Gary Taubes “The Case Against Sugar”

A recent best-seller has great insight into the the history of Sugar and its impact on diet. Gary Taubes has written a new book that details the history of sugar and the sugar industry.  Tuabes has made a career looking at bad science and the effects of sugar on the American Diet.   Here is a brief review of the book.  

For those of you that do not know Gary Taubes isjournalist that for most of the last 10 yearswriting and studying about nutrition and in-particular the effect of carbs and sugar on the obesity.   Taubes has written two previous books “Good Calories Bad Calories”  and “Why We Get Fat”  that detail the his thoughts and present a good review of the current thinking and research in the nutritional science, of which he is often critical.

The case against sugar makes it clear shy he feels the much of the writing and studies on the subject are limited and are often flawed if not outright deceptive.  Taube starts with a extensive history of sugar in the diet around the world.  He lays out the case that as sugar was introduced around the world the incidence of diabetes has increased dramatically. From Ancient China to Europe to Native American populations,  everywhere that sugar was introduced, diabetes increased to levels that had not seen before.  On every case, in every continent,  this happened without exception.     

What about Fat.  Isn't fat dangerous.  It does not seem that this is dangerous as sugar is at least in Taubes thinking.   Eskimo populations that have lived blubber did not have a high incidence of either heart disease or diabetes.  It only became an issue after they introduced processed foods.  

Taubes does a great job of cataloging how the years the Sugar industry thru various has hindered good research and pushed its own agenda.  They lobbied the government to change the rules against artificial sweeteners and changed the dietary stat to fit their needs.   One is reminded of how the tObacco industry acted when you read about this.   It is is a harrowing look at why Nutrition research and coverage, which is difficult enough, is complicated further by purposeful obfuscation of the food industry. 

If you are interested on some of the reasons that we have as much sugar our diet and at least one of the reasons that we have as much obesity as we do in America.   

Post submitted by Kurt Hutchinson, PT Clinical Lead of OrthoHealth - Illinois Bone and Joint Institute

“What the Health” Review

Recently you may have noticed that a very popular documentary on Netflix entitled “What the Health”  The star and director is Kip Andersen.  Maybe this just appeared on my feed since I watch most every documentary and most anything associated with Health care.  Many of you will know that this film has caused some controversy and for its message and its methods.  This documentary is one of the prime examples of why most people struggle with health care and nutritional information. There are just so many mixed messages out there in the media its hard to know who to trust.   That is why this is a fascinating topic.   Here is what you might want to know if you watch this film.  

First of all there are several key points that are made in the documentary that are well made about the general state of American health.  

For Example:

  • 1 in 3 Medicare dollars are spent on Diabetes
  • 1 in 10 health care dollars spent on Diabetes
  • Diet is a huge factor in health and a poor diet with processed foods will certainly lead to poor health outcomes.   

All of this is well settled but beyond that there is a clear agenda that come thru very clearly and repeatedly.  The message is this: All meat is bad and the root of all evil.   

Andersen edits the film in a way that makes it seem like no one in the American Cancer Society will address his clear conclusion that all meat is bad.  He does this by calling up the ACS and asking complicated questions of the receptionist.  When she can not answer his complicated questions he frames this a conspiracy in the food industry to hide theand not just him being a unreasonable pain in the neck to this poor phone operator.  

Other examples of the kind of statements that are made in this film that are problematic:

At one point, Dr Neal Barnard states that sugar does not cause any ill effects and that only animal fats are a concern. This seems like a difficult statement to square in the face of recent research in low sugar diets.  Additionally everywhere the sugar was introduced in human history diabetes has followed.  Gary Taubes lays this out in his book, “The Case Against Sugar” very clearly.   The filmmaker also states that eating meat is as bad as smoking.   Following this up with“How are kids allowed to eat meat like this” and ‘by eating meat Is it’s like Ive been smoking my whole life.”   
This is a clear overstatement of the data that is present on eating meat.  Here is an example from the research.    

