7/27 - practus interuptus

DaBruinz · Jul 29, 2014

DocHoliday said:

Typical arse response.. Dude, you claim to be in med school, but clearly you don't know jack about the subject so you should just keep your mouth shut and move along since you really have nothing to offer.

DocHoliday · Jul 29, 2014

DaBruinz said:
Typical arse response.. Dude, you claim to be in med school, but clearly you don't know jack about the subject so you should just keep your mouth shut and move along since you really have nothing to offer.

I do know jack. Here it is: for every 99 patients who are obese that come into our school clinic, only 1 can blame it on genetics.

That's not to say everyone does blame it on genetics. To their credit, a fair amount of patients know their eating habits are to blame but yet an infuriating percentage of them continue to get hostile when confronted about it.

Provide people rationalization for their poor choices and they will rationalize away. There is no point debating metabolic disorders as a significant factor when doing so helps delude the 99%.

Horace's Ivories · Jul 29, 2014

Calorie restricted diets have been shown to result in epigenetic changes that are associated with weight loss, and a reduced risk of developing diabetes, heart disease, and cancers.

In other words - diet can affect genetics.

Here is a reference study if interested:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3175174/pdf/1741-7015-9-98.pdf

Ring 6 · Jul 29, 2014

DaBruinz said:
Typical arse response.. Dude, you claim to be in med school, but clearly you don't know jack about the subject so you should just keep your mouth shut and move along since you really have nothing to offer.

Ironic that you say someone has nothing to offer while all you offer is a personal attack.

Hael · Jul 29, 2014

At the end of the day, it is always calories in = calories out (even for the small minority of people who have metabolic disorders, assuming normalization). This is a physical law. No offense to the obese who are struggling to lose, but I assure you there is no such thing as a human who is a perpetual motion machine of the 1st kind. (To say this tongue in cheek.. there were no fat people at Auschwitz).

Now of course that there is more to it than that. People have to be careful of yoyo diets. There are psychological factors involved. There are generally speaking all sorts of tricks that make things much easier to handle (for instance trying to lose weight if you eat 1500 calories worth of twinkies and mcdonalds is possible in principle, but really much much harder than if you are eating lean chicken breast, fish, oatmeal and fresh fruit). And of course the big one.. Progress takes years.

I also personally feel that not enough time is spent to actually building muscle mass from the gym. For instance, 5 years after starting out a highly vigorous strength training program, I burn far more calories at the same weight than I ever did as a younger man. This makes any diet that I do (on a cut) so much easier. In my late thirties, I am now under 10% body fat and I feel fabulous, and one of the things i've learned is that I can really 'feel' the difference food does to my body and performance. I can also spot the cues that I used to mistake (did you know thta for instance, a lot of people mistake the cue for water when they are dehydrated as a cue to eat instead?)

Snake Eyes · Jul 29, 2014

PatsWickedPissah said:
Read the last Bio of Jobs. Great book. The guy did kill himself by ignoring Drs advice by going Eastern diet

Eastern diet? He was a fruitarian.

Deus Irae · Jul 29, 2014

Snake Eyes said:
Eastern diet? He was a fruitarian.

People here are confusing "alternative" with Eastern, just as Doc Holiday is confusing "effective" with Western.

DocHoliday · Jul 29, 2014

Deus Irae said:
People here are confusing "alternative" with Eastern, just as Doc Holiday is confusing "effective" with Western.

If it's proven not effective, it quickly stops being Western medicine. This is the whole point. Meanwhile pointless 'Eastern' remedies will continue to be given despite being proven worthless.

Deus Irae · Jul 29, 2014

DocHoliday said:
If it's proven not effective, it quickly stops being Western medicine. This is the whole point.

except that your claim is not always true, as I demonstrated with the ulcer example.

DocHoliday · Jul 29, 2014

Deus Irae said:
except that your claim is not always true, as I demonstrated with the ulcer example.

So we are still knowingly mismanaging ulcers despite knowing a better way? News to me.

JR4 · Jul 29, 2014

Hael said:
At the end of the day, it is always calories in = calories out (even for the small minority of people who have metabolic disorders, assuming normalization). ....

Here a thought about calories in(CI) = calories out(CO).
The concept people try to convey with with respect to losing weight is
that if CI < CO you lose weight and if CI > CO you gain weight and CI=CO weight stays the same.
So to lose weight all you have to do eat less and exercise more. Right? Wrong.
Millions of dieter doing just that fail over and over and it’s not that all of them are not
trying or maintaining their CI < CO life style.

