Blue Cross Blue Shield recently completed a study of medical conditions in the millennial population, and found there is a rapid decline in health index score for general populations after the age of 27.
Millennials from ages 34-36 have higher prevalence rates for nearly all of the top 10 conditions than Generation X members within the same age range. This suggests a significant decline in expected health status, far worse than in previous generations. Six of these conditions are behavioral-health related, and four involve physical health. All of them are influenced by lifestyle and diet. Millennials specifically had an increase in major depression, hyperactivity, and type 2 diabetes.
The study also found the millennial generation is shifting towards a vegan or vegetarian diet, with a larger percentage of self-identified vegetarians and vegans than any other generation (12%). The primary reason why individuals converted to a vegan or vegetarian diet was for “general wellness or general disease prevention” (75%), according to the study. There is currently a cultural and economic push for a more vegan or vegetarian lifestyle. Sales of plant-based alternatives to animal-based foods, including meat, cheese, milk, and eggs, grew 17% over the past year, while overall U.S. food sales rose only 2%.
My concerns and questions are: Could the increase in veganism be associated with an increase in the prevalence of these medical conditions? Could medical conditions be pushing millennials to experiment with a vegan lifestyle, seeking relief from a predisposing cause? Are we repeating the errors of Ancel Keys?
The popular Japanese saying Hara Hachi Bu (腹八分目), which translates to “eat until you are 80 percent full,” gives insight into what you can do to make changes to lower your weight and insulin resistance. You can make simple changes in everyday habits to learn to eat only until 80 percent full.
First, you should eat more slowly. Eating faster results in eating more. Slow down to allow your body to respond to cues, which tell us we are no longer hungry. Next, you should focus on food. Turn off the TV and the computer. If you’re going to eat, just eat — you’ll eat more slowly, consume less and savor the food more.
Another strategy is to use smaller dishes. If you choose to eat on smaller plates and use tall, narrow glasses, you’re likely to eat and drink significantly less without even thinking about it. You can also drink a large glass of cold water with lemon 10 minutes before eating a meal and again 10 minutes after finishing a meal.
Finally, resist the urge to snack, and don’t have anything in the house that you should not eat. These strategies can help you with weight management and to follow the advice of the Japanese.
To reverse diabetes, weight loss and a low-carbohydrate diet must be combined. These are independent factors for reversing diabetes.
Weight loss can achieve diabetes reversal through decompressing (decongesting) the liver and pancreas, improving blood flow, and reducing adipocyte hormonal responses.
As the worldwide epidemic of obesity continues to worsen, the epidemic of type 2 diabetes follows, and 1 out of every 2 Americans born today is predicted to get type 2 diabetes. Clinically, we observe a progression of obesity to eventual type 2 diabetes through the lens of insulin resistance and metabolic syndrome.
In a recent study at Ohio State University, obese patients with metabolic syndrome ate a low-carbohydrate diet but maintained their weight. A four-week low-carb diet resulted in the reversal of the metabolic syndrome, even though there was no weight loss. Reversal of metabolic syndrome is key to reversing prediabetes and type 2 diabetes.
Parker N. Hyde, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight, 2019; 4 (12)
A low-carbohydrate diet can achieve diabetes reversal through reduced insulin requirements (reduced insulin production), a reduction in glycated lipids, proteins, and receptors, reduced lipid storage, and increased lipid mobilization
The clinical relevance of this is that patients can become rapidly insulin sensitive again, well before they have returned to normal weight. Explaining this to patients provides the encouragement they need to continue a long path to ultimate success. The only way we will know a patient’s insulin sensitivity is to actually check the insulin level.
Have you had your insulin level checked?
There has been an intentional, unlabeled increase in manufacturing fructose, which is having an impact on weight and leading to the obesity epidemic. Soda drinkers in particular are consuming more fructose than people realize.