They discuss that eating processed meat is placed in the same category as Smoking and Asbestos as it increased the relative risk of cancer.  This is true but is just a general classification and does not capture the full picture.  First of all, they conflate relative risk andabsolute risk.  Meaning that I you ate processed meat daily then your risk of cancer would go up from about 4% to 5%  This a 20% increase in the realize risk in cancer but the absolute risk of getting cancer in your lifetime goes up only about 1%.   Now 1% is nothing to ignore. Over the course of our country this is thousands of people every year that would get cancer that otherwise would not.   (See the link to Aaron Carroll below for his much more detailed explanation of this)

Now all of this is not to say that eating processed meat is good.   It is clearly not ideal.  However if you eat processed meat less than daily then the risk should be less.  Eating this every day does have real health risks but if we don't eat like this daily then we have less than a 1% increase in risk. We do not have to misrepresent this egregiously to say that it is has risks.   We can be honest with people about the risks.  Lots of meat can be bad for you but in an attempt to push a whole food Vegan diet there are a lot of difficult claims are made. 

Including:

  • Meat causes cancer. (See above)
  • Sugar can not cause diabetes
  • Carcinogens are presenting every chicken that we eat.  
  • Eggs are dangerous and are as bad as cigarettes.  
  • Genes have limited impact on heath and Meat is a better indication of the risk of heart attack and other diseases.
  • Cheese is linked to SIDS and autism because of how it is processed
  • Chicken is worst because of the injected saline that causes many health problems 
  • The use of antibiotics in farming is “ like 7 9/11’s”

Now I think that over time food companies have not been honest and it is clear that processed foods are very problematic and Trans fats are basically the worst thing you can eat.  There are very good arguments that eating less meat is good for the environment and many people have serious moral concerns about eating meat.  Those are bigger questions than we can settle in this space but I respect those ideas.  Eating a whole food plant based diet can clearly be a healthy diet for some people.   But that is not the only option and we do not need to overstate the case or misrepresent data to make a more effective point. 

For a couple of different opinions please take a look at this review on vox.com

 https://www.vox.com/science-and-health/2017/7/25/16018658/what-the-health-documentary-review-vegan-diet

Or this rebuttal that is well done form a Vegan that does a nice job of reviewing the research form a Vegan perspective.   

https://www.youtube.com/watch?v=paQtMnrV6oM

Finally the always Excellent Aaron Carroll and his excellent series Healthcare triage who also writes in the NY Times in The Upshot. 

https://www.youtube.com/watch?v=aOVBOwbqcT8

Post submitted by Kurt Hutchinson, PT Clinical Lead of OrthoHealth - Illinois Bone and Joint Institute

The Weight Loss Trap

Recently there was a Time Cover story entitled “The Weight Loss Trap”.  ( http://time.com/4793832/the-weight-loss-trap/ ). It was a excellent discussion about the difficulties that most face in weight loss and how some of the things we believe and have been told get in the way.   

Overall it recounts the depression sate of American Health.  155 million citizens are overweight, diabetes is on the rise and any people are searching for answers.  In 1990, Adults with Obesity made up 15% of the population.  Now 20 years later that number is 25% in many states and up to 40% overall Time notes.  How did we get to this place.   

This was about the time the low fat food craze took off in foods and people started to focus on fat.  If I eat less fat I will be less fat.   Why?   Because fat does not make you fat. The fat I thesis foods have been replaced with sugar to improve the taste with terrible side effects.   This may sound like a stretch but much of the consensus is that fat is not the biggest factor, and sugar is the biggest culprit.   All calories for all sources are not all created equal.  So what to do. 

That is what Kevin Hall, a researcher at the National institute for Health or NIH was wondering after he saw “The Biggest Loser” on TV and was intrigues.   He did a study to follow up on the contestants to see how they did after the cameras were turned off.  What could he learn from those contestants to help the millions that are struggling with their weight. It turns out, he did not find answers, what he found was a cautionary tale.   

