Constrained Carbohydrate Common Denominators: Pt 2 The Zone

In the first part of this series, "Constrained Carbohydrate Common Denominators", we introduced the goal of finding some "low-carb" nutritional guidance that can be syndicated to the broadest possible audience. To review, this message is not intended for people who are already following paleo or primal lifestyles, sophisticated self-quantifiers and nutrition geeks, or Cross-fit super-people, and it is meant to have relevance across the socioeconomic and educational achievement spectrum. We accept the view that everyone falls somewhere on the more-or-less continuous spectrum of perfectly regulated blood sugar to extreme cases of metabolic syndrome and diabetes. The goal of this exercise is to find a dietary prescription, which combined with the sort of physical activities anyone can incorporate into their regular life, moves one down this curve, towards a functioning metabolism and a normal weight. In some cases, weight loss will be an important side-effect but it is general well-being and avoidance of the diseases of modern society that is the primary success criterion. Although we don't view food 'addiction' as a root cause of the obesity epidemic; it seems to be an important part of the phenomenology of metabolic damage and it seems plausible that it has an important nonlinear feedback effect on this condition. An ancillary goal of this exercise would be to shift societal resources away from intensifying and fueling this behavior. It is important that the nutritional messages that are distilled are reasonably straightforward and require only basic background in food groups, macro-nutrients and reading nutritional information on labels. The guidelines cannot be overly precise or fiddly, and shouldn't require too much fine tuning. We are quite sympathetic to the view articulated by S. Andrei Ostric

...what I believe in regards to a philosophy regarding health and nutrition. You have to keep a lot of plates spinning to make it work ie low carb, avoid grains and sugars, avoid gluten, avoid processed foods, eat whole foods, eat your vegetables, get sleep, get exercise, get rest, control your stress, avoid fructose, don’t overeat, enjoy meals with family and friends. All those things are the plates, and you have to keep them spinning. Sometimes the plates break, and you have to start over, sometimes you need help get the plate spinning, sometimes you still break the plate and yo have to find a new way to do it. But most important is have fun (that is passion, involvement, and awareness) during the process, and remember its the whole that counts not just one plate.

Nevertheless, we are looking for some time-homogeneous solutions that are stable to perturbations. We start this survey with The Zone diet, created by Dr. Barry Sears. Our rationale is that The Zone has been around since the mid-90s, longer than most diets that would qualify as carb-constrained; it is very well known and has spawned a mini-industry of books, educational resources and products; most importantly, it is actually moderate in carbohydrates (suggested macro-nutrient ratio of 30-30-40 fat/protein/carb) so is closest to the 'Standard American Diet' and presumably would be a less severe modification for most people. The diet removes sugar and most simple carbs and replaces them with 'healthy' fats and moderate amounts of protein. An interesting differentiation of the Zone approach is the direct focus on avoiding systemic low-level inflammation rather than trying to influence fat metabolism. Of course, we are not attempting a comprehensive exploration of his diet here but are touching on a few key aspects. To fully appreciate the perspective, please see his website or Dr. Sears' interesting books, including "Toxic Fat" which we found refreshingly different in its perspective though obviously speculative in aspects.

 Dr Sears was gracious enough to respond to a couple of questions we sent him which, though, specific, to us strike at the essential differences between established low-carb dietary frameworks; we reproduce his answers here. (Please note that Thought-Fuel Company has no affiliation or business relationship with Dr. Sears or his company.)

Many low-carb diets focus on control of insulin and, more recent, leptin. When we asked if it was more important to optimize insulin or leptin he responded:

It's not optimal hormonal levels of either insulin or leptin that is the goal, but reduction of cellular inflammation in their target cells that compromises their signaling to the interior of the cell . Thus you are looking for an optimal anti-inflammatory diet that makes both insulin and leptin work more effectively. The best anti-inflammatory diet remains the Zone diet coupled with high dose fish oil and very low in omega-6 fatty acids. As you reduce cellular inflammation, the levels of insulin and leptin will begin to fall.

