By Michael Anchors, MD, PhD
Posted by Michael Anchors, MD, PhD
Thursday, November 03, 2016 9:32 am Email this article
Last week I read Gary Taubes’ wonderful book How We Get Fat and What To Do About It (2010). The book taught me nothing new, but I admired the clear way Gary expressed things. In particular he reminded me that it is impossible to lose weight by eating less or exercising more. Because of insulin, if you exercise more, you WILL eat more. If you eat less, you WILL move less. You cannot overcome it with willpower.
Pause for a moment to consider how much of what most people and doctors “know” is bullcorn. I continue to be amazed by it. Science and math, reading, are the only things on which you can rely. What people only tell you is worthless.
Gary reminded me that as people age, they gain weight and there’s little you can do about it. Under the influence of insulin, men increase the amount of the enzyme LPL on the surface of fat cells in the upper body. Women, same thing, but lower body. LPL increases the share of dietary fat going to fat cells to be stored, less going to muscle as fuel.
What you can do about it is to decrease insulin by eating less sugar, sweeteners and white flour. Type 2 diabetics on insulin shots should change their diet to get down to as low a dose of insulin as possible.
If you get Gary’s book, ignore everything he says about cholesterol in the later part of the book. The book was written in 2010 and Gary was not yet up to speed on that issue. I wasn’t either, but we are now. Fat and cholesterol have nothing to do with heart attacks. There you go—another example of the nonsense most people “know”.
By Michael Anchors, MD, PhD
For years I have been telling dieters to avoid “diet” sodas because the artificial sweetener in them is too sweet. Sweet flavor itself raises insulin, blocking weight loss. Dieters would be better off with the high fructose corn syrup in regular Coke than with the aspartame in Diet Coke, or so I thought.
Now I must modify that advice. Overconsumption of cola-type drinks increases the occurrence of kidney stones, and that fact is especially true of the type sweetened with high-fructose corn syrup. The intake of fructose increases the urinary excretion of calcium and oxalate. Ninety per cent of kidney stones are composed of calcium oxalate. Moreover cola-type sodas, diet or non, contain phosphoric acid. Phosphate contributes to starting stones. Fresca and Sprite don’t have phosphate, but they are still fraught with the fructose issue.
There is abundant evidence that cutting dairy products out of the diet does NOTHING to prevent kidney stones. Ditto the advice to reduce coffee and chocolate. Any doctor who gives that advice should be ashamed; the truth is published everywhere. Google it, you’ll see. The ultimate cause of kidney stones is nanobacteria (read chapter 13 of my book Medical Myths Doctors Believe available on Kindle. But if the chemicals needed to produce stones are not present in the urine, the bacteria alone cannot create stones.
Given those heuristics, you wouldn’t know what to expect regarding the effect of sodas on stones. But the studies are clear. Consumption of cola-type sodas increases the occurrence of stones by about 24%. That’s for one soda a day. I have seen fat patients who consume a six-pack a day! Kidney stone pain is so terrible and the damage so severe, it is not a risk you should run. So the best advice is to stop drinking so many sodas of any type. If you are unwilling to modify your behavior that much, then it’s best to go back to Diet Coke, even though it has bad effects as far as weight.
By Michael Anchors, MD, PhD
Americans combine french fries with many things. For a dollar extra Dunkin Donuts will give you an order of fries with your donut! As far as losing weight, I don’t care if you eat fries as part of a meal, as long as you don’t eat a lot of them and you don’t eat fries as a snack. They strongly raise insulin; we are trying to keep insulin low between meals.
I am particularly interested in separating starch from meat and/or cheese. Meat/cheese has loads of calories but they can’t all get in because meat/cheese is a weak stimulus to insulin. Starch has less calories–it would even be a good diet food–EXCEPT starch drives insulin all the way up, so that the calories from accompanying meat get in, calories that otherwise would not get in. That’s why the meat/cheese and starch combo is so fattening. The whole idea to combine meat and starch originated in the U.S. during the Depression or during famines in other countries. If you have very little food total, if you combine these two items, this way, you will be less likely to starve. But if you are trying to lose weight, combining meat and starch is the last thing you want to do!
Think about it. Meat and potatoes, burger and fries, chicken and biscuits, chicken and rice, turkey and dressing, mac and cheese, spaghetti and meatballs, pizza, Mexican food etc. The French are immune to this nonsense. They eat almost all their carbs at breakfast. They eat few carbs at lunch or supper.
Anyway French fries aren’t French; they are Belgian. The first Americans to encounter “frites” were soldiers during World War I. Our soldiers being as ignorant of world geography then as Americans are now, thought they were in France, because they heard French being spoken around them. In fact they were in Belgium; French is the language of southern Belgium.