As anyone who has participated in our Orthohealth webinar knows the answer to what he found. (and if you have not signed up already do it now.  Really. It’s OK we will wait….its just on the Right side of our information page)   The contestants on average gained 66% of the weight that they had lost and 4 were heavier than they were before.   Why was this?  Because as the contestants lost weight their metabolism slowed to a significant degree, probably as an evolutionary hold over form when food was scarce.  So the more they lost the slower the metabolism and easier it would be later to gain the weight back.   (Not Fair is it,  but as a professor once told me “In nature, there is never a free lunch.”  There are always tradeoffs in any complex system.)

But answers are emerging as to some of the ways that we do know to improve heath and not just focus on weight. Here are just a sampling of some of the findings in a large study of people that lost weight and kept it off:

  • Not every diet works for everyone. Most people try a few different kinds of diet before they find what works for them.   
  • Most people increase their activity and the most common activity was walking
  • Most choose not to focus on a number for their weight but do check in on weight about 1x a week.
  • Those that had goals like living longer and increasing time with family and improving their lifestyle did better than those that just wanted to lower their weight.
  • They in general watch less then 10 hours of TV a week.  

There are many factors that people tend to share but these generally make sense. Not everyone responds the same to every diet.   One study listed even said that those that ate the exact same meal had different blood sugar levels after the meal.  To some extent this makes sense.   Not everyone responds the same to things in their environment, (i.e. allergies) medication, so why should food be any different.  Humans are complex machines and there are many variations in our systems.   

The article is worth your time.  My final takeaway is:  changing things like diet and exercise are hard.  Anyone that tells you its not you should probably ignore.  Not everyone will get to the same place, in the exact same way, or at the same time, but with persistence we can all make changes that improve our health.  And our health is more than just the number on a scale.   If we remember that, and we are kind to ourselves, then we can start to move ourselves in the right direction.   

Post submitted by Kurt Hutchinson, PT Clinical Lead of OrthoHealth - Illinois Bone and Joint Institute

Introducing Method Testing to OrthoHealth

It's already the 2nd month of the New Year.  And already, I have seen my fair share of "New Year's Resolution Injuries."   Many people have set a goal of losing weight and getting healthier. They've begun to exercise. They've joined gyms, enrolled in bootcamps, and jumped on the latest exercise fad workout.  And shortly after, they've arrived in my office with injuries to their knees, shoulders, backs, hips that have derailed their efforts.

We all know that exercise is important for our overall health.  People who exercise on a routine basis tend to live happier, healthier, and longer lives.  However,  getting started can be the biggest challenge. 

How do I do it?  What are my goals?  How much is too much? 

Most people who are beginning exercise are doing so for improved health. Therefore, it is critically important to assess your health prior to developing an exercise program that is effective --- and SAFE. 

Fortunately, the level of exercise needed for overall health is probably much less than what most of us think.  For health and wellness, going for a walk, gently peddling a bicycle, or gardening can be effective exercises for health maintenance.  Good health through exercise is well within reach, even for those of us (myself included) with musculoskeletal injuries or degenerative conditions..... (hint: it's much less than those commercials for gyms would have you believe.)

At IBJI, we have an exercise assessment called "METHOD TESTING"  which allows us to determine a unique metabolic fingerprint for each individual.  The basis of metabolic testing is determining when your body begins to produce lactic acid during movement and exercise.  Lactic acid is a byproduct of burning the least efficient fuel in your body. Its what your body produces when you have run out of the BEST gas, figuratively speaking.   It comes from burning "emergency stores." Prolonged but sustainable exercise burns fuel that is readily available and high efficient -  fat stores.  Fat stores provide the BEST fuel for your body.  When your body is fueling with fat stores,  your body does NOT produce lactic acid. 