Putting aside all the fundamental questions about underlying biochemical mechanisms and how they interplay in the complex system of human metabolic health, there have been some critiques of the Zone diet approach. Here we mention a few of the more frequent ones: 1. The Zone diet is really calorie restricted, due to the caloric intake being calibrated to the 30% protein component -- which for most people equates to 300-500 calories. This doesn't strike us as a severe defect; There are a number of studies connecting calorie restriction with longevity and disease avoidance. Dr Rosedale's diet, which is much more 'severely' low carb, also emphasizes reducing food intake and lowering body temperature. 2. Unlike many of the currently vogue Primal and Paleo low-carb diets (though not all, eg De Vany), The Zone steers strongly away from the consumption of saturated animal fats. We asked Dr. Sears about this:

Saturated fats have a slight inflammatory effect because of their ability to bind to toll-like receptors and initiate an inflammatory response. However, omega-6 fatty acids are more inflammatory because they generate arachidonic acid. Both should be kept to a minimum by replacing them with monounsaturated fats (non-inflammatory) and omega-3 fats (anti-inflammatory).

Other more controversial aspects of the approach include the inclusion of soy as a protein source and the prescriptive macro-nutrient ratios for each meal. We view each of these as potentially positive in the 'common denominator' context. For many people without sufficient access to beef or dairy sources, even if soy protein is not optimal, it may be better than eating carbs. And as long as they don't need to be exactly adhered to on every occasion, a uniform macro-nutrient ratio per meal may be the easiest long-term rule to follow.

In future installments we hope to look at other low-carb diets through this same lens.
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Constrained Carbohydrate Common Denominators

It has been clear for some time that the direct and indirect costs associated with diabetes and related metabolic disorders, heart disease, Alzheimer's, cancer, etc. are outstripping any conceivable economic growth and are a a truly systemic threat.   To many of us, reversing many of the misguided notions of nutrition, reinforced by the agricultural and pharma industries, that have dominated the past 30yrs is key if there is a hope to counteract this trend on a global scale.

But what is the right approach?  Decision support is always a tricky trade-off between complexity and adoption. People need tools to make decisions about their diet but the tools that are optimized and capture the most idiosyncratic variation may not be the ones that have the most broad impact.

If you look across the Primal/Paleo/Perfect-Health/Rosedale/Whole30/DeVany/Taubes/Eades etc. guidelines there is a lot of commonality but a significant amount of variation, mainly coinciding with incomplete empirical evidence or where the underlying processes are still unknown leading to multiple consistent interpretation of the same experiment.  In any case, the proponents and followers of these approaches are likely to be significantly more intrinsically curious, educated, economically successful,  and fascinated by the challenges of  n=1 experiment, analysis and interation than the average population.   Many people involved in these communities have experienced first-hand the acute effects of metabolic damage and were highly motivated and equipped to solve their personal problems.

All the frameworks start off seeming very straightforward as far as approximate macro-nutrient guidelines, approved and disapproved foods, supplementation, exercise and other behavioral guidelines.  But under closer examination and experience, all sorts of fine tuning becomes desirable.  Some of this is very natural as the needs of a severely metabolically challenged obese person, vs someone just trying to maintain weight at a  comfortable level are different.  But then the question of objective function becomes more and more prominent: is it weight loss, general health and disease avoidance, longevity, reproductive success?  And of course it is logical to think that one's personal history to date has a significant impact on what nutritional tweaks are most effective.

Although the cost issue has gotten a fair amount of attention and some debunking, it also seems unavoidable that the diets mentioned above are expensive to execute and maintain.  Whether it is dependence on grass-fed meat, supplementation, protein bars, access to organic vegetables, or simply the time to analyze and make good choices,  these are luxuries of the developed world and perhaps only the economic elite thereof.

So the question is, what are the broad messages that can be extracted from all the epidemiology and great analysis that have been done in response to the current crisis.  Fortunately we can hold up hope that more general and compelling principles/guidelines/explanations will emerge from the data in coming years as these movements intensify.   But change needs to be implemented immediately and thus we need to isolate a few principal components (in statistical terms) of our current state of knowledge and use these as the basis for a general message.  This will not be sufficiently precise, optimal or 'perfect' enough for sophisticated practitioners but are intended to maximize impact on mass behavior.  The most important success criteria is that the guidelines can be applied practically at the largest possible population.

