Super Size Me - the Swedish Experiment

A research from Linkoping University, Sweden, published in the medical journal "Gut", showed that regular indulging in fast food caused, in less than 4 weeks, a pathologic rise in the level of a liver enzyme, alanine aminotransferase (ALT) in the blood. The fast food experiment subjects aimed for a body weight increase of 5-15% by eating at least two fast food-based meals a day with the goal to double the regular caloric intake in combination with adoption of a sedentary lifestyle for four weeks. They limited their daily exercise to less than 5000 steps for 4 weeks. The authors suggested that an increased flow of monosaccharides to the liver could induce the production of the enzyme in the liver cells. The authors, therefore, recommended that physicians should include not only questions about alcohol intake, but also recent excessive food intake, when evaluating reasons for a new elevation of ALT.

An article in the Guardian gave a little history how the Dr. Fredrik H Nystrom's Swedish experiment design was influenced by Morgan Spurlock's 2004 documentary "Super Size Me", in which Spurlock ate nothing but McDonald's food for a month. You may remember that doctors urged him to abandon his experiment after getting the results of blood tests which show that his liver is so badly damaged it looks as though it is the result of heavy drinking. The results of the Swedish study did document liver enzyme test abnormalities, but those were not as dramatic as Spurlock's.

It is actually not necessarily a matter of whether the food is consumed from McDonald's, a family restaurant, or cooked at home. It is not entirely a matter of whether the food is "fast food" or a fully served multi-course meal in a fancy restaurant. The central issue is all about choices. How many calories, how many of those are proteins, how many are from carbs, and how many are from fat. Wherever you eat, you have to make the best choices regarding the portions and the quality of food. Stay healthy!

Reference:

Fast food based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects. Stergios Kechagias, Åsa Ernersson, Olof Dahlqvist, Peter Lundberg, Torbjörn Lindström, and Fredrik H Nystrom. Gut 2008 Feb 14; [Epub ahead of print] PMID: 18276725

Roundup - What's the Problem?

"... as an adult, we understand even if you ruin an appetite, there's another appetite coming right behind it. There's no danger in running out of appetites. I've got millions of them." --Jerry Seinfeld. The "Heart Attack" episode.


Fact: When food is in short supply, obesity as a public health problem does not exist. As a matter of fact, being obese under those circumstances signifies being wealthy or of higher economic status than the average population. Look at countries where some are living in poverty, and others are more affluent. Which segment of that society has a problem with obesity?

Fact: When food is made available and affordable, in the presence of abundance, the average person will eat more. Much more. Bigger portions. It is surprising to see people who immigrated as adults from less affluent countries continuing to eat the portions and at the times that they were used to, and stay slim. They have already developed the habits and controls and they stay satisfied with the portions and types of food that they used to consume. Their first generation kids, however, who were not raised in such a controlled environment, may become overweight or obese.

Fact: When food is not only made available in abundance 24 hours a day, but is also advertised all day long, people tend to consume even more. And branding does affect their choices.

Fact: Social networks can strongly enhance the spread of obesity.

One conclusion I can draw here is that: External influences tend to have a stronger effect on controlling how much we eat than spontaneous internal influences, in the average person. It takes a conscious effort and proper habit building and modifications to overcome those external influences. That we are victims of an environment and a culture that facilitates (or may even encourage) habits that will make us unhealthy, the only true refuge is our own ability to change habits and behaviors that developed under those circumstances. Although I stress on over-eating as a deadly habit, it is important to notice that serious under-eating as in anorexia nervosa is at least as deadly, if not more.

Remember, weight control is achieved through three elements:

1. Diet (portion acontrol and quality control)

2. Exercise or physical activity

3. Behavioral change towards healthy habits

Everything else (a diet program, a trainer, a pill, a surgical operation) is a tool that helps you control your energy storage (and, consequently, the weight of fat) through one or more of the above mechanisms.

Stay healthy! Happy Holidays!