METHOD TESTING allows us to determine at what heart rate and workload your body is beginning to produce lactic acid.  With this knowledge, we can tailor make an exercise program just for you that allows you to burn the most efficient fuel in your body (fat stores) without producing lactic acid buildup.  Your unique heart rate profile and metabolic fingerprint can help us help you achieve your exercise goals.  Exercising for weight loss and fitness? .... we can target a heart rate.... YOUR IDEAL HEART RATE ... for your goal. Exercising for improved performance?  There's a heart rate for that too.... again based on YOUR metabolism.  This is the ultimate patient-specific workout program. 

How is Method Testing performed?  It requires a treadmill, step climber, or stationary bike.  We slowly increase your workload, monitor your heart rate, and test your lactic acid levels through minimally invasive blood sampling.  A unique metabolic fingerprint will be generated -- YOUR METABOLIC FINGERPRINT -- that can be used to design a goal - specific program for you.

For more information about Method testing, please contact Cory Leman at cleman@ibji.com

Post submitted by Dr Eric Chehab, MD, Orthopedic Physician with OrthoHealth - Illinois Bone and Joint Institute

A Day Without Sugar

The start to a new year often comes with thought and anticipation about what we are hoping to accomplish in the next twelve months.  Sometimes goals can be long term and measuring them up against a year long period seems reasonable.  But I think that most goals are better measured on a daily basis.  We start the day with an intention to do one thing, and then at the end of the day think about how well it went.  Easy.  You may not always hit the mark, but at least you know what to focus on tomorrow.  If all goes as planned, you can pat yourself on the back and do it again the next day.  Bit by bit, this leads to long term change.

So after recently reading an opinion piece in the New York Times*, I began to think about how the idea of reducing the amount of sugar we eat can be a daily goal instead of a mondo weight loss dilemma.  The scientific research continues to point to excessive sugar intake as a direct connection to disease.  The obesity epidemic, diabetes, heart disease and dementia all have strong links to eating and drinking too much sugar.  A good daily goal would be to significantly reduce or better yet, eliminate added sugar in our diet.

An easy way to start is to stop drinking sugar sweetened beverages - this includes soda, juice, sweetened coffee drinks, flavored milk, basically anything that has added sugar grams listed on a label.  Steer clear of sweets in the form of cookies, candy, breakfast cereals, granola bars and sweetened fruited yogurt.   These are daily goals that can have positive impact on health and metabolism.  Some days won’t be perfect, but by keeping a focused daily intention, sugar intake will go down.

My 12 year old son looked over my shoulder and spotted the title for this blog post while I was writing and he casually asked if I was writing a fairytale.   I understand how this idea would seem like an impossibility, but I think the real question should be, when did it become the norm that sugar shows up in almost everything we eat?  

*A Month Without Sugar, David Leonhard, New York Times, December 30, 2016 

Post submitted by Arleen Temer-Wittcoff, a Registered and Licensed Dietitian and Certified Diabetes Educator with OrthoHealth - Illinois Bone and Joint Institute

How to Take the Stress Out of the Holidays

When you think about the upcoming holidays, do you feel anxious and uneasy or happy and excited? Does your heart pound and mind race with details of the gathering that you plan to be the best ever?  For most of us, we look forward to what should be a slower more peaceful time of the year, however more often the reality is that it's very busy and not so peaceful. There are extra errands to run for that perfect gift and chores to do in preparation of our house guests, add that to our day to day responsibilities and you have HOLIDAY STRESS.

Holiday stress like traditional stress, signals a fight or flight response from the central nervous system. The brain communicates to the hypothalamus, which alerts the adrenal glands, to release the hormones adrenaline and cortisol. When immediate stress is over, the central nervous system tells the body to return to its normal state. However, if the body cannot return to its normal state because the stressor (the holiday season) is still present or there was no physical release of these hormones, they will build up in the system and cause havoc to the mind and body.  

Our body in response to the added responsibilities of the holidays will go into overdrive and release additional cortisol and adrenaline to help us adapt. In the short term this may be helpful, but if we don’t manage it head on we are setting ourselves up for what could be a challenging start to a healthy new year.