Manufactured high-fructose corn syrup contains a ratio of 55:45 fructose to glucose. High-fructose corn syrup was invented in the early 1970s and began to replace regular sugar in prepared foods around 1975. The onset of the obesity epidemic coincides with the use of HFCS. Current sweetened beverages made with HFCS have a fructose-to-glucose ratio of approximately 60:40, containing 50% more fructose than glucose. According to the National Institute of Health, “Several major brands appear to be produced with HFCS that is 65% fructose. Finally, the sugar profile analyses detected forms of sugar that were inconsistent with what was listed on the food labels.”
https://www.ncbi.nlm.nih.gov/pubmed/20948525
The intentional and unlabeled increase in fructose seems strange. Sugar content varied widely from amounts stated on labels; on average, the drinks had 18% more fructose than expected. HFCS is supposed to be 55% fructose, as compared to the 50% in table sugar.
Most foods and drinks are supposed to be using HFCS that is 42% fructose, but many sodas and drinks were using HFCS with a far higher content. Beverages that contained 65% fructose were Coke, Pepsi, and Sprite. Beverages that contained 60% fructose were Dr. Pepper, Gatorade, and Arizona Iced Tea.
Americans drink about 50 gallons of soda every year (containing 34 pounds of sugar), and soda drinkers are consuming far more fructose than anyone realized. Fructose specifically activates the reward center. Could it be the sugar-sweetened beverage companies know that the reward system is activated by fructose, creating more compulsion to purchase? The incidental side effect is excessive fat accumulation in the liver, and our epidemic of NAFLD, metabolic syndrome, prediabetes, and type 2 diabetes. Could the priming of the opioid epidemic also be associated?
Vegetable oil may have something to do with neuropsychiatric conditions, including neuroinflammation, anxiety, and depression. Research has found processed foods, especially the origin of the fat content, are associated with many of our neuropsychiatric conditions.
Processed food contains primarily PUFA (polyunsaturated fatty acids) omega-6 vegetable oils. Rancidity in vegetable oils is difficult for the human palate to discern, and therefore shelf stability of processed foods can be prolonged. The standard American diet has a greater than 20:1 ratio of the bad omega-6 oils to the good omega-3. This distorted ratio is associated with many neuropsychiatric dysfunctions, including profound anxiety. Restoring a healthy ratio of 4:1 (even by supplementing omega-3) seems to reduce this profound anxiety.
Buydens-Branchey, L., & Branchey, M. (2007). Long-chain n-3 polyunsaturated fatty acids decrease feelings of anger in substance abusers. Psychiatry research, 157(1-3), 95–104. doi:10.1016/j.psychres.2007.01.004
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225526/
Weight loss is clearly of primary concern to Americans, but the healthcare industry doesn’t seem to have a good solution. America doesn’t have a healthcare system; we have a sick maintenance cabal.
Between 1989 and 2016, the average American gained 29 pounds and spent more than $1 trillion on weight loss products. In 2016 alone, chronic diseases driven by the risk factors of being overweight or obese accounted for $480.7 billion in direct health care costs in the U.S., with an additional $1.24 trillion in indirect costs due to lost economic productivity. The total cost of chronic diseases due to obesity and overweight was $1.72 trillion, equivalent to 9.3 percent of the U.S. gross domestic product (GDP). Obesity as a risk factor is by far the greatest contributor to the burden of chronic diseases in the U.S., accounting for 47.1 percent of the total cost of chronic diseases nationwide.
Obesity has become such a significant independent disease that over the past 20 years, a completely new sub-specialty of obesity medicine has developed. Obesity affects more than one-third of the population, but less than 2 percent of obese individuals in the United States are actively treated, and of those treated, less than 10 percent manage to maintain weight loss.
Despite the fact that widespread obesity is a relatively new disease, associated with multiple reversible lifestyle factors, most of the clinical research funding and physician education has been geared towards medication management rather than lifestyle intervention. Using this standard of care approach, only 1 in 167 patients maintains weight loss.
Recommending dietary changes, as well as not prescribing medications, both erode profit margins for Big Food and Big Pharma. There is no money for them in a healthy population; all the money is in sick care.
Foods made to taste exceptionally good (hyperpalatable) through combining high fat and high sugar can also lead to behavioral addiction, which can lead to obesity.
