin was the next agent, but many didn’t like its after taste. Then came aspartame (Equal). This had no bitter after taste and became the favorite until someone started a rumor that aspartame killed ants, and was originally developed as a rat poison – this is untrue on both counts.

First, aspartame was developed as an artificial sweetener and second, it does not kill ants (I tried it, as have a lot of others – sadly it doesn’t work). Splenda does contain calories (because of our FDA regulations it is allowed to be listed as “zero calories” but it is not). Splenda has 3.36 calories per packet (1 gram). It tastes like sugar and is generally easy to cook with – however; one package of Splenda is 600 times sweeter than an equal amount of sugar.

Two other sweeteners have joined the market in the United Sates. Stevia- is a product of several plants and was recently approved as a food additive in the United States, and Truvia (a proprietary blend of Stevia made by Coca-Cola and Cargill the Pepsi produce it PureVia). These are essentially all the same. There are some other sugar-alcohols like Xylitol that function as sweeteners.

The issue with artificial sweeteners has been getting use to the sweet taste, and thus an increase in appetite. In rats that are consuming artificial sweeteners there is an increase in their body weight over time as they increase the amount of food they consume. Not that we are rats – but avoiding the overly sweet taste is important. And there is no accident that while many of my weight loss patients consumes large quantities of “diet cola” – they still consume a lot of calories to go with them. It is also no accident that once our patients get off artificial sweeteners, they lose more weight.

People who drink sodas that have artificial sweeteners have a sixty percent increase in stroke and heart disease. Sixty percent!

How do you gain weight with artificial sweeteners? Since they are so sweet, you naturally want food to balance out the sweetness. Increasing the quantity of food allows you to increase the bitter, sour, and other sensations to balance the sweet taste. Remember, your palate always wants to return to a balance.

Overall –avoid the artificial sweeteners. Still- what is better than artificial sweeteners in soda? Simple water. It is free (unless you are in a city where the water tastes bad) and is regulated more tightly than most things

Imagine a way that the government could reduce the level of obesity and it would cost nothing.  The government had that chance- and they blew it.

The US Department of Agriculture denied a request by New York State to run a pilot program where the city of New York would not allow people to purchase soda, or other sugar sweetened beverages, using food stamps. There are at least seven other states requesting such pilot programs.

It is not surprising that the opposition to this proposal came from the beverage industry who said, “It’s another attempt for government to tell people what they can and can’t drink. Singling out one specific item is discriminatory and unfair.”

Really? No one is saying they can’t drink soda – simply that the government won’t purchase items that are not in line with the intent of the food stamp program which is, “to provide for improved levels of nutrition among low-income people each month.”

The USDA said that city retailers would not be prepared to implement the new policy.  The food stamp program is run with a debit-style card. If a beneficiary is purchasing items from the grocery store not covered by food stamps, such as tobacco or alcohol, the cashier collects the money for those items after the food is deducted.

The original Food Stamp Act prohibited purchase of “soft drinks,” but that was changed because of regulatory issues-, which are now overcome thanks to technology. In fact, New York City officials stated that the “program’s electronic benefit card looks and acts like a credit or debit card” and that it only covers “some of the items in a typical s hopping cart, so program participants are already accustomed to supplementing their purchases with personal funds.”

The USDA also said “the proposal lacked rigorous methods to asses changes in sugar sweetened beverage consumption resulting from the new policy and the effects of those changes on obesity and health.”  A pilot program doesn’t have to prove that sugar sweetened beverages are not “food.” Even the original act prohibited these items.

The government purchases millions of gallons of sugar laden drinks for food stamp holders every day. Obesity is the number two killer in the United States – and by denying this simple pilot program are paying for obesity.  Preventing obesity costs nothing – paying for the effects of obesity costs everything.

References:

US Department of Agriculture. The Food Stampe Act of 1964. http://www.fns.usda.gov/snap/rules/Legislation/pdfs/PL_88-525.pdf.

Jessica Shahan, Associate-Administrator, Supplemental Nutrition Assistance Program, USDA, to Elizabeth Berlin, Executive Deputy Commissioner, New York State Office of Temporary Disability Assistance. August 19, 2011.

Scott-Thomas C. Food stamp soda exemption in NYC is discriminatory, says industry. Food Navigator-USA. May 5, 2011. http://www.foodnavgator-usa.com/Business/Food-Stamp-soda-exemption-in-NYC-is-discriminatory-syas-industry

JAMA, September 28, 2011 Vol 306, No. 12 page 1370-1371

This Sunday in the New York Times, Sept 25,2011, Mark Bittman showed that it was not cheaper for a family to eat out at Fast Food places. And it also costs them in terms of calories, sodium, and the quality of food.  We want to expand that to not only fast food restaurants, but common chain restaurants.

Cooking at home is less expensive – less for food costs, less for calories, less for sodium.  Eating out at chain restaurants often have more calories than even fast food places – for example:

Most salads at TGIF’s are 1200 to 1500 calories.  That is as many calories as most individuals should have for an entire day!  One of the least calorie items there is their burger – at 800 calories, and can be split between two people.  Thankfully TGIF’s puts calories on their menu.  Not meaning to pick on TGIF’s – we have found the same looking through the menus of Applebees, Red Lobster, Rubios, Village Inn, and other chain restaurants.

