Away for a few days

There’s been an emergency in my family, and I’ll be offline for a few days.  I’ll respond to comments when I get back.

Revelation

Last Wednesday, my husband, who was going straight to class after work, mentioned in IM that he was going to finish his lunch sandwich for dinner.  Apparently, it was just too big for him for lunch.

Now, I’m pretty sure I saw that sandwich sitting in the fridge that morning – it didn’t look so big to me.  I am pretty sure I could’ve finished it, together with a side of chips and a cookie. Or two.  Or three.  Except I don’t eat that way any more.  (Oh, and it was turkey, which I dislike intensely.  One of the great joys of giving up on low-fat is that I never have to eat turkey again.  Or canola oil.  Or fat-free dairy products.  But I digress.)

My first thought was, I can’t understand people who can be satisfied with half a sandwich.

Then I realized, I had lunch at 3:00 because I wasn’t hungry before then.  And I couldn’t finish mine, either.  The difference was, mine was meat, cheese, veggies, and seeds (pumpkin seeds, to be exact).  I was going to eat 3 oz. of cheese for the calcium, but I could only manage to get through two.  So actually, I can be satisfied with a half a sandwich – the inside half!

Every time I think of my low-fat days and the constant hunger, the shaking, the hunger pains, the sleepiness, and the sheer amount of time I spent putting food in my mouth – and then compare it to how I eat now, I marvel at how I’ve finally discovered what normal hunger is like.  Contrary to the six-small-meals-a-day crowd, normal hunger means being satisfied with three meals a day and not needing snacks.  It means not spending all your time thinking about the next thing you’re putting in your mouth.   (I know, I know, I’ve been advocating the notion that not everything works for everyone.  So, if you are a six-meals person, let me phrase this as a question.  Why?  Why are you hungry all the time?  Do you think it’s normal?)  And it means actually sometimes being unable to finish everything that’s on your plate.

My husband is lucky.  His body knows when to stop eating, even if what he’s eating contains carbs.  My body only knows when to stop eating if I’m eating fat, and lots of it.  I guess that’s what I’d better do, then.

Now I’m thinking of Jack Sprat and his wife.  I had a Mother Goose book when I was a kid, and Jack was pictured as super-skinny, and his wife as an obese globe.  I bet a lot of Mother Goose books illustrate them that way.  My fond hope is that one day they will both be pictured as normal-sized people who just have different metabolic needs!

When Inderal Meets Low Carb

I’ve commented before on how disturbing Inderal dreams can be.

Last night I dreamed I was eating in my college dining hall.  I had half an English muffin.  Then I went back for the second half.  Then I had a croissant.  Then a bagel.  Then another croissant.  You know where this is leading, don’t you?

I’m sure the “fat is all in your head” camp will say that this is because I miss these foods.  On the contrary, this was not a dream of desire.  It was a nightmare.  It was like I dreamed I was eating poison.

Neurology Appointment on Wednesday

Long-time readers of this blog may remember that about 3 months ago, I tried to make an appointment with a neurologist who specializes in migraine, and was told that he was booked until late October.  I made the appointment, my PCP prescribed Inderal, and I haven’t had a migraine since.

I’ve been wondering whether I should keep this appointment, since I’ve been completely migraine-free since starting Inderal, and perhaps I could free up the appointment for someone who really needed it.  I decided to call and describe the situation.  The receptionist talked me out of cancelling, saying that I should come in and be evaluated, because if I cancelled the appointment and later started having migraines again, it would be another 3 months before I could get an appointment.  “I see this happen all the time,” she said.  If the doctor had evaluated me and the migraines came back, he could consult with me by phone if necessary.

OK.  I did not cancel the appointment.  It’s probably for the best.  I want to ask if he’s heard anything about ketogenic diets for migraine (thanks to all my readers who have provided information sources, by the way).  I’m also more than a little concerned about Inderal’s affect on insulin levels, but it seems to be working so great against migraine that I’m reluctant to stop it without asking some questions.  I want to ask him exactly how Inderal works, and whether there are other drugs that affect the same brain pathways without raising insulin levels.  And of course, if there are other drugs, I want to know what side effects I could expect.  Finally, while this isn’t a problem at this time of year, Inderal is somewhat bothersome during hot weather, when my normal, non-drug-influenced BPs already run a little low; it would be nice if I could find an alternative before next summer – I felt limp for much of July and August.