Excess Fat, Red Meat, Alcohol, and Cancer

"Food, Nutrition and the Prevention of Cancer: a global perspective", a report produced by the World Cancer Research Fund together with the American Institute for Cancer Research , has been the most authoritative source on food, nutrition, and cancer prevention for 10 years. In October 2007, the updated Report was released in Washington, DC. The Report is the result of a five-year process that included examination of the world's literature by a panel of the world's leading scientists, supported by observers from United Nations and other international organisations

The Report found out that carrying excess body fat increases the risk for cancer of the colon, kidney, esophagus, pancreas, and endometrium, as well as breast cancer in post-menopausal women. Their first recommendation is: Be as lean as possible within the normal range of body weight.

The Report also indicated that there is convincing evidence linking consumption of red meats like beef, pork and lamb to colorectal cancer. The recommendation is: Limit intake of red meat and avoid processed meat. People who eat red meat to consume less than 500 g (18 oz) a week, very little if any to be processed. ‘Red meat’ refers to beef, pork, lamb, and goat from domesticated animals including that contained in processed foods. "Processed meat" refers to meat preserved by smoking, curing or salting, oraddition of chemical preservatives, including that contained in processed foods.

Another recommendation: Limit alcoholic drinks. The evidence on cancer justified a recommendation not to drink alcoholic drinks. The report specified that, based solely on the evidence on cancer, even small amounts of alcoholic drinks should be avoided. But, because other evidence shows that modest amounts of alcoholic drinks are likely to reduce the risk of coronary heart disease, the Report recommended limiting rather than avoiding, alcohol consumption.

The strongest evidence on methods of food preservation, processing, and preparation showed that salt and salt-preserved foods are probably a cause of stomach cancer.

The World Cancer Research Fund global network consists of the following charitable organisations: The American Institute for Cancer Research (AICR); World Cancer Research Fund (WCRF UK); Wereld Kanker Onderzoek Fonds (WCRF NL); World Cancer Research Fund Hong Kong (WCRF HK);Fonds Mondial de Recherche contre le Cancer (FMRC FR) and the umbrella association, World Cancer Research Fund International (WCRF International)
The World Cancer Research Fund global network funds research on the relationship of nutrition, physical activity and weight management to cancer risk, interprets the accumulated scientific literature in the field, and educates people about choices they can make to reduce their chances of developing cancer.

Source:
An abbreviated version of the full Report http://www.dietandcancerreport.org/downloads/summary/english.pdf

For a summary of the recommendations:
http://www.wcrf.org/home/recommendations.lasso

Hungry, Satisfied, or Full?

For the sake of simplicity and to make points clearer, I will use definitions that may be different from the standard broad dictionary definitions:

Hunger: The unpleasant feeling that accompanies a real physical need for nourishment or food.
Fullness: The feeling that maximum capacity to eat has been reached.
Satiety: A state of satisfaction that can be reached when not hungry, but before feeling full.

When we are hungry, we know it. Of course we need to eat. The trick is either not let yourself get really very hungry, so that you can avoid over-eating, or simply develop the habit of recognizing a point of satiety, or satisfaction, before actually feeling full. Remind you, I am using the definitions outlined above. So, how to recognize that point of satisfaction? Well, that point can be appreciated by allowing your brain to recognize that you are not hungry anymore. The signal will come up, but you have to give it time to reach up there. What that means? Don't eat too fast. Do not enter in your mouth one large bite at a time. Once in your mouth, take your time chewing your food. Enjoy the taste of the food. Chew 20 times before actually swallowing. After swallowing the well-chewed bite, wait a little bit before you get the next bite into your mouth.

If you are using portion control (for example, after weight loss surgery, or as a part of dieting), put on your plate only the portion that you are supposed to eat. If there is more on your plate, do not clear your plate. Eat slowly as described above, till you have almost completed your portion, then STOP. Even if you are not satisfied, stop. Distract yourself. Do something. Then ask yourself in 10 minutes or so: "Am I still hungry? Or do I want to eat just because? If you are not truly hungry, and if you reached the portion size that you have decided, you have probably reached the point of satisfaction and hopefully the above techniques gave your brain enough time to appreciate that signal. Remember, feeling full (using the definition that I wrote above) is not a good signal to stop eating. It is too late. And if you had Lap Band, gastric bypass, or a sleeve gastrectomy, you are probably setting yourself up for a stretch of the pouch. In case of an adjustable gastric band in particular (like the Lap Band), stretching the pouch may be a factor in slippage (prolapse). So, be careful, and stay healthy!

