Paleo Diet Article in Sound Consumer

Monday, January 30, 2012
I recently wrote an article for my local natural foods grocery store, PCC, about the "Paleolithic" diet.  You can read it online here.  I explain the basic rationale for Paleo diets, some of the scientific support behind it, and how it can be helpful for people with certain health problems.  I focused in particular on the research of Dr. Staffan Lindeberg at the University of Lund, who has studied non-industrial populations using modern medical techniques and also conducted clinical diet trials using the Paleo diet.
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The New Health Law Needs to Be Repealed, Expanded, and Replaced—So Long As It Doesn’t Have a Mandate

Last week’s State of the Union speech was notable because the President hardly mentioned the new health care reform law.Avoiding what is supposed to be the centerpiece domestic accomplishment of President Obama’s first term stuck out like a sore thumb.He said almost nothing because the Obama team simply doesn’t know what to say.The fact is the Affordable Care Act (ACA) is generally unpopular, and

Insulin and Obesity: Another Nail in the Coffin

Friday, January 27, 2012
There are several versions of the insulin hypothesis of obesity, but the versions that are most visible to the public generally state that elevated circulating insulin (whether acute or chronic) increases body fatness.  Some versions invoke insulin's effects on fat tissue, others its effects in the brain.  This idea has been used to explain why low-carbohydrate and low-glycemic-index diets can lead to weight loss (although frankly, glycemic index per se doesn't seem to have much if any impact on body weight in controlled trials). 

I have explained in various posts why this idea does not appear to be correct (1, 2, 3), and why, after extensive research, the insulin hypothesis of obesity lost steam by the late 1980s.  However, I recently came across two experiments that tested the hypothesis as directly as it can be tested-- by chronically increasing circulating insulin in animals and measuring food intake and body weight and/or body fatness.  If the hypothesis is correct, these animals should gain fat, and perhaps eat more as well. 

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What Causes Insulin Resistance? Part VII

Monday, January 23, 2012
In previous posts, I outlined the factors I'm aware of that can contribute to insulin resistance.  In this post, first I'll list the factors, then I'll provide my opinion of effective strategies for preventing and potentially reversing insulin resistance.

The factors

These are the factors I'm aware of that can contribute to insulin resistance, listed in approximate order of importance.  I could be quite wrong about the order-- this is just my best guess. Many of these factors are intertwined with one another. 
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Three Announcements

Sunday, January 22, 2012
Chris Highcock of the blog Conditioning Research just published a book called Hillfit, which is a conditioning book targeted at hikers/backpackers.  He uses his knowledge and experience in hiking and conditioning to argue that strength training is an important part of conditioning for hiking.  I'm also a hiker/backpacker myself here in the rugged and beautiful Pacific Northwest, and I also find that strength training helps with climbing big hills, and walking farther and more easily with a lower risk of injury.

Richard Nikoley of the blog Free the Animal has also published a book called Free the Animal: Beyond the Blog, where he shares his strategies for losing fat and improving health and fitness.  I haven't had a chance to read it yet, but Richard has a reasonable perspective on diet/health and a sharp wit. 

Also, my friend Pedro Bastos has asked me to announce a one-day seminar at the University of Lisbon (Portugal) by Dr. Frits Muskiet titled "Vitamins and Minerals: A Scientific, Modern, Evolutionary and Global View".  It will be on Sunday, Feb 5-- you can find more details about the seminar here.  Dr. Muskiet is a researcher at the Groningen University Medical Center in the Netherlands.  He studies the impact of nutrients, particularly fatty acids, on health, from an evolutionary perspective.  Wish I could attend. 

Important Research From Medicare Demonstration Projects: Almost Nothing Works

Thursday, January 19, 2012
I will suggest that most of us believe the way to control health care costs, and at the same time maintain or improve quality, is to both use the managed care tools we have developed over the years, and perhaps more importantly, change the payment incentives so that both cost control and quality are upper most in the minds of providers and payers.The Congressional Budget Office (CBO) has just

What Causes Insulin Resistance? Part VI

Wednesday, January 18, 2012
In this post, I'll explore a few miscellaneous factors that can contribute to insulin resistance: smoking, glucocorticoids/stress, cooking temperature, age, genetics and low birth weight.