The French themselves know that “frites” are not French. The English call them “chips”. The only people in the world who call french fries “french fries” are Americans. I noted that on the menu at the MacDonalds in Montpellier, France, french fries were called frites.
by Michael Anchors, MD, PhD
Patients use a lot of meaningless words, as though mere talking is enough. For example they are eager to tell me they eat “healthy”. I have no idea what they mean. The word “healthy”, an adjective, means ‘not sick’. So are they saying they eat not-sick? What does that mean?
When pressed on the “healthy” issue, they used to tell me they ate low-fat foods and avoided red meat. Now they have absorbed enough news media to know that red meat is okay (TIME magazine June 23, 2014 and November 9, 2016); carbs are the real problem. But recently they have started telling me they avoid “processed” food. Other than a few fruits, aren’t all foods processed before being eaten? I’m confused.
Other malapropisms. “Natural”. The dictionary defines it as “existing in or caused by nature; not made or caused by humankind.” By that definition there’s nothing in the store that’s natural other than the rock used to wedge the door open. Or how about “organic”? The dictionary defines that as “of, relating to or derived from living matter” or “of or relating to a bodily organ”. Which one of these things is meant?
Talk sense. Use real words. Stop focusing on food. Food is just food. You can eat what you like, as long as you’re not snacking or eating huge portions.
On the first visit many people are proud of exercising. They seem unphased that for all their exercise, they gained weight. Their explanation — “muscle weighs more than fat” — is nonsense; muscle is more dense than fat, not heavier. On the second visit patients adopt a different dodge. They are still exercising, of course because they believe exercise makes you lose weight, even when they know it does not. In America belief trumps knowledge. (Pun intended)
So now patients tell me they are exercising to “tone up”. Asked what “tone up” means, they point to the loose skin hanging from their upper arms. They know better than to tell me that exercise makes their skin shrink, so they say exercise fills up the underlying space with muscle. But it doesn’t, especially not in women. Without testosterone women can’t build much muscle. Only the surgeon’s knife can eliminate the loose skin, and it’s usually not worth it. My two cents.
By Michael Anchors, MD, PhD
In the office I often say, “Late last year I took an important step that tremendously improved my rate of success. I lowered my standards. I decided I am not trying to make women skinny anymore. There is no reason to do it. Men don’t want women to be skinny. GI Joe doesn’t want Barbie to look like this.”
I show off a Barbie doll.
“Or like this.” I show off six copies of SELF magazine. “Men hate this. None of the women on the cover have boobs. None of the models inside do either. All eight editors of SELF magazine are women, and I can tell you they are anti-breast. Compare that magazine with a man’s magazine.”
I show copies of the SPORTS ILLUSTRATED swimsuit edition.
“Notice the difference? These women have curves. Admittedly I’m not sure what sport is being illustrated here. So you don’t have to be skinny to be attractive to men. The whole focus on being superskinny is something women do to themselves and to each other.
“You don’t have to be skinny to be healthy either. Look at this study by Flegal at al. 2005. The group with the longest lifespan is not the skinny people; it is the overweight people, BMI 25-30. The words “normal” and “overweight” have been misused.
“So I am not trying to make women skinny. If you want to do that, that’s on you. I told you how to do it–the Ten Orders. My goal is simply to make women at a lower weight, and to make them know true things, and to put value on things that are truly important. I want my patients to enjoy moderate portions of good food at mealtimes. And to have conversations and hobbies, good friends and great vacations. I want them to stop damn focusing on food and diets. I want them to be happy.”
By Michael Anchors, MD, PhD
My sister is my main helper, taking the initial history on new patients, and she is a dog lover. When I get the chart, it always has information on the patient’s pets. I didn’t ask for this, but it has had a useful result–I have noticed that all the dogs and most of the cats of obese patients are themselves obese. This confirms that animals presented with an excess of food will overeat. I suppose we should not have expected the majority of people to be any different.
If in the past or in other countries people kept their weight down, it was due to (1) a lack of food, (2) a culture prizing leanness such as in Argentina or (3) fortuitous cultural habits such as the French long lunch and small supper. Some people may be overweight due to genetic events such as a defect in the TRIM-28 gene, but rare events like that cannot explain the common obesity of Americans and Mexicans. Most of it is behavioral.
If your dog is fat, why don’t you feed him less? He can’t get his own snacks or overfill his bowl. When I was a child, my parents fed our dogs once a day, not twice. In the future I will suggest to new patients that they put their fat pets on a diet. I roundly expect to find that patients who can’t get their fat dog to lose weight, can’t lose weight themselves either. And that among patients who do lose weight, the exercise of thinking about their pet’s weight will help the patients lose.