Hyperpalatable foods can produce an addiction‐like syndrome. Animals presented with either high‐sugar or high‐fat diets eat excessively but do not gain weight as they offset the increased intake by eating less. It is only the high fat and sugar combination that causes weight gain.
We believe that the obese patients’ relationship to food is more similar to a behavioral addiction like pathological gambling rather than a classic substance addiction, but there is no clear-cut withdrawal mechanism. With “food addiction,” according to the National Institutes of Health, there is a “harmful use that is maladaptive but does not meet the criteria for dependence.” The refeeding cycle is driven by external cues, anticipatory cues, pancreatic training, and loss of fat metabolism adaptation. Specific nutrients do, however, cause an endorphin activation and a neurochemical effect in the brain.
To lose weight and process insulin most effectively, we must recognize some simple truths about ketosis and carbohydrates. Nutritional ketosis is the default human state, and consuming mostly carbohydrates is the preparatory stage for fat storage now, so you can be in ketosis later.
When you spend more time out of ketosis than in ketosis, you will develop insulin resistance. However, more ketosis is not better — you need just enough that you are predominately using fat as fuel.
The debate should be what combination of healthy food and activity is necessary to achieve a predominant state of ketosis. Once we get to this debate, 2/3 of our current chronic health expenditures will magically evaporate.
Nutritional ketosis has been found to improve metabolic and inflammatory markers, including lipids, HbA1c, high-sensitivity CRP, fasting insulin, and glucose levels, as well as aid in weight management. We discuss these findings and elaborate on potential mechanisms of ketones for promoting weight loss, decreasing hunger, and increasing satiety. Humans have evolved with the capacity for metabolic flexibility and the ability to use ketones for fuel. When we are eating low numbers of carbohydrates, insulin levels remain low and ketogenesis takes place. These conditions promote the breakdown of excess fat stores, sparing of lean muscle, and improvement in insulin sensitivity.
Curr Nutr Rep. 2018 Sep;7(3):97-106. doi: 10.1007/s13668-018-0235-0.
Counting calories often fails. Instead, focus on eating real food.
What is a calorie?
A calorie in physics is the energy required to raise the temperature of 1 gram of water to 1 °C. The calorie you see on a food package, however, is actually a kilocalorie, or 1,000 calories, the amount of energy needed to raise the temperature of 1 kilogram of water 1 degree Celsius. The original method used to determine calories in a given food directly measured the energy it produced. The food was placed in a bomb calorimeter, a sealed container surrounded by water. The food was completely burned and the resulting rise in water temperature was measured.
What is a nutritional calorie?
Calories in food and calories as measured in physics are not the same. Nutritional calories exclude non-digestible components, such as dietary fiber and artificial sweeteners, both of which could be burned in a bomb calorimeter to generate heat. Many of these components humans can’t digest, such as cellulose, are the primary energy source for other species. Human calories are dependent upon the body’s ability to catabolize them, which usually involves enzymatic action rather than a high-temperature oxidation reaction.
Food labeling
Food labeling information is based upon food component calorie estimation, calculated by adding up the calories provided by the energy-containing nutrients: protein, carbohydrate, fat, and alcohol. Because carbohydrates contain some fiber that is not digested and utilized by the body, the fiber component is usually subtracted from the total carbohydrate before calculating the calories. The Atwater system uses the average values of 4 Kcal/g for protein, 4 Kcal/g for carbohydrates, 9 Kcal/g for fat, and 7 Kcal/g for alcohol.
http://www.nal.usda.gov/fnic/foodcomp/
http://www.nat.uiuc.edu
These nutritional calories are the energy available in food, which our body can use for chemical reactions or store in reserve as fat or glycogen, We count the calorie value that the body can extract from the food eating but ignore the interaction of that food as a signaling molecule, the non-digestible components, and the thermic energy consumed in breaking the food down for consumption.
There occurs a paradox in nutritional science where a high-calorie consumption of one food substrate causes weight gain, while the same calorie value of another substrate seems to cause weight loss, leading some to suggest that calories don’t count.