I’ll confess that what I want to hear is:  ketogenic diets work extremely well for migraine; there’s a high likelihood that I won’t need Inderal as long as I stay on a low-carb regimen; and if low-carb does not completely resolve the migraine situation, there are other prophylactic drugs that do not raise insulin and have very few side effects.

Yeah, right, I can hear my fellow migraine sufferers say.  Well, a girl can dream, can’t she?

Bill Maher Nails It

Today, I spent much of my day reading Protein Power by the Drs. Eades.  I’d never read it before, and it really highlighted not only how much we rely on prescription drugs to treat diseases that are caused by lifestyle, but just how much prescription drugs actually make lifestyle diseases worse.  Example:  you eat a lot of carb, your insulin levels go up, causing you to retain water.  Your blood pressure goes up.  Your doctor prescribes a beta blocker and a diuretic, which get your blood pressure somewhat under control, but also raise your insulin levels further, causing you to gain weight.  Your blood lipids go up, so the doctor prescribes a statin, which causes your insulin to go up, and the next thing you know, you’re a Type II diabetic, and you’re lucky if your doctor even knows how to treat Type II correctly.  (Should you get insulin?  Metformin?  What diet should you follow?  The answers to these questions depend in part on whether your body can actually still produce insulin, but judging from the experience of friends, it can be very hard to get a 5-hour GTT, and when you do get it, half the time the techs don’t measure your insulin levels.)

So I was quite delighted to find a link to this video in my inbox.  I’ve often remarked that the only two reliable news sources in America are The Onion and Jon Stewart.  Why is it, anyway, that only comedians can tell the truth in our world?  Is it because that bit of laughter is the sugar-coating (whoops! I mean “pat of butter”) that makes the bitter truth go down better?

Oh, and add to my previous list of things we can all agree on:  fried Coke is bad.

The Magic Diet

Yesterday while looking for references to the ketogenic diet in treating epilepsy, I was charmed to see this on Epilepsy Action’s page about ketogenic diets for children:

Children as young as four have been taught to say, “No thank you, I’m on a magic diet”.

The Magic Diet – I like it.  I’m going to use it.  It sounds so much less clinical than “low-carb” and far less controversial than “Atkins.”

Diet Tricks That Didn’t Work For Me

I’m not talking about diets, here – low-carb vs. low-fat vs. low-calorie, in all their variations.  I’m talking about all those little tricks that don’t have much to do with what you consume, but other little associated tricks that are supposed to aid in weight loss.  I’m not saying these fail for everyone, but they certainly didn’t help me.  I’d be interested in learning what didn’t work for my readers.

1. Eat several small meals a day.  This didn’t work for me because it meant that I was always obsessed with my next meal.  Plus, because the meals were small, I’d be ravenous if I had to skip one for some reason.  How do people who claim to do this actually manage it?  I found dropping everything 6 times a day to eat to be a huge pain the a$$.  Our world is built around the “Three Squares” concept; it’s very troublesome trying to schedule in those extra 3 meals.  Give me three normal-sized meals a day, or, as my husband and I often do on the weekends, two normal-sized meals and a snack, and I’m good.
2. Drink a lot of water.  This advice comes in two forms – drink 8 glasses of water a day, or drink 1/2 oz. for each pound of your current weight.  This mostly just overfilled my stomach and aggravated my acid reflux, not to mention making me that unpopular person on any road trip who has to stop once an hour.  Now I drink when I’m thirsty.  I probably drink a liter to a liter and a half of water a day, more in warm weather.
3. No food is a forbidden food.  That’s supposed to be psychologically healthy somehow, the idea that we ought to be able to occasionally indulge in whatever we want.  But the truth is, 98% of what’s in the center aisles of the grocery store is overpriced, overmanufactured, addictive crap.  (Exceptions:  canned tuna, sardines, olive oil, vinegar.)  I’m not sure how it’s good for my mental health to allow myself to think of this crap as food, much less food that I should be allowed to eat.  So in a way,  this diet trick is right on – these foods are not forbidden foods, because they are not foods!
4. Exercise first thing in the morning to rev up your metabolism.  Whenever you hear the phrase “rev up your metabolism,” substitute “increase your appetite.”  I was never hungrier than when I was trying to hit the gym before work every day.  This may work for some people, but I am not one of them.
5. Join a support group.  This is not a commentary on all groups, but the internet group I joined was not really that helpful.  I liked everyone in the group and enjoyed their conversation, but their notion of support seemed to be, “It’s OK that you strayed from your diet; you’re only human.”  Dude, I don’t need a support group to rationalize for me; I am perfectly capable of rationalizing on my own.  What I need from a support group is a good swift kick in my fat a$$.
6. UPDATE, later on 10/26.  Fit in extra walks throughout the day.  You’ve probably heard this advice – park your car at the far end of the parking lot and walk.  Park your car several blocks from your office and walk.  Take the long way back to your desk from the bathroom.  I was thinking of this walking back from the public library after lunch today.  I have never owned a car.  The closest I’ve ever lived to a transit stop was 3 blocks; and most of the time it’s been more like 1/2 mile.  If walking a few extra minutes here and there were the magic guarantee to slimness forever, I should never have gained 60+ pounds in the first place.  (Of course, I do grant that it’s possible I’d be even fatter if I owned a car.)