-----------------------------------------
Case: Kate training as an Ironman athlete.

Training 15 to 20 hours a week, sports = swimming, biking and running.
Many days included “brick” works outs = all three events back to back.
Some days were double workouts.

Workouts were about 500 calories so total calories about 10,000 per week.
Plus her daily requirements were 1800cals for dressing.eating etc.

She lost weight and was eating 1500 cals/day.
Calories IN was about half of what she needed.
At some point in this routine, NOT changing anything in Calories IN and Calories OUT
she began gaining weight!!!

She gained back 65pounds while still maintaining 1500 calories and her exercise routine.
HOW IS THIS POSSIBLE???? Her times got slower and slower and she became
depressed. Wouldn’t YOU???
--------------------------------------------------
The reason for Kate's issue is labeled 'Diet FOG'.
The body doesn’t see the excess fat being stored it just sees the
Lack of Calories IN and goes into a protection mode and begins storing energy as fat!

This is part of the reason diets fail people but this is just the beginning.
This survival mechanism is just one aspect of the metabolic machinery.
If you want to learn more I highly recommend reading the book
"The Metabolic Storm" by Doctor Emily Cooper. (Kate example is from her book)

JR4 · Jul 29, 2014

DocHoliday said:
.....

Provide people rationalization for their poor choices and they will rationalize away. There is no point debating metabolic disorders as a significant factor when doing so helps delude the 99%.

So Doc (soon to be),
You going to tell your patients just eat less and exercise more? If you know a metabolic disorder is
behind the problem you won't tell them about it but rather tell them something that won't work?
In fact it may in time even make their situation worst!
Hey Doc, it is OK to tell your patient you don't know how to help.

DocHoliday · Jul 29, 2014

JR4 said:
So Doc (soon to be),
You going to tell your patients just eat less and exercise more? If you know a metabolic disorder is
behind the problem you won't tell them about it but rather tell them something that won't work?
In fact it may in time even make their situation worst!
Hey Doc, it is OK to tell your patient you don't know how to help.

I'm referring to the national discussion on obesity. Too much fixation on an unlikely scenario.

Personally, should a patient fail to lose weight and I am convinced he is dutifully dieting and exercising - THEN it's time to explore other disorders. You wouldn't waste money on tests to explore such disorders until then.

Patjew · Jul 29, 2014

JR4 said:
Here a thought about calories in(CI) = calories out(CO).
The concept people try to convey with with respect to losing weight is
that if CI < CO you lose weight and if CI > CO you gain weight and CI=CO weight stays the same.
So to lose weight all you have to do eat less and exercise more. Right? Wrong.
Millions of dieter doing just that fail over and over and it’s not that all of them are not
trying or maintaining their CI < CO life style.

-----------------------------------------
Case: Kate training as an Ironman athlete.

Training 15 to 20 hours a week, sports = swimming, biking and running.
Many days included “brick” works outs = all three events back to back.
Some days were double workouts.

Workouts were about 500 calories so total calories about 10,000 per week.
Plus her daily requirements were 1800cals for dressing.eating etc.

She lost weight and was eating 1500 cals/day.
Calories IN was about half of what she needed.
At some point in this routine, NOT changing anything in Calories IN and Calories OUT
she began gaining weight!!!

She gained back 65pounds while still maintaining 1500 calories and her exercise routine.
HOW IS THIS POSSIBLE???? Her times got slower and slower and she became
depressed. Wouldn’t YOU???
--------------------------------------------------
The reason for Kate's issue is labeled 'Diet FOG'.
The body doesn’t see the excess fat being stored it just sees the
Lack of Calories IN and goes into a protection mode and begins storing energy as fat!

This is part of the reason diets fail people but this is just the beginning.
This survival mechanism is just one aspect of the metabolic machinery.
If you want to learn more I highly recommend reading the book
"The Metabolic Storm" by Doctor Emily Cooper. (Kate example is from her book)

If only Kate stopped eating fruit and replaced it with vodka. Then she'd be as hot and ripped as me. Poor, poor fat Kate.

Danger Zone · Jul 29, 2014

Deus Irae said:
People here are confusing "alternative" with Eastern, just as Doc Holiday is confusing "effective" with Western.

Just as Deus is confusing his "being objective" with "an obsessive need to be correct".

Marinlik · Jul 29, 2014

JR4 said:
So Doc (soon to be),
You going to tell your patients just eat less and exercise more? If you know a metabolic disorder is
behind the problem you won't tell them about it but rather tell them something that won't work?
In fact it may in time even make their situation worst!
Hey Doc, it is OK to tell your patient you don't know how to help.