The laws of physics are not broken, however — calories do matter with respect to energy balance. Whether fat, protein, or carbohydrate, a surplus of calories will lead to weight gain. The relevance is the quality of the calorie and the body’s response to those specific nutrients as signaling molecules beyond the direct caloric value. The body’s ability to convert the food substrate into usable energy is based upon a highly complex process, starting with a mechanical breakdown of food as well as chemical and enzymatic processes throughout the gut that are significantly affected by the individual microbiome. The body is not static, and how it utilizes a nutrient and the extraction of energy associated with that nutrient changes continuously. The real issue in obesity and type 2 diabetes management is how the body utilizes the nutrients presented, and if that specific approach works for that specific individual, in that specific time.
Food as a nutrient and as programming:
Food should be viewed as both a source of nutrient energy (globally translated as calories), but also as a set of instructions to the body, a program directing the body to a specific action. Food is not completely degraded to its elemental parts during digestion; it maintains components of integrity, which then programs the cells. A corrupted program can lead to outcomes such as obesity or diabetes or even an autoimmune state. These instructions are not interpreted just by the body, but also the gut microbiome, which can independently translate the instruction set and create its own programming subroutine, which then affects the body. Conventional nutritional advice ignores the instructional programming code carried in the food we consume, but these instructional programs cannot be ignored.
Focusing on feeling deprived only increases desirability.
It’s easier to track not eating sugars and artificial sugars than actually counting their calories. Tracking and reliving the calories of carbohydrates you didn’t eat stimulates ghrelin, the hunger hormone.
Instead of calories, focus on real food.
It’s easier to track pounds of steak, fish, shrimp, or chicken than calories. It’s not what you didn’t eat; it’s what you did eat and who you are that matters. You are a person that doesn’t eat sugars (artificial or natural), you don’t fall prey to the big processed food manufacturers, and you know the truth about vegetable oil.
Focus on feeding windows and time-restricted feeding.
It’s easier to track the hours of healthy eating than calories. If you know that you will only eat in a limited time window of 6 to 8 hours per day, the rest of your time becomes available for real activity.
A calorie is a calorie only if it is incinerated in a bomb calorimeter, and the heat is given off is measured. Biologically derived calories from different foods have entirely different metabolic effects on the human body. Equal calorie portions of sugar, alcohol, meat or olive oil have widely differing effects on hormonal systems such as insulin, and satiety signals such as cholecystokinin or peptide YY. It is irrelevant how many calories a portion of food on a plate contains. What matters is how our body responds to the ingestion and absorption of those calories, how they are metabolized, and the resulting level of satiety (fullness).
The current caloric reduction strategies promoted for weight loss are ineffective. Using the standard calorie reduction approach produces a probability of attaining a normal weight at 1 in 167, generating a greater than 99% failure rate.
Fildes A et al. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health. 2015;105: e54–e59
It is wrongly assumed that excessive caloric intake is the root cause of obesity. A calorie of food energy has different metabolic fates depending upon the hormonal stimulation. That same calorie may be used to generate body heat or stored as body fat. Obesity is a disease of failed energy partitioning, not one of total energy intake. The primary driver of this partitioning is the hormone insulin, which is specifically a fat storage growth hormone.
Focusing on calories in and calories out produces an inherent bias against high-fat food, which may actually protect against obesity and related diseases. The simplistic calorie focus results in a dietary guideline supportive of replacing fat with starch and sugar, which promotes insulin resistance.
It is our hope that shifting focus away from calories and emphasizing a dietary pattern that focuses on food quality rather than quantity will reduce obesity, related diseases and cardiovascular risk.
Malhotra A, DiNicolantonio JJ, Capewell S. It is time to stop counting calories, and time instead to promote dietary changes that substantially and rapidly reduce cardiovascular morbidity and mortality. Open Heart 2015;2(1) DOI: 10.1136/openhrt-2015-000273[published Online First: Epub Date]|.
Snacking will make you fat because of the chronic high insulin from the constant feeding.