So what do you say, readers?  What diet tricks didn’t work for you?

Ketogenic Diet for Migraine?

I started this blog many months ago as self-help for my migraines, and it has evolved into a blog about low-carb, with occasional migraine-related posts.  If you want a little more detail about this evolution, check out my About the Migraineur page.  If you want a lot more detail, read the archives. 

I have never claimed that there was any connection between migraine and a low-carb diet, but the thought has been nagging at the back of my mind.  So many other health problems clear up when I limit grain, other starches, and sugars – what if migraine were another?  What if I could get off Inderal, which has slowed, but not stopped, my weight loss?

Now, this new study from France has me wondering if low-carb could actually be a preventive measure for migraine.  Warning: extremely technical language.  If you’re not inclined to technical terms, (hey, I’m a bit of a nerd myself), try the layperson’s explanation on Jimmy Moore’s blog, where I originally found this.

Or, if even that’s too much, allow me to oversimplify even further.  A ketogenic diet is one that reduces carbohydrates and replaces them with fat, thereby leading the body to produce ketones and burn them for energy.  It’s long been known that a ketogenic diet can help control epilepsy in children – see this excellent article on Epilepsy Action’s website.  According to the new study, the ketogenic diet works by changing the balance of two neurotransmitters, GABA and glutamate, in the brain.  On a ketogenic diet, GABA increases, and glutamate decreases.  This is because burning glucose causes the body to make more glutamate, and burning fat causes the body to make less.

Call me gobsmacked.

GABA may not mean anything to the average migraineur, but anyone who has ever suffered from migraine should be very familiar with glutamate.  Glutamates in all their forms (mushrooms, parmesan cheese, soy products, MSG and its kin) show up frequently on lists of common migraine food triggers.  What I did not know what that glutamate acts as an excitatory neurotransmitter, which just means it causes neurotransmitters to fire.  I also didn’t know that glutamate is actually produced by our bodies, and I didn’t know that it often occurs in inverse ration to GABA, which is a neurotransmitter that inhibits the firing of neurons.

This suggests (but does not prove) that you can spend all the time you want avoiding all those glutamate-rich foods, but as along as you are feeding your brain a steady supply of glucose, it’s just gonna keep cranking out glutamate on its own.

Also note that one commonly prescribed migraine preventive is Topamax – an anti-seizure drug.  This also suggests (but does not prove) that treatments that are effective for epilepsy may also be effective for migraine.

Things it would be nice to know:

1.  How much glutamate occurs in the brain on the 300 g of carb a day recommended by the USDA?
2.  How much glutamate occurs in the brain on the 20 g to 50 g of carb a day recommended by many low-carb diet plans?
3.  How do these numbers compare to the glutamate in a reasonable-sized serving of Parmesan cheese or mushrooms?
4.  When is someone going to do a study of the effect of a ketogenic diet on migraine?  (Geez, I wish I were a scientist right now …)

Still, I find this very exciting – it really would be nice to get off Inderal!

Things We Can All Agree On

The Gary Taubes vs. Mehmet Oz episode of the Larry King Live show was emblazoned wtih the overwrought title, “The Hottest Diet Debate Since Atkins.”