Smoking tobacco acutely and chronically reduces insulin sensitivity (1, 2, 3), possibly via:
  1. Increased inflammation
  2. Increased circulating free fatty acids (4)
Paradoxically, since smoking also protects against fat gain, in the very long term it may not produce as much insulin resistance as one would otherwise expect.  Diabetes risk is greatly elevated in the three years following smoking cessation (5), and this is likely due to the fat gain that occurs.  This is not a good excuse to keep smoking, because smoking tobacco is one of the most unhealthy things you can possibly do.  But it is a good reason to tighten up your diet and lifestyle after quitting.

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Will the Feds Be Ready With the Fallback Insurance Exchanges by October 2013?

Insurance exchanges have to be up and running in all of the states by October 2013 in order to be able to cover people by January 1, 2014.If the states don't do it, the feds have to be ready with a fallback exchange. States have to tell HHS if they intend to be ready by January 1, 2013.The White House just released a report saying that good progress is being made in 28 states. That begs the

What Causes Insulin Resistance? Part V

Sunday, January 15, 2012
Previously in this series, we've discussed the role of cellular energy excess, inflammation, brain insulin resistance, and micronutrient status in insulin resistance.  In this post, I'll explore the role of macronutrients and sugar in insulin sensitivity.

Carbohydrate and Fat

There are a number of studies on the effect of carbohydrate:fat ratios on insulin sensitivity, but many of them are confounded by fat loss (e.g., low-carbohydrate and low-fat weight loss studies), which almost invariably improves insulin sensitivity.  What interests me the most is to understand what effect different carbohydrate:fat ratios have on insulin sensitivity in healthy, weight stable people.  This will get at what causes insulin resistance in someone who does not already have it.

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Disparities in US Healthcare System

Friday, January 13, 2012
Healthcare disparities pose a major challenge to the diverse 21st century America. Demographic trends indicate that the number of Americans who are vulnerable to suffering the effects of healthcare disparities will rise over the next half century. These trends pose a daunting challenge for policymakers and the healthcare system. Wide disparities exist among groups on the basis of race/ethnicity, socioeconomic status, and geography. Healthcare disparities have occurred across different regional populations, economic cohorts, and racial/ethnic groups as well as between men and women. Education and income related disparities have also been seen. Social, cultural and economic factors are responsible for inequalities in the healthcare system. The issue of racial and ethnic disparities in healthcare have exploded onto the public stage. The causes of these disparities have been divided into health system factors and patient-provider factors. Health system factors include language and cultural barriers, the tendency for racial minorities to have lower-end health plans, and the lack of community resources, such as adequately stocked pharmacies in minority neighborhoods. Patient-provider factors include provider bias against minority patients, greater clinical uncertainty when treating minority patients, stereotypes about minority health behaviors and compliance, and mistrust and refusal of care by minority patients themselves who have had previous negative experiences with the healthcare system. The explanation for the racial and ethnic disparities is that minorities tend to be poor and less educated, with less access to care and they tend to live in places where doctors and hospitals provide lower quality care than elsewhere. Cultural or biological differences also play a role, and there is a long-running debate on how subtle racism infects the healthcare system. Inadequate transportation or the lack of knowledge among minorities about hospital quality could also be factors of inadequate care. Racial disparities are most likely a shared responsibility of plans, providers and patients. There's probably not one factor that explains all of the disparity, but health plans do play an important role. Racial and ethnic disparities in healthcare do not occur in isolation. They are a part of the broader social and economic inequality experienced by minorities in many sectors. Many parts of the system including health plans, health care providers and patients may contribute to racial and ethnic disparities in health care. It is seen that there are significant disparities in the quality of care delivered to racial and ethnic minorities. There is a need to combat the root causes of discrimination within our healthcare system. Racial or ethnic differences in the quality of healthcare needs to be taken care of. This can be done by understanding multilevel determinants of healthcare disparities, including individual belief and preferences, effective patient-provider communication and the organizational culture of the health care system. To build a healthier America, a much-needed framework for a broad national effort is required to research the reasons behind healthcare disparities and to develop workable solutions. If these inequalities grow in access, they can contribute to and exacerbate existing disparities in health and quality of life, creating barriers to a strong and productive life. There is a need to form possible strategies and interventions that may be able to lessen and perhaps even eliminate these differences. It is largely determined by assumptions about the etiology of a given disparity. Some disparities may be driven, for example, by gaps in access and insurance coverage, and the appropriate strategy will directly address these shortcomings. The elimination of disparities will help to ensure that all patients receive evidence-based care for their condition. Such an approach will help establish quality improvement in the healthcare industry. Reducing disparities is increasingly seen as part of improving quality overall. The focus should be to understand their underlying causes and design interventions to reduce or eliminate them. The strategy of tackling disparities as part of quality improvement programs has gained significant attraction nationally. National leadership is needed to push for innovations in quality improvement, and to take actions that reduce disparities in clinical practice, health professional education, and research. The programs and polices to reduce and potentially eliminate disparities should be informed by research that identifies and targets the underlying causes of lower performance in hospitals. By eliminating disparities, the hospitals will become even more committed to the community. This will help to provide culturally competent care and also improve community connections. It will stimulate substantial progress in the quality of service that hospitals offer to its diverse patient community. Ongoing work to eliminate health disparities will help the healthcare departments to continually evaluate the patient satisfaction with services and achieve equality in healthcare services. It is important to use some interventions to reduce healthcare disparities. Successful features of interventions include the use of multifaceted, intense approaches, culturally and linguistically appropriate methods, improved access to care, tailoring, the establishment of partnerships with stakeholders, and community involvement. This will help in ensuring community commitment and serve the health needs of the community. There is the need to address these disparities on six fronts: increasing access to quality health care, patient care, provider issues, systems that deliver health care, societal concerns, and continued research. A well-functioning system would have minimal differences among groups in terms of access to and quality of healthcare services. This will help to bring single standard of care for people of all walks of life. Elimination of health care disparities will help to build a healthier America. Improving population health and reducing healthcare disparities would go hand in hand. In the health field, organizations exist to meet human needs. It is important to analyze rationally as to what actions would contribute to eliminate the disparities in the healthcare field, so that human needs are fulfilled in a conducive way.