There are many different ways of tackling the problem and we are deliberately ignoring the complicated interconnections and nuances of cause and effect.  The point is to get results. Should inflammation be the primary focus, or is it avoiding insulin resistance or leptin resistance ?  Are there acceptable protein and fat sources that can be produced at the necessary scale ?  Should we be looking for a macro-nutrient oriented food pyramid or a few simple 'don't eat this' (eg Fructose) rules.  Are there candidate diets that fit the bill.  As an example, consider the popular Zone diet?  The amount of carb allowed and the fat avoidance compared to most of the diets mentioned above may make it unappealing to some... but maybe it is more practical for most people to limit high glycemic load foods, and not try to navigate the delicate balance of maintaining satiety with the right fats while severely restricting carbs.

We would love to get comments and suggestions.

Carb Addiction Part 3 -- filling the 'gap'

Apparently as drugs have moved out of improving neighborhoods, the carb pushers have rushed in to take their place.




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Upper West Side Momofuku Milk Bar Certified Open

•   Posted by Niko on September 24th, 2011

   
  

  
  

  The menu for the Upper West Side Milk Bar

   
  

  Updated: Sunday, September 25, 2011: David Chang’s Upper West Side Momofuku Milk Bar is now open.
  As I watched the line grow outside the shop on Sunday morning I had a thought about how much things have changed in NYC over the last 25 years. In the 1980’s (and even into the early 1990’s) they also sold “crack pies” on this corner of West 87th Street, although minus the “pie” part. Now, people line up to pay $5 for a thin slice of dessert or $6 for soft serve made from cereal milk. Crazy.

   
  

  

   
  The sign and the paper menu says “Open Every Day”.  They were serving croissants (pistachio) and cookies (compost, blueberries & cream, cornflake & marshmallow and corn), buns (pork, veggie) soft serve, pies by the slice, etc.  561 Columbus Ave at 87th Street.

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And related

Amid increasing concern about the health impacts of sugar overconsumption, and particularly the addictive qualities of sugar, the first annual Sugar Addiction Awareness Day (SAAD) is kicking off October 30, 2011. The effort, supported by many leading physicians, researchers, nutritionists, and obesity experts, promotes a fun but sugar-free Halloween and aims to raise awareness of the potentially dangerous, and addictive, effects of excessive sugar consumption, especially for young people.

“Halloween candy seems like an innocent treat, but the reality is that millions of Americans are hooked on refined sugars, and it starts in their youth,” Jill Escher, founder of SAAD and author of the book, Farewell, Club Perma-Chub: A Sugar Addict’s Guide to Easy Weight Loss. “Chronic sugar consumption is a big contributor to the sweeping epidemics of obesity, metabolic syndrome and diabetes we see today. I am excited to stand with many leading lights in supporting Sugar Addiction Awareness Day as a big step forward in helping people break the cycle of sugar dependence.”

"The trouble with fructose: A Darwinian perspective" by Robert Lustig, MD from Ancestry on Vimeo.

Decisions under uncertainty: expectations, capital and an unfortunate current example

This is not a political site and we are not interested in making political or moral statements.  But we are deeply interested in how people and societies make decisions under uncertainty.

Theoretically one needs to account for both the expected value of the strategy and some cost of carrying uncertainty, as long as it persists.

What is the value in an execution?  Accepting the eye-for-eye 'logic' for a moment we have:

• Pright = probability guilty verdict is correct
• Cost of original crime = -1.0
• 'Value' of imprisonment to date = +0.25  (22 yrs)
• Incremental value of immediate execution =   0.50 
• 'Value' of imprisonment for rest of life = ?  = 0.25?
• Cost of being wrong and executing =  large negative (Let's be generous to the eye-for-eye perspective and call it -0.50 and neglecting the immense  societal costs.  We will also neglect the societal costs- if any- of life imprisonment when death-penalty was 'justified'.)