That got me thinking – there’s way too much conflict in the diet wars.  (The fact that I unselfconsciously chose the phrase “diet wars” only supports my point.)  Low-fat and low-calorie proponents tell low-carbers that we are clogging our arteries with saturated fat, killing too many animals, following fad diets, and must be delusional if we think that we can eat more calories and lose weight.  We low-carbers, in turn, often fall prey to the temptation to accuse the low-fat folks of cooking the data, unintelligently following the conventional wisdom instead of thinking for themselves, not understanding how science is done, and having undue influence over public policy, food production, and the media.  I am guilty of it, too.

I think a lot of LC eaters feel that we have to be on the defensive, because we spend so much of our time bucking the norm.  It would be nice if we could all agree to disagree.  I am not going to dispute the claims of people who claim to have lost, and kept off, significant amounts of weight on low-fat, low-calorie diets.  If it works for you, do it.  But my dream is that one day low-carb will be presented by the authorities as a viable option for weight loss and disease prevention, so that people can make informed decisions on what to eat without constantly feeling like they are fighting the tide.  Because today, more than 5 years after the NYT Magazine article that generated renewed interest in LC, following LC is again just like swimming upstream, except without the spawning in the end.  That, in my opinion, is ridiculous.

But that’s no excuse for avoiding civil discourse.  In that spirit, then, let me list a few things we can all agree on:

• Donuts and French fries are bad for you.  They are high in fat, high in carbs, AND high in calories.
• Green vegetables are good for you.  They are low in fat, carbs, and calories.
• Trans fatty acids are bad for you.

OK, peeps, help me out here.  I can’t think of any more.

Well, all right:

• Exercise is good for you.

I added that one sort of reluctantly.  The role of exercise is controversial.  Everyone agrees it’s good for you, but no one can seem to agree on how much, what kind, or why.

[racks brain for several hours]

Nope, still can’t come up with any.  I was about to add “Drink 8 glasses of water a day,” until I remembered that I myself don’t believe that one.  (Too much liquid, like too much food, aggravates my acid reflux, and so far I don’t seem to have died of dehydration.)

Ah, no wonder nutrition is a battlefield!

Still, we at least have a few points of agreement.  So tonight, when I eat my salad, I shall raise my fork in honor of my low-fat friends and adversaries everywhere!

Moral Judgments from The Fat Pig

Last week while browsing the Fanatic Cook blog I ran across this excerpt from a book called The Fat Pig Diet, by the ironically named Michael Winner.  (Don’t forget to read section 2 of the excerpt, too.  If you can stand it.)

Winner has written a 304-page book to tell people that the secret to weight loss is to “eat less.”  I wonder what he needs the other 303.99 pages for.

When I started reading this excerpt, I rolled my eyes.  Just what we need, another simplistic solution for weight loss, I thought.  After all, if losing weight were a simple matter of eating less, Winner’s book wouldn’t have the company of 44,126 other diet books, which is how many I found by searching Amazon.com in “Books” for “weight loss.”  (Search performed at 7:25 PM EDT on 10/25/07 – your number may vary.) But as I read further, my eye-rolling switched to eye-popping.

Everything Winner says indicates that he thinks managing obesity is just a matter of willpower, and that the reason that he is no longer a fat pig is that he finally summoned up the willpower to stop eating too much.  My main purpose here is not to question the details of Winner’s story, but at one glaring moment he overlooks (deliberately or not, I cannot say) something so important that I feel an obligation to point it out.  He describes how, with a great increase in exercise and a modest reduction in food (“just a little caution,” he calls it) he lost 10 lbs in 2 years.  Big whoop, ten pounds in two years, when you start out weighing 220 lbs and exercise for an hour and a half a day.  (If exercise is so great, by the way, aren’t you supposed to have more to show for more than 1,000 hours of it?) He then mentions, briefly, that he was prescribed metformin to treat diabetes, and even admits that metformin is known for aiding weight loss.  But he does not mention that the way metformin works is by improving the body’s ability to use insulin, thereby breaking the “eat-carbs-release-too-much-insulin-feel-blood-sugar-drop-crave-more-carbs-cycle.”  And it was on metformin that he finally begins to shed weight in earnest.