New Obesity Review Paper by Yours Truly

Thursday, January 12, 2012
The Journal of Clinical Endocrinology and Metabolism just published a clinical review paper written by myself and my mentor Dr. Mike Schwartz, titled "Regulation of Food Intake, Energy Balance, and Body Fat Mass: Implications for the Pathogenesis and Treatment of Obesity" (1).  JCEM is one of the most cited peer-reviewed journals in the fields of endocrinology, obesity and diabetes, and I'm very pleased that it spans the gap between scientists and physicians.  Our paper takes a fresh and up-to-date look at the mechanisms by which food intake and body fat mass are regulated by the body, and how these mechanisms are altered in obesity.  We explain the obesity epidemic in terms of the mismatch between our genes and our current environment, a theme that is frequently invoked in ancestral health circles.

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I Hope Trustmark Tells HHS to Go Pound Sand

Today, the Department of Health and Human Services announced that, "Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states."The HHS statement continued, "In these five states, Trustmark has raised

2012: A Year of Huge Uncertainty in Health Care Policy

Tuesday, January 10, 2012
2013 may be the most significant year in health care policy ever.But we have to get through 2012 first.Once the 2012 election results are in there will be the very real opportunity to address a long list of health care issues.If Republicans win, the top of the list will include “repealing and replacing” the Affordable Care Act. If Obama is reelected, but Republicans capture both houses of

What Causes Insulin Resistance? Part IV

Monday, January 9, 2012
So far, we've explored three interlinked causes of insulin resistance: cellular energy excess, inflammation, and insulin resistance in the brain.  In this post, I'll explore the effects on micronutrient status on insulin sensitivity.

Micronutrient Status

There is a large body of literature on the effects of nutrient intake/status on insulin action, and it's not my field, so I don't intend this to be a comprehensive post.  My intention is simply to demonstrate that it's important, and highlight a few major factors I'm aware of.

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What Causes Insulin Resistance? Part III

Sunday, January 8, 2012
As discussed in previous posts, cellular energy excess and inflammation are two important and interlinked causes of insulin resistance.  Continuing our exploration of insulin resistance, let's turn our attention to the brain.

The brain influences every tissue in the body, in many instances managing tissue processes to react to changing environmental or internal conditions.  It is intimately involved in insulin signaling in various tissues, for example by:
  • regulating insulin secretion by the pancreas (1)
  • regulating glucose absorption by tissues in response to insulin (2)
  • regulating the suppression of glucose production by the liver in response to insulin (3)
  • regulating the trafficking of fatty acids in and out of fat cells in response to insulin (4, 5)
Because of its important role in insulin signaling, the brain is a candidate mechanism of insulin resistance.