Here are 3 ways to help combat and meet the effects of stress head on so that it does not interrupt the spirit of the upcoming holidays. 

Eat foods that lower stress 

  • Steel Cut Oatmeal boosts the levels of Serotonin and calms the central nervous system 
  • Oranges decrease levels of the stress hormones and strengthen the immune system
  • Spinach and leafy greens contain magnesium which can help fight stress, headaches, and fatigue
  • Omega 3 fatty fish can prevent surges of the stress hormones and fight against winter depression 
  • Avocados high in potassium reduce high blood pressure and can curve your craving for a high-fat treat this holiday season
  • Almonds are full of many vitamins including Vitamin E to boost your immune system and can make you more resilient to holiday stress and depression

Exercise

  • We all know that exercise is important and during this holiday season probably a little more challenging to get to the gym. But even 20-30 minutes of aerobic activity a couple times a week; (i.e.  walking, running, or the elliptical) will help the body recreate the “flight” response releasing the stress hormones and decreasing the cortisol levels in our body. Can’t fit 20 minutes that into your day?  Break it up , do stairs instead of the elevator or escalator, park a good distance away from the front of the store. Every little bit helps.

Take some time to breath and be mindful

  • It may seem like the impossible to take 5 minutes during this season for yourself, but research shows that giving yourself time to “just be” will help bring you back to the present where you can make more conscious sound decisions.  It can also help you relax and decompress during stressful times by slowing your heart rate, lowering your blood pressure, and decreasing your cortisol levels. 

Make this the year that you enjoy your holidays and go into the new year feeling healthy and prepared instead of making that your new years resolution.

References:
Cortisol: Why”The Stress Hormone “ is Public Enemy NO.1/ Psychology today.com  Jan, 22, 2013
Slideshow:Stress-Reducing Foods -MedicineNet.com Reviewed by Kathleen M. Zelman, MPH, RD, LD on June 24, 2016

This article was written by Donna Taylor, Integrative Health Coach as a part of IBJI's OrthoHealth Holiday Resources. 

The Sleep and Sugary Drink Connection

A new study, led by UC San Francisco scientists, reveals that people who sleep five or fewer hours a night are likely to also drink significantly more sugary caffeinated drinks, such as sodas and energy drinks.  It is not clear whether drinking sugar sweetened beverages causes people to sleep less or whether lack of proper sleep make people more vulnerable to using sugar and caffeine to stay awake.  It’s likely that both explanations are true.

Multiple research studies have linked sugary beverage consumption to metabolic syndrome, which is a group of medical conditions that include high blood sugar and excess body fat, which can lead to obesity and type 2 diabetes. 

Scientists analyzed the records of 18,779 participants in the National Health and Nutrition Survey (NHANES), an ongoing national study of dietary habits and health.   The researchers found that:

  • People who regularly slept five or fewer hours per night also drank 21 percent more caffeinated sugar-sweetened beverages ( including both sodas and non-carbonated energy drinks ) than those who slept seven to eight hours a night. 
  •  People who slept six hours per night regularly consumed 11 percent more caffeinated sugar-sweetened beverages than those who slept seven to eight hours a night.

No conclusion could be definitively made about cause and effect.  But this study shows that there is a strong correlation between sub-optimal sleep levels and increased intake of sugar sweetened beverages.  Scientists safely conclude that sleeping too little and drinking too many sugary drinks have both been linked to negative metabolic health outcomes, including obesity.

Source:  UCSF NewsCenter 

Post submitted by Arleen Temer-Wittcoff, a Registered and Licensed Dietitian and Certified Diabetes Educator at OrthoHealth - Illinois Bone and Joint Institute

Dr. Eric Chehab Presents at Active by Design Summit

On October 4th, IBJI Orthopedic Surgeon Dr. Eric Chehab presented at the Active By Design summit, held at the Botanic Gardens.  This presentation was part of a larger summit which focused on bringing together local municipality leaders to highlight how we can design our local communities to support active movement for people of all abilities.