Could it be that Michael Winner’s dramatic weight loss had little to do with his newfound willpower, and much to do with getting his glucose metabolism under control?  Could it be that Winner’s inability to eat just a little ice cream, instead finishing off the whole pint (or two, a situation I sadly remember myself from my pre-low-carb days), was not a sign of weak will but rather the manifestation of unstable blood sugar?  And could it be that the one and a half hours of daily exercise Winner took helped him, not because they burned calories but because they increased the sensitivity of his insulin receptors, again resulting in less insulin production, better blood sugar control, and better appetite control?

And that brings me to my real beef with Winner’s reasoning – his take on weight loss is rife with moral judgments and insults.  The fact that they are (mostly) aimed at himself doesn’t make them any less insulting or facile.  In just this short excerpt, he says he “could never resist temptation.”  He refers to his previous habits as “piggish” and ”undisciplined.”  His friend calls him a “fat bastard.”  Winner calls himself “the pig of the western world,” and implies that dieting is a matter of being able to “stand it,” as if it’s all willpower.  He says that “greed prevents” fat men from becoming thin men.  He refers to an overweight actress as a “fat cow,” because she rejects his diet advice (which is, after all, simplistic, questionable, and hard to follow).  He says that hunger pangs go away after a while if you exercise “control.”  And in the second excerpt, he says, “Why, you may ask, did I have to wait until I was nearly 70 before I finally managed to lose weight, and keep it off? The answer is simple. Because I was a total pig.”

(As a formerly rather fat person who is now a slightly less fat person, I have to tell you, gee, I can hardly wait to read the other 302 pages.  Because I just love the implication that fat people like me are lazy gluttonous slobs.  I can’t get enough of it!  And if you are a current or former fat person, I bet you’ll find it delightful, too.)

If you’ve ever been obese, fat, chubby, pudgy, or a little on the large side, Winner’s theme will sound familiar.  You’ve heard it before – you’re fat because you eat too much, exercise too little, are a greedy glutton, and have no willpower or self-control.  And if you’ve ever been obese, fat, chubby, etc, I would be very surprised to hear that you have never tried a weight-loss diet or an exercise regimen, or both.  And if you are still obese, fat, chubby, etc., (or worse, if you are obese, fat, chubby, etc., again, after having once lost weight), one can only conclude that it is because that diet or regimen failed in some way.  And if the diet or regimen failed, you probably felt that you failed, too.

I’ve been there.  I’d spend two or three days eating a teensy bit of smoked turkey breast (ick) with fat-free veggie “cheese” on dry whole wheat bread (six to eleven slices a day, just like the USDA said), with a side of raw veggies and an apple with fat-free caramel dip, washed down with diet Coke or skim milk.  After a few days, I’d be so hungry I’d give up.  And when I say “hungry,” I’m not talking about minor physical symptoms here, a few rumblies in my tummy.  I’m talking about shaking and breaking out into a cold sweat and fearing I’d pass out, or hunger pangs so intense all I could do was lie down while slowly consuming some food until they subsided.  So eventually I’d give up on the low-fat diet and scarf down a pint of super-premium ice cream, the kind where one serving provides 75% of the maximum saturated fat the USDA (screw them, by the way) says you should eat in a day.  And there are four servings in a pint.  And I would actually feel all right for a while.

Or I would get up on a Sunday morning, eat a bagel with fat-free “cream” cheese and have my coffee with fat free “half and half.”  (Half what and half what, I now wonder.  I think it’s half corn-syrup solids and half hydrogenated oil.  And how can they call it cream cheese if it has no butterfat?  If you’re my age or older, you might remember that, in the 70s, if a company made a product that was a substitute for the real thing, it had to be labelled as “substitute” or “imitation.”  We had more than a few jars of imitation mayonnaise around the house when I was a kid, not for any diet reasons but because they were cheaper than the real stuff – no longer the case, by the way; fat-free is big money now.  How come fat-free half and half and fat-free cream cheese and fat-free mayonnaise aren’t labelled “imitation” any more?  That’s probably the USDA’s fault, too.  But I digress.)  It would be a beautiful sunny day, and I would think, “I ought to go out for a walk after I’ve read the newspaper.”  I’d sit down and read the paper and a half hour after my low-fat, high-carb breakfast I’d be so sleepy that I’d be unable to keep my eyes open.  I’d wake up several hours later, the day completely shot, and feel like a lazy slug.