So for the execution strategy
      Expected value =  -0.75 (current state) + Pright*(0.50)+Pwrong*(-0.50)

For the don't execute strategy
      EV = -0.75 +0.25

So, to make execution a good decision (better expected outcome) we need
     -0.75+Pright(0.50)+(1-Pright)*(-.50) > -0.5    

                                            or    Pright>75%

So even on an expected basis we need to be very certain the verdict is correct.  Moreover, if one introduces the a more realistic assessment of the damage to the justice system and society of being wrong, the need for certainty will be greatly increased.

For instance:
if Cost of being wrong and executing = -2.0 we need to be 90% certain.

When the cost of uncertainty 'capital' (say, proportional to the standard-deviation of the payoff distribution)-- which will accrue until conclusive evidence is discovered is brought into the picture-- the demands on Pright will be higher still.

So even if one accepted the death penalty from a moral perspective, given the dubious nature of the legal case, it seems that a very bad decision was made.

Coexistence of food reward and carb theories of obesity? pt 2

Our own observations and reading of the literature strongly support the hypotheses that:
1. significantly reducing carbs, especially wheat and sugar leads to weight loss
2. wheat and sugar can have severe adverse health consequences, especially when excessively consumed

That said, obesity as a macro phenomenon (no pun intended) seems obviously a result of behavioral and fundamental biological factors. (Behavior is highly influenced by biological factors as well as other sensory inputs but is an emergent phenomenon). If food reward factors contributes significantly to high carb intake, then it seems reasonable to see the increase of availability of highly palatable food as a major "cause" of obesity.

It has been argued that, absent any other serious health conditions, one cannot become obese without eating a high carb diet.  This may be perfectly true but is it a sufficiently useful conclusion if it requires the caveat that “high” needs to be defined individually based on their genetics, individual history, and level of food addition (people who are following an on-average low carb diet who occasionally binge may do more damage to themselves than people on a higher average carb diet– negative convexity!)

So it seems that the debate boils down to whether the complex system involved has some natural regulation so that the behavior associated with food reward are only associated with high carb intake or whether other factors can significantly contribute to and perhaps exacerbate the food reward behavior.  It is generally assumed that there is effective regulation and so something has to fail (metabolic damage) in order to transition into the vicious cycle of weight gain and food reward.  However, this failure may be an abstraction in itself: perhaps there is a range of regulation effectiveness across the population and by moving into a new regime of food consumption we are seeing that variation in the form of the ‘obesity epidemic’. Alternatively one could hypothesize that on an individual level regulation is only effective within some range of inputs. When the frequency of exogenous shocks to consumption (of something) crosses some tipping point, the market feedback effect of making more highly palatable food leads to a systemic effect.

Our overarching point is that it may not be very fruitful (another unintentional pun) to try to isolate food reward from carb consumption as an underlying cause as they may reinforce each other in very complex ways.

Coexistence of Food Reward and Carb theories of obesity

Chris Kresser has an interesting post:

Reframing the obesity debate: cause/effect, genetics & robot clones.
His theory of obesity (reproduced below) may not be completely satisfying for people looking for mechanical explanations, but it is certainly not inconsistent with what has been demonstrated empirically.

Modern lifestyle + genetic predisposition = obesity

It really is that simple.

Modern lifestyle includes processed, refined and highly rewarding and palatable foods, excess fructose, unprepared grains (especially flour), industrial seed oils, environmental toxins, sedentary behavior, stress, infections and dysregulated gut flora.

But the modern lifestyle doesn’t cause obesity in all people. I’m sure we all know someone who eats a horrible diet, doesn’t exercise, is under tons of stress and lives a shockingly unhealthy lifestyle – but doesn’t gain a single pound.

That’s where genetics come in.

The current raging debate about the root or dominant cause of obesity seems rather futile given the number of conflating factors and collinearities and even the lack of clear definitions of the terms being used. Can one define obesity rigorously: is it an instantaneous state or a change from some other state; does the definition vary given the individual? If it is not a precise medical condition but rather a societal problem/theme it is hard to understand why food reward mechanisms and carbohydrate mechanisms of obesity cannot peacefully coexist as important contributors and even reinforce each other non-linearly. To many people there are few foods as palatable as sweet pastries, etc.