Santa Fe Salad 1500 calories

Eating out at most chain restaurants is not avoiding calories, or getting better food quality than at Fast Food- in fact, the calories are more.

The bottom line: home economics – it is cheaper and healthier to learn to cook, and to learn to cook at home. We have lots of recipes, and techniques to help you (cook book coming soon).

If you do want to eat out- there are some great restaurants that we highly recommend: not only does the food taste great, but it is prepared from fresh ingredients – and have fewer calories.  In Phoenix, Tarbell’s, in New York any of the restaurants by Gordon Ramsay, Thomas Keller, Bobby Flay, or Morimoto.

Food made fresh is great. Like Ramsay demands

For many the issue comes down to cooking. Cooking at home is daunting for some individuals – they never learned it, they think it is difficult, and we have lost an entire generation of people who cook. There are now five fast food places for every supermarket. So what causes people to not eat at home:

(a) Time – hard to imagine this one. As a busy surgeon I have the time to cook for myself and my family. It is a lovely hobby, and when I go home I like to get into shorts, flip-flops, and relax cooking making a great meal.

(b) Cooking skill – this is not a difficult but it is thought of as difficult. We spend a great deal of time teaching our patients to cook (we do weight loss surgery). Our recipes, videos are all designed to show that it takes less effort to cook than one can imagine.

(c) Perceived food costs – we have fixed that myth. It really costs more to eat out, than eat at home

Some blame the effective job of marketing that chain restaurants and fast food places have done. But, we are not robots- and those who wish to improve their health, will learn to cook. Most simply need to know that cooking is a great hobby. For the single men, let me quote you from my favorite dating expert, “If you cook dinner for your date, be careful, you will probably end up cooking breakfast.”

The results, as they were with President Eisenhower- are not likely to be different.  Eisenhower ended up eating almost nothing but Melba toast and grapefruit, obsessed with his cholesterol level, and having more heart attacks until the last one killed him.

What is the evidence that a vegan diet is healthier for a person than a diet with animal proteins? None. There is no evidence that a diet that is based around plants or a diet with low animal fat does little.

Some will cite epidemiologic data- a poor source for data less than a level one.  If you cite epidemiologic data you have to explain all the data—and often they ignore the “French Paradox.”  Or ignore that while the Japanese eat little meat and have few heart attacks – their average consumption has increased over 22 percent with no increase in heart attacks (often people cite data from post World War 2 Japan, and not current Japan – and then ignore the data about stroke rate). When all epidemiologic studies are examined – one cannot justify a plant based diet on those.

Some cite the Journal of the American Medical Association (JAMA) study claiming that an animal based diet had more mortality than a plant based diet – but few have read the study.  While Dr. Ornish jumped on this study, saying it justified what he has been telling people- apparently he didn’t read the study either.

This study divided people into two groups- the low-carb group received 37 to 60 percent of their calories from carbohydrates (that isn’t low carbohydrate by any standard). The meat group was not divided out for those who smoked and were overweight (a higher portion of the meat group smoked and were obese). The vegetable group had 30 per cent of their calories from animals, as opposed to 45% for the meat group (so not really a vegetable group).  Once again, an epidemiologic study  and it is flawed.

What we do know from science about low-density-lipoproteins is that they fall into two groups- one group is far more deadly than the other, causing the majority of atherosclerotic plaques.  That is the group with the high tri-glyceride levels is the one that is deadly. Of this there is no doubt in the scientific community.  When the Very Low Density Lipoprotein and apo B – leading to high low density lipoprotein – leads the the increased in artery plaque leading to heart attacks and strokes.  The lower the triglyceride levels then the lipoproteins secreted by the liver become the subspecies of intermediate-density lipoproteins, which are far less cause of atherosclerosis than the others.  Where does the triglycerides come from? Not animal proteins, but primarily carbohydrates.

Bottom line from science – the more triglycerides – result in atherogenic small, dense LDL proteins – and this happens from carbohydrate rich foods.

What about Greece, and Southeast Asia, and Japan(after world war 2) . These populations barely had enough food to survive.  They didn’t use refined carbohydrates – and ate whatever they could. It was not the low-intake of saturated fat that protected them, rather the relative lack of a refined carbohydrate leading to low triglyceride levels. Still, those studies, championed by the late Ancel Keys, are still cited.  This in spite of overwhelming evidence to the contrary.

Back to President Clinton – a vegan diet will not save his heart. Saturated fat is not what led to the atherosclerotic plaques – rather, it was the abundance of triglycerides from highly processed and abundant carbohydrates. What he has done that will help him is, lose weight, have heart surgery, take medication –but  in terms of diet, President Clinton falls into what Eisenhower did, as well as every anorectic—when the only thing they can control is diet, they will fall victim to fads that sound healthy, are promoted by TV MD’s – but have no science to back them up.

If you want to be a vegan for health, there is no data to support that. In fact, vegans have a life expectancy that is less than pescetarians (fish eaters) and omnivores.President Clinton – a Vegan