Along with Dr. Cheheb, this event featured Mark Fenton a leading national public health, planning and transportation consultant whose expertise is working with communities across the United States to evaluate and build communities, programs and policies that support opportunities for walking and bicycling as part of one’s daily lifestyle. 

Below is Dr. Chehab's introduction presentation. 

Walking statistics presented in this presentation were referenced from the below article. http://www.health.harvard.edu/newsletter_article/Walking-Your-steps-to-health

Sugar vs. Fat - An Orthopedist Perspective

This blog post is a continued response to the September 12th 2016 New York Times article "How the Sugar Industry Shifted Blame to Fat". You may access the original article here. 

It seems almost too diabolical to be true.  The sugar industry essentially bribes scientists to discredit the link between sugar and heart disease.  The scientists, once bribed, instead demonize fat.  That alone would be bad enough.  Yet to top it off, one of the scientists who was paid off ends up at the US Department of Agriculture, where in 1977 dietary guidelines promoting carbohydrate consumption and warning of fat consumption were published.  Though not yet proven, I cannot help but conclude that the obesity epidemic that we have been plagued with since the 1980s is a direct result of these USDA guidelines --- or better yet, "misguidelines.'

As an orthopedist, I see many patients who suffer daily from joint or back pain due to weight gain.  I always try to reassure them that it's not their fault.  Instead, they have been the victims of incredibly bad advice.  I tell patients routinely that a breakfast of low fat yogurt, granola, and an 8 oz glass of apple juice sure sounds like a healthy breakfast.  But that breakfast contains 16 teaspoons of sugar!  Imagine going to the sugar jar, and swallowing 16 teaspoons of sugar!   This article supports the notion that not only have we been following incredibly bad advice, we have been following crooked advice.  Published evidence has been mounting for the past decade of the ill effects of sugar.  Yet this was recognized by the sugar industry almost FIFTY YEARS AGO.  It should make us all very angry.

Fortunately, there have been improvements in how research is conducted and reported.  Sources of funding are required to be disclosed, so that these types of conflict of interests can be minimized.  Yet there will always be biases and influences in science, particularly for research as difficult as nutrition science. There are just too many variables tocontrol.  But for public safety, we have to be sure, and reassured, that the science that we are basing dietary recommendations is sound.... and free of influence.

Written by Dr. Eric Chehab MD, IBJI Orthopedic Surgeon, OrthoHealth Clinical Lead

Sugar vs. Fat - A Nutritionist's Perspective

This week’s nutrition news focused a spotlight on how in the 1960’s the sugar industry paid scientists to down play sugar’s effect on heart disease and instead tried to lay the blame on saturated fat instead.  The food industry has a long history of funding research that influences nutrition science.  No doubt this is a risk when industry is offering financial payment to scientists to write papers that support industry cause.  In this case, the goal was to shift public opinion to believe that sugar was a harmless factor in heart disease.  

Readers of nutrition science articles should be skeptical of study results for any trial that was funded by industry.  Studies funded by public, university or government would have less conflict of interest issues.   The good news is that today, there are more checks and balances and scientists cannot be so easily bought off to write for profit.  And even if they did, the chance that a respected journal would publish such a study is not likely.  But just in case, consumers are advised to check out who funded the study to make sure that the research was unbiased.  Get your nutrition information from sources that have no financial gain from the information.  Rely on health experts who have reviewed evidence and have culled out the garbage nutrition claims.

In regards to Sugar vs. Fat…. stay away from sugar sweetened beverages and added sugars.   Taking in high amounts of sugar is not good for your health and has been linked to disease.   And while you are at it…skip the unhealthy fatty fried foods as well.

Interested in reading more about this topic?  Check out these links:
http://www.npr.org/2016/09/17/494360187/industry-influence-in-nutrition-research
http://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html?_r=0

Post submitted by Arleen Temer-Wittcoff, a Registered and Licensed Dietitian and Certified Diabetes Educator at OrthoHealth - Illinois Bone and Joint Institute