There have been two major changes in our dietary habits since the 1970s, prior to the onset of the obesity epidemic. The change to a high-carbohydrate, low-fat diet has been well documented and has played an important role in causing obesity. However, the increase in meal frequency plays an equal if the not larger role and has been largely ignored. In the 1970s, the average number of eating opportunities was three – breakfast, lunch and dinner. By 2005, that number had almost doubled. Now we eat breakfast, snack, lunch, snack, dinner, and snack — and each of these contains refined carbohydrates more often than not.
Cameron JD. 6 meals per day do not result in greater weight loss. Br J Nutr. 2010 Apr;103(8):1098-101
Popkin BM. Does hunger and satiety drive eat anymore? Am J Clin Nutr 2010;91:1342–7
Tracking calories to determine that you are eating less is self-deception, and even if you did meticulously track calories, you would be off by as much as 20-50 percent. Even if you were absolutely perfect at tracking the actual calories, your calculations wouldn’t account for the bio-availability of nutrients, the effect of anti-nutrients from vegetables, or the thermic effect of food. Your resting metabolic calorie requirement changes from day to day, hour to hour, and season to season. Your gut microbiome, which determines nutrient absorption, changes continuously and interacts with your enteric nervous system and central nervous system.
Some people assume that their workout equipment which provides “calories burned” is actually accurate, but it’s not. Many people also reward themselves with a snack for exercising, which is a bad idea.
Instead of calorie counting:
Practice Hara Hachi bu, Confucian teaching, that instructs people to eat until they are 80 percent full. “Eat until you are eight parts (out of ten) full” or “belly 80 percent full.”
Simple changes to your eating patterns or the environment will dramatically increase the joy of food.
First, eat more slowly. Eating faster results in eating more. Slow down to allow your body to respond to cues, which tell us we are no longer hungry. You have a hormone called leptin that lets you know you are full, but if you wolf down your food, it doesn’t have enough time to work. Therefore, you should focus on food. Turn off the TV and the computer. If you’re going to eat, just eat.
Second, use small plates and tall, narrow glasses.
Third, cut out all the snacks. People eat from boredom or they eat from chemical signaling. Most of this chemical signaling can be eliminated when you remove artificial flavors, refined sugars, and industrial seed oils.
You probably have the mantra “breakfast is the most important meal of the day” stuck in your head. This was a baseless marketing phrase created in 1944 by General Foods to sell more cereal. John Harvey Kellogg of the Kellogg’s cereal company, a deeply religious Seventh Day Adventist, believed that cereal would improve Americans’ health and keep them from masturbating and desiring sex. Before the invention of cereal (to reduce masturbation), breakfast was not as standard or routine. Kellogg might actually have been half right — breakfast didn’t improve health, but increasing feeding frequency with processed cereal foods results in more insulin resistance and worsened male impotence.
Cut out breakfast, unless it is one of your two meals of the day and it falls inside your eating window. Regular breakfast consumption increases weight and insulin resistance by adding unnecessary calories to diets. https://doi.org/10.1136/bmj.l42
Eliminate vegetable oil.
One of the easiest substitutions you can make is eliminating vegetable oil and replacing it with real fat. Real fat tastes better, makes your food more flavorful, and carries fat-soluble vitamins.
Bottom line:
If you are eating real food, then your willpower is better spent somewhere other than calorie counting and calorie restriction. Remember, you are retraining your body to know when it’s actually full and to know what real hunger is. Your goal is to eat only when truly hungry.
Eliminating breakfast and restricting food to a 6 to 8 hour period of a given day makes this simple. Get rid of artificial flavorings, artificial and refined sugars, and refined foods. Healthy fat makes you satiated for a longtime. Satiety and the nutrient density of food is the ultimate test.
It’s not what you didn’t eat; it’s what you did eat and who you are that matters. It’s more about how your body responded to the food you did eat.
Reframe who you are:
You are a person that doesn’t eat sugars (artificial or natural), you don’t fall prey to the big processed food manufacturers, and you know the truth about vegetable oil.
There are some misconceptions about food and what to eat and not eat. The truth is that food is medicine and information for your body. Food is for real hunger, not boredom. Each patient is unique and any advice will need to be medically tailored.
