Aside

A Twinkie does not = 1.5 apples.

I read the awesome article Bariatric Medicine: Seven Exciting Developments” by Sean Bourke MD on a flight from NYC to San Francisco last weekend. I identified with it enough feel compelled to summarize my favorite points for you all. Dr. Bourke is a bariatric doctor, meaning he works with those that are overweight or obese (and thus often times diabetic).

1. “Not all calories are created equal” is finally becoming accepted and substantiated.

Everyone differs in their level of tolerance for carbohydrates. Some people need more, while others need less. Some people need very little, whether it is for life or for the short term to treat a disease. Eating carbs above an appropriate level for your genetics, environment, and activity can lead to fat gain (adiposity), fat making you sick (adiposopathy), or both. In the last 40 years, diabetes and obesity have skyrocketed. What has been the major change in dietary habits? More carbs. As Dr. Bourke put it, “Carbohydrates, not [dietary] fat, may well represent our greatest metabolic and cardiovascular health risk contributing to obesity.” Because humans cannot consume more than 30-40% of their calories from protein, those that must eat a very low carbohydrate diet must make up the difference with fat intake. These people, namely those who have type 2 diabetes, insulin resistance, or metabolic syndrome, would do best with a well-designed low carb diet including particular fats while avoiding others.

Fats to emphasize: Heart healthy mono-unsaturated fats from avocados, nuts, olive oil. Heart neutral saturated fats from coconut and grass fed meats. Omega-3 rich fats from fish like salmon and tuna.

Fats to avoid: Omega-6 heavy fats found in vegetable, corn, and soy oils. All trans-fats, always, no matter what, because I said so.

In cool news, there is a test currently being developed to pinpoint an individual’s carbohydrate tolerance, so that exact recommendations can be given in the future!

2. Blood work is becoming more meaningful.

We now know and understand that heart health is more than just a cholesterol level. Most people are aware that HDL is good and LDL is bad. But now we can dig even deeper. LDL is also divided into subsets based on particle size. Some LDL’s are large and fluffy in our blood and others are hard and dense. The hard dense ones make you more likely to get a clogged artery and have a heart attack. The large fluffy ones are more likely to bounce of the walls of your arteries and not create a blockage.

And guess what alters our HDL and LDL levels, as well as affecting the LDL size….

Carbohydrate intake.

White flours and sugar increase LDL, particularly the small, hard LDL. Luckily, there is now testing available to determine what an individual’s levels of the various sizes of LDL are. Lipid fractionation yields blood results that can help doctor’s make more personalized recommendations for diet and lifestyle habits of their patients.

3. Ketogenic diets may provide antioxidant protection to the body.

Ketogenic diets are not for everyone and should not be confused with keto-acidosis, which necessitates higher levels of ketones in the blood. A ketogenic diet involves eating a low enough quantity of carbohydrates daily to force the body to produce ketones to burn for energy. A recent study by Shimazu et al found that a ketogenic diet may produce epigenetic changes to our DNA that prevent oxidative stress and free radical formation. This in turn may slow aging and help prevent diseases like coronary artery disease and Alzheimers.

4. For many patients, exercise is not the best way to lose weight.

Before interpreting that as a go ahead to forgo cardiovascular or muscular training, let me first say that exercise is extremely important for a plethora of reasons, like increasing insulin sensitivity, bone density, heart health, stress reduction, and general sexiness. However, exercise is should not be your big guns for weight loss. What you eat is the key to losing weight and is the basis of your health (at least in my opinion). You cannot outrun a crappy diet.

5. “Nutrition is the linchpin on which the solution to obesity crisis must turn.”

80% of the 600,000 food listed in our food supply have added sugar. Each American eats an average of 156 pounds of sugar per year, up from only 5 pounds in the 18th century. The solution? Eat real food.

Not all calories are created equally, and any system that allows you to interchange a Twinkie for 1.5 apples is wrong.

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2 responses to “A Twinkie does not = 1.5 apples.

  1. The title of this post cracked me up. :p But sadly, I HAVE known people to figure “a cal is a cal” or “a carb is a carb” and therefore the Twinkie comparison “should be accurate” and your body should react the same way. It’s not and it doesn’t.

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