You have to understand that the problem that you are talking about is in an extreme minority. Most are fat because they eat more than they actually need. Not because of genetics or disease

JR4 · Jul 29, 2014

Marinlik said:
You have to understand that the problem that you are talking about is in an extreme minority. Most are fat because they eat more than they actually need. Not because of genetics or disease

No I do not realize that and neither do you.
When have you done extensive research on this topic, seen thousands of patients, conducted advance research using the latest equipment to analyze blood work, been able to track the level of the many
hormones involved and had the knowledge to understand how these hormones interact with each other
and had access to detailed daily activities of the patients whose blood work you analyzed?

How do you explain the millions of dieters who have some success losing weight then hit a barrier, the
so called "plateau"( many give up when this happens ). "Extreme minority"? Bull

If you are so sure you know what you are talking about you should open a diet center and help these
millions of people who are sincerely trying to lose weight and failing, who lose some weight but hit
a plateau at some point. Maybe you can convince them to just hang in there only an
"Extreme minority" can't overcome the plateau.

Now genetics may have some role but I'm not sure about what that is other than I have notice in my
life time overweight parents often have children who are overweight. Now that could be due to
life style but it could also have to do with some genetic disposition in the metabolic system.
But even if genetics is involved, once a better science is known about the problems in the metabolic
processes, there maybe treatments to make metabolism work better even for people with such
genetic issues. That day is coming and I bet 10 years from now endocrinologist will be able to
help people who really want to lose weight. There will always be gluttons who eat for pleasure
but for those who are really trying to lose weight a better day is coming.

JR4 · Jul 29, 2014

DocHoliday said:
I'm referring to the national discussion on obesity. Too much fixation on an unlikely scenario.

Personally, should a patient fail to lose weight and I am convinced he is dutifully dieting and exercising - THEN it's time to explore other disorders. You wouldn't waste money on tests to explore such disorders until then.

and then.. suppose your were convinced "he is dutifully dieting and exercising "
what test would you order and what would you be looking for?

DocHoliday · Jul 29, 2014

JR4 said:
and then.. suppose your were convinced "he is dutifully dieting and exercising "
what test would you order and what would you be looking for?

The major genetic causes of obesity tend to come with obvious mental disabilities, so we can skip those for now. Individuals have been found with these disorders with normal intelligence though so genetic screens for these would be last on my list if nothing else hit.

Hormone levels would be next, specially cortisol and thyroid hormones. These can cause one to be overweight but in no way would explain obesity by themselves. Diet and exercise would still contribute partially.

The list goes on briefly (there just aren't many legitimate other causes of obesity that diet and exercise doesn't fix) but we would get into 'things I will rarely see in my career' territory. These include a tiny number psychiatric disorders (even these are just a failing of diet really), lipid metabolism errors (exceedingly rare and would have been diagnosed very early), etc.

Horace's Ivories · Jul 29, 2014

JR4 said:
No I do not realize that and neither do you.
When have you done extensive research on this topic, seen thousands of patients, conducted advance research using the latest equipment to analyze blood work, been able to track the level of the many
hormones involved and had the knowledge to understand how these hormones interact with each other
and had access to detailed daily activities of the patients whose blood work you analyzed?

Actually, Dr. John McDougall has treated over 5k patients at his clinic in CA over the past 10 years and has seen tremendous results with the diet I have been referencing. I have personal experience helping many folks in the same diet.

How do you explain the millions of dieters who have some success losing weight then hit a barrier, the
so called "plateau"( many give up when this happens ). "Extreme minority"? Bull

The problem is people in the situation you describe are in need of extreme dietary changes. Most diets that work for a while ( as you describe then plateau) are either ketogenic, which is unhealthy, or its so calorie restrictive a Buddhist Monk wouldnt be able to do it long term (well maybe).

Now genetics may have some role but I'm not sure about what that is other than I have notice in my
life time overweight parents often have children who are overweight. Now that could be due to
life style but it could also have to do with some genetic disposition in the metabolic system.
But even if genetics is involved, once a better science is known about the problems in the metabolic
processes, there maybe treatments to make metabolism work better even for people with such
genetic issues. That day is coming and I bet 10 years from now endocrinologist will be able to
help people who really want to lose weight. There will always be gluttons who eat for pleasure
but for those who are really trying to lose weight a better day is coming.

You are right - the bad eating habits cause a metabolic change which is then passed down through generations of similar eating. That said, my NIH article reference in a prior post speaks to the ability of diet to affect that.

7/27 - practus interuptus

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