Alcohol after Gastric Bypass

A glass of wine or two. A beer. A little mixed drink. Would that be OK after a gastric bypass? Well, early after the surgery, while the stomach is healing, you really want to avoid the irritant effect of alcohol. You want your pouch to heal well. So, the answer, as far as we know, is "no". But, what about drinking, let's say 6 months, a year, or more after the surgery? A very interesting study confirmed the previous opinion, that is, alcohol levels go higher after gastric bypass than people who had no such surgery. In a study published in the September issue of the journal "Surgery for Obesity and Related Diseases" (SOARD), researchers from Stanford School of Medicine, Stanford, California, concluded that the gastric bypass patients had a greater peak alcohol level and a longer time for the alcohol level to come back down to zero than the individuals who did not have gastric bypass. A particularly interesting finding was that the gastric bypass patients did not feel that alcohol influenced them any more than the no-surgery group. Could that explain why there are reports of post-gastric bypass patients who were cited for driving under the influence (DUI) after a small social alcoholic drink? Maybe. But also remember that there are other complications related to alcohol intake. Liver disease from alcohol is well-known. To develop alcoholic liver disease on top of the known obesity-related liver disease can be particularly dangerous. Alcohol is not good for peptic ulcers, either. Alcohol calories are empty calories, which is not what gastric bypass patients want to ingest. Also alcohol drinking has been linked to vitamin B1 deficiency. Severe vitamin B1 deficiency can lead to serious nerve damage, that is, Wernicke’s encephalopathy. So far, we do not have a perfectly scientific answer to the question: Is it OK to drink, in moderation, if you are not driving, several months or years after gastric bypass? We just do not have the final answer, and prefer to err on the cautious side. Better be safe than sorry.

References:
Klockhoff H, Naslund I, Jones AW. Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery.Br J Clin Pharmacol. 2002 Dec;54(6):587-91.

Hagedorn JC, Encarnacion B, Brat GA, Morton JM. Does gastric bypass alter alcohol metabolism? SOARD. 2007 Sept;3(5):543-8. (Note: This is the study quoted above)

Can TV ads influence our kids' taste buds?

This is not exactly a bariatric surgery topic, but, nevertheless, a very interesting one. Does advertising/branding affect children's taste? Well, we know that TV ads do influence kids, who, as a consequence, keep begging and nagging for an advertised product. The pressuring will intensify, once other parents provided your kids friends with the product. What standing do you have when you stick to the hated "No", while the attractive TV ads say "yes", and peers' parents have given the sign of approval?

A very interesting study came from Stanford Prevention Research Center and Stanford University School of Medicine. It was published in the August, 2007, issue of the "Archives of Pediatrics & Adolescent Medicine." (1) Kids aged 3-5 years (yes, that young!) were entered into a food tasting game, where they were given 2 identical food items, one wrapped in a McDonald's typical wrapping, and the other wrapped in a plane white wrapping. Items included not only hamburgers, fries and chicken McNugget's, but also baby carrots, which are not even sold at McDonald's, but were placed on top of a McDonald's french fries bag and on top of a matched plain white bag. McDonald's was chosen because it is a good example of a well-branded and heavily marketed source. Guess what? There was a statistically significant higher taste preference for the foods associated with the branded wrappings. This study is remarkable for its hypothesis, and the results that came out of it.

The authors concluded that branding of foods and beverages influences young children's taste perceptions. The authors also suggested that branding may be a useful strategy for improving young children's eating behaviors.

No wonder, a report of a joint "WHO/FAO Expert Consultation" indicated that: "Heavy marketing of fast-food outlets and energy-dense, micronutrient-poor foods and beverages" is a "probable" cause of excess weight gain and obesity. There has been strong evidence of a relationships between television viewing and obesity in children. Could that be, at least partially, due to the food advertising to which they are exposed? You bet.

(1) Robinson TN, Borzekowski DL, Matheson DM, Kraemer HC. Effects of fast food branding on young children's taste preferences. Arch Pediatr Adolesc Med. 2007 Aug;161(8):792-7. PMID: 17679662