Even something as simple sounding as the statement 'you can eat as much meat as you want on a low carb diet' means different things to different people. Richard D Feinman recently gave his take on this in terms of satiety on a high fat, low carb diet.

If you have a weight problem, it is likely that you don't stop eating when you are no longer hungry but instead you continue for a number of possible reasons: eg,  you simply enjoy it (food reward),  you are distracted by hard thought, or perhaps are compensating for stress. One could also legitimately interpret 'eat as much as you want' to mean that there is some perfectly efficient diet (macronutrient breakdown perhaps) that would allow for effectively infinite consumption with the body only using what it needs for optimal performance and getting rid of the rest. Or is the statement meant to be true in some impractical limit which may not be nutritionally sound from a health standpoint, but would technically allow for easy weight loss?

Carb Addiction! (Expanded post).

We have been giving a little thought to why there is seemingly so much resistance in the medical and nutrition communities to the notion of sugar and refined carbs being a major factor in progressive physical and mental degeneration. There is a rather obvious answer to this question which doesn't seem to been sufficiently discussed. Like so many areas where logical analysis seems to be ignored by one group or another, it is worthwhile considering the personal and self-interest angles, though this always feels uncomfortable. But here are some propositions:

1) Medical doctors and associated nutrition experts and policy makers are inclined to ignore the theory and supporting evidence around sugar and carbs because they themselves cannot bear the thought of giving them up -- which would be the inescapable conclusion if they allowed themselves to accept these ideas.

2) Doctors and scientists are more likely than the general population to grow up priding themselves on their intellect, possibly in exclusion of their physical capabilities; this is natural because it is seen as their competitive advantage. Many have also experienced achieving great success (careerwise at least) by focusing on their mental achievements and ignoring the physical side as far as diet and exercise. As they age any mental decline they are aware of is a) expected- everyone knows that mathematicians typically do their best work before they are X yrs old- usually 40 is quoted b) to some extent compensated for by increased knowledge and experience. A tendency develops, and we were under the same possible delusion, that the brain and body are independent systems that can be successful independently and decline through time 'naturally'. A much more natural hypothesis is that brain health and efficiency and body health and efficiency are intertwined. Progressive degeneration of one system -- resulting from a lifetime of sugar and carbs -- is mirrored in the other. This is a very disturbing possibility for those who have grown up focused on their mental muscle and the advantages it brings them.

But who can blame them. A brief search of the internet, a visit to a bookstore, or a stroll down through a city neighborhood exposes the impressive energy and effort being poured into increasing their appeal of desserts through the perfect balance of sugar, salt and fat. Looking back say 20 years, it seems inescapable that there has been a dramatic increase in variety, quality and ubiquity of tantalizing pastries and desserts, aided of course by the internet and the associated foodie culture. If a brewing company introduced an extra-high alcohol content beer, there would undoubtedly be a certain amount of outcry over the dangers of abuse, at least in some populations.  But apparently carbohydrates and sugar are still held to a very different standard.

Here are some people lining up for 100 varieties of pie in Little Rock, AK and some other
examples of products humans managed to live without for many thousands of years:

http://www.seriouseats.com/2011/07/this-week-at-serious-eats-world-headquarters-20110729-slideshow.html#show-176604

And there are artists who just do cakes and donuts etc...  is it meant to be ironic? Or is it a way of feeding the addiction, heightening the intensity in between snacks?

And then there is the cupcake proliferation:


View Larger Map

And from the Research Labs, the innovation continues around the clock...

http://www.amazon.com/gp/product/0811876373/ref=as_li_ss_tl?ie=UTF8&tag=cakespycom-20&linkCode=as2&camp=217145&creative=399377&creativeASIN=0811876373

And whatever side of the culture wars -- Red State, Blue State or something else -- there is a place in the high carb universe for you:

It isn't enough to try to argue the medical science, and the statistics; this appears to be a full-fledged society level addiction which needs to be confronted head-on.  There are significant economic forces at work here, just like on the pharmaceutical and agribusiness side of the battle .