Hara Hachi bu (腹八分目) is a Japanese phrase that translates to, “Eat until you are eight parts (out of ten) full” or “belly 80 percent full.” You can make simple changes in everyday habits to learn to eat until you are only 80 percent full.
First, eat more slowly. Eating faster results in eating more. Slow down to allow your body to respond to cues, which tell us we are no longer hungry. You should also focus on food. Turn off the TV and the computer. If you’re going to eat, just eat. You’ll eat more slowly, consume less, and savor the food more.
Second, use small dishes. Choose to eat on smaller plates and use tall, narrow glasses. You’re likely to eat significantly less without even thinking about it. Ten minutes before eating a meal, drink a large glass of cold water with lemon, and do so again 10 minutes after finishing a meal. Don’t snack, and don’t have anything in the house that you should not eat.
There are more steps you can take to make yourself healthier:
Step Step Step: Walk for 10 minutes after every time you eat or drink anything, even if it’s just water.
Step 1: Stop all vegetable oils — no canola, corn, soybean oil, Crisco, or margarine. Vegetable oils are also called industrial seed oils and were originally industrial waste products. Look at all food labels, and do not eat food with any vegetable oils listed. Do not use any spray-on oil. Instead, eat healthy oils and fats such as olive oil, coconut oil, butter, avocado, and duck fat.
Step 2: Eliminate all sugars and artificial sweeteners, or anything that is sweet on your tongue. Eliminate all refined sugars (juices, soda, diet soda, candy, chips).
Step 3: Sleep well and get at least 7 hours of uninterrupted sleep every night. Do not use your TV, phone, or computer in bed.
Step 4: Supplement with 4-6 grams of Krill or Fish Oil per day. Consider adding minerals like magnesium and salts as well. Ketone supplements may also play a role.
Step 5: Decide if you need a Cleanse Protocol or the Live Health Protocol. The purpose of either is NO vegetable oils, NO refined carbohydrates, and getting restorative sleep.
Cleanse Protocol: If you are starting out and are uncertain if specific foods may be contributing to your inflammation, or if you have weight to lose and are stuck, the cleanse protocol may be appropriate. You should only eat twice a day. During this time, you can eat as much beef, chicken, or fish as you like, and you can add butter and spices. That’s it for the next 4 weeks, then re-add one item per week that you might be sensitive to, as long as it still fits under the Live Health Protocol. Drink only water.
Live Health Protocol: This protocol helps you to live healthily and reduce your pain and inflammation. You should eat real food, such as meat (beef, pork, chicken, and fish), whole real eggs, green leafy vegetables, and seeds and tree nuts (almonds, macadamia). Drink only water, coffee, and unsweetened tea.
- Don’t eat fake industrial foods, carbohydrates or sugars (grains, cereals, grits, oatmeal, rice, rice cakes, pasta, potatoes, bread), fruits, or nuts from the soil (peanuts, cashews). Don’t drink soda, juice, diet soda, or creamers in coffee.
Bonus points:
Eat one to two tbsp of psyllium fiber dissolved in warm water 30 minutes before bed.
The ultimate health supplement is to skip one meal per day and eat only twice a day, in a short 6 to 8-hour feeding window.
No caffeine after 3 p.m.
Am I on the right track?
Some patients need immediate feedback, and this can be done by measuring ketones as a marker of fat loss.
Don’t make this complicated. Eat the same thing every day for the first few weeks, and choose between 4-5 different meals. You should feel full after the meal. Don’t snack. It’s a process that will take a few weeks to learn.
Don’t think of this as not having something, look at what you can have and eat until you are satisfied.
The more vegetable oil and sugar you eat, the worse your pain and inflammation will be. You may have to increase your salt intake if you feel fatigued or get muscle cramps. Medications may have to be adjusted.
It’s about reducing your sugar intake and increasing protein and healthy fats, and the rest will take care of itself.
It’s a way of living, not a diet. This is a process: you will fail a few times, but each time you fail you learn. Don’t try, just do.
For more information