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What Causes Insulin Resistance? Part II

Saturday, January 7, 2012
In the last post, I described how cellular energy excess causes insulin resistance, and how this is triggered by whole-body energy imbalance.  In this post, I'll describe another major cause of insulin resistance: inflammation. 


In 1876, a German physician named W Ebstein reported that high doses of sodium salicylate could totally eliminate the signs and symptoms of diabetes in certain patients (Berliner Klinische Wochenschrift. 13:337. 1876). Following up on this work in 1901, the British physician RT Williamson reported that treating diabetic patients with sodium salicylate caused a striking decrease in the amount of glucose contained in the patients' urine, also indicating an apparent improvement in diabetes (2).  This effect was essentially forgotten until 1957, when it was rediscovered.

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What Causes Insulin Resistance? Part I

Friday, January 6, 2012
Insulin is an ancient hormone that influences many processes in the body.  Its main role is to manage circulating concentrations of nutrients (principally glucose and fatty acids, the body's two main fuels), keeping them within a fairly narrow range*.  It does this by encouraging the transport of nutrients into cells from the circulation, and discouraging the export of nutrients out of storage sites, in response to an increase in circulating nutrients (glucose or fatty acids). It therefore operates a negative feedback loop that constrains circulating nutrient concentrations.  It also has many other functions that are tissue-specific.

Insulin resistance is a state in which cells lose sensitivity to the effects of insulin, eventually leading to a diminished ability to control circulating nutrients (glucose and fatty acids).  It is a major contributor to diabetes risk, and probably a contributor to the risk of cardiovascular disease, certain cancers and a number of other disorders. 

Why is it important to manage the concentration of circulating nutrients to keep them within a narrow range?  The answer to that question is the crux of this post. 

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New York Times Magazine Article on Obesity

Wednesday, January 4, 2012
For those of you who haven't seen it, Tara Parker-Pope write a nice article on obesity in the latest issue of NY Times Magazine (1).  She discusses  research showing  that the body "resists" fat loss attempts, making it difficult to lose fat and maintain fat loss once obesity is established.
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High-Fat Diets, Obesity and Brain Damage

Monday, January 2, 2012
Many of you have probably heard the news this week:

High-fat diet may damage the brain
Eating a high-fat diet may rapidly injure brain cells
High fat diet injures the brain
Brain injury from high-fat foods

Your brain cells are exploding with every bite of butter!  Just kidding.  The study in question is titled "Obesity is Associated with Hypothalamic Injury in Rodents and Humans", by Dr. Josh Thaler and colleagues, with my mentor Dr. Mike Schwartz as senior author (1).  We collaborated with the labs of Drs. Tamas Horvath and Matthias Tschop.  I'm fourth author on the paper, so let me explain what we found and why it's important.  

The Questions

Among the many questions that interest obesity researchers, two stand out:
  1. What causes obesity?
  2. Once obesity is established, why is it so difficult to treat?
Our study expands on the efforts of many other labs to answer the first question, and takes a stab at the second one as well.  Dr. Licio Velloso and collaborators were the first to show in 2005 that inflammation in a part of the brain called the hypothalamus contributes to the development of obesity in rodents (2), and this has been independently confirmed several times since then.  The hypothalamus is an important brain region for the regulation of body fatness, and inflammation keeps it from doing its job correctly.

The Findings

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Junk Free January

Sunday, January 1, 2012
Last year, Matt Lentzner organized a project called Gluten Free January, in which 546 people from around the world gave up gluten for one month.  The results were striking: a surprisingly large proportion of participants lost weight, experienced improved energy, better digestion and other benefits (1, 2).  This January, Lentzner organized a similar project called Junk Free January.  Participants can choose between four different diet styles:
  1. Gluten free
  2. Seed oil free (soybean, sunflower, corn oil, etc.)
  3. Sugar free
  4. Gluten, seed oil and sugar free
Wheat, seed oils and added sugar are three factors that, in my opinion, are probably linked to the modern "diseases of affluence" such as obesity, diabetes and coronary heart disease.  This is particularly true if the wheat is eaten in the form of white flour products, and the seed oils are industrially refined and used in high-heat cooking applications.

If you've been waiting for an excuse to improve your diet, why not join Junk Free January?