And because the issue of fat and weight loss is so fraught with moral terms, I’d feel guilty.  I’d feel like a failure at dieting; I’d feel like a failure at exercising.  And I kept getting fatter and fatter and lazier and lazier.

I will have much, much more to say about this when I review Good Calories, Bad Calories, but first let me ask the question which should’ve been obvious to my then ever-fattening self:  if I was experiencing severe physical symptoms – cold sweats, shakiness, hunger pains, and drowsiness – that were alleviated by eating or inactivity, does that not suggest that mere willpower had nothing to do with it?  Shouldn’t that have suggested that something physical was going on?

So why wasn’t it obvious?

The reason it wasn’t obvious is the clamor of voices shouting, “Fat people are lazy.  Fat people are gluttonous.  Fat people are fat because they spend all their time sitting in front of the TV scarfing down Cheetos.  If you are fat, it’s because you have no willpower.”

The moral stigma is nothing new.  Gluttony and Sloth have been numbered among the Seven Deadly sins at least since the time of Pope Gregory.  But, peeps, that was the 6th century.  Since 590 AD, we’ve learned that the sun is not the center of the universe, that microorganisms cause smallpox, that our blood circulates rather than just sloshing around inside us, and that instead of four elements, there are hundreds of them.  Why has our understanding of Why People Are Fat not been upgraded in the last 1,417 years?

What if it is not the quantity, but the quality of what we eat, that matters?  What if, as Taubes suggests, we’ve got cause and effect mixed up?  What if it’s not that we are fat because we eat too much and don’t exercise enough?  What if the opposite is true, that we eat too much and don’t exercise enough because we are fat?  What if a fat person’s body directs most of the energy consumed straight to the fat cells, leaving little energy for normal activities?  What if that makes fat people tired and hungry all the time?  What if the cause of this condition is not eating too much food, but the wrong kind?  And what if the kind of food that makes you hungry and tired is exactly the kind of food that’s everywhere, the kind that’s cheap (pasta), ubiquitous (check out any snack machine - heck, they even sell snacks at the Home Depot), easy to prepare (just add boiling water), found in virtually every restaurant from McDonald’s to Le Cirque, widely considered to be suitable food for children (macaroni and cheese, cookies, juice, crackers), served at every meal (your daily bread), requires no refrigeration (white flour, Fritos) and promoted by the government as healthy (the bottom of the Food Pyramid)?  What if finding genuine alternatives to the food that makes you hungry and tired were really difficult?  (Try this some day - count the different brands of unsweetened full-fat yogurt at your local grocery store.  I predict that the number will be 0 or 1.  Then count the varieties of sweetened, fat-free yogurt.)  What if people looked at you funny if you tried to skip these foods that make you hungry and tired and instead ate the food the government claimed was going to kill you?

I’m not asking you to be convinced that all of those what-ifs are true.  But for the sake of argument, just suppose for a moment that they are true.  Does it call into question the You’re Fat Because You’re a Lazy Glutton Theory of Obesity?  Does it suggest an alternate explanation of why fat people eat a lot and don’t exercise?  What if, instead of a weak will, all of us lardasses are all genuinely hungry and tired?

I’m not trying to say that we have no personal responsibility.  Lord knows, some days it’s just plain hard to skip the carbs.  They’re everywhere, and every day, every meal, I have to make a conscious decision that I am not going to eat high-carb foods.  After I bought brownies for my husband’s family, I made him take the leftovers to his office so I wouldn’t be tempted.  But let me tell you, it was thousands of times easier not to eat those brownies after I’d been well nourished by lamb and spinach with whole-milk paneer, than if I’d already been eating nothing but a non-stop stream of the low-fat, high-carb food the USDA wants me to eat.  It is a lot easier to skip junk food if you are not shaking and faint from low-blood sugar, if you are not so hungry that your stomach hurts.  And if you’ve been eating exactly the wrong foods because that’s what the officials tell you, and all it has done is make you fat and tired and hungry and unhealthy, how is that you are a lazy glutton?  And aren’t you mad, just plain angry at the people who promote these foods and the people who call you ugly names because you actually consumed them?

At least Winner used to be fat.  The worst is when some lifelong skinny person says, “Well, I’ve been skinny all my life, but …” and goes on to tell you, Fatty, how your problem is that you eat too much and don’t get enough exercise.  Don’t you just want to smack them?