To The Obesity Steering Group.
You are asking how we should be tackling obesity on behalf of the MedicalRoyalColleges and Faculties.
This is an excellent strategy.
First of all we need to use established knowledge in the areas of Physiology, Biochemistry and Endocrinology.
We have to eat protein, preferably of animal origin, as humans are unable to produce 10 of the about 20 amino acids we need for protein production in our bodies. Therefore, proteins are essential in the diet.
We require animal fat to maintain our cell membranes and our fat depots. We also need fats as our primary energy source. We consist of a minimum of 10 % animal fat, and fat is used for padding to protect vital organs. Our brain and neurological systems are also mainly composed of fat. Therefore, we need to acknowledge that fat is an essential nutrient.
Almost all cells contain mitochondria, and the only fuel mitochondria accept is AcetylCoenzyme A, (shorthand ACoA or acetic acid) in the Krebs cycle where AcCoA is added to oxaloacetic acid to form citric acid. The citric acid is then metabolized to two CO2, two H2O and 15 ATP (adenosintriphosphate) and back to oxaloacetic acid to recycle with the next available AcCoA. Our mitochondria have to use AcCoA as fuel but it makes no difference to mitochondrial metabolism if the AcCoA comes from fat or carbohydrates.
Animal fat has the same composition in all warm blooded animals. Very nearly 50 % saturated fats, and 50 % monounsaturated fats. The rest, about 5 %, are polyunsaturated fats. This composition is key to maintaining the correct melting temperature of fat for the function of cell membranes and fat depots. This is also why fish, living in a cool environment, have to have more polyunsaturated fats to produce fat with lower melting temperature. For a similar reason, horses and cows during wintertime have a higher proportion of polyunsaturated fats in their hoofs, and cloven, as their feet are colder than the rest of the body. That polyunsaturated rich oil is called hoof oil and was used to dampen nautical compasses, before the cheaper silicone oils were available.
Also, all essential micronutrients like vitamins and minerals we have to eat are in ample amounts in animal food, but are scarce in vegetables and carbohydrate containing food.
Carbohydrates are necessary in small amounts in our blood. The normal range of glucose is 3-6 mmol/L. This means that there are 1.5-3 grams glucose in the total blood volume of a 70 kg person. This amount of glucose is essential to the red blood cells (RBC) as they lack mitochondria and need glucose to anaerobically metabolize it via 2,3-diphosphoglycerate (2,3-DPG) (Rapoport-Luebring pathway) . This allows the release of oxygen from haemoglobin and also creates two molecules of ATP and two molecules of lactic acid per molecule of glucose, powering the energy requirements of the RBC.
If you eat 5 grams of carbohydrates then the blood glucose level will increase another 10 mmol/L from 5 mmol/L to 15 mmol/L. This glucose level will trigger the beta cells of the pancreas to release insulin to lower the toxic level of glucose.
Insulin’s primary effect is to restore the blood glucose level back to 3-6 mmol/L. An elevated level of glucose is toxic to the body, as glucose nonenzymatically binds to proteins causing Advanced Glycation Endproducts (AGE). The most well known AGE is HbA1c, glycated haemoglobin, where glucose or fructose sterically hindering oxygen binding to haemoglobin reducing oxygen transportation in the blood.
Thus, carbohydrates create havoc even in relatively small amounts. When blood sugar levels rise, insulin stops the production of AcCoA from fat. At which point the main source of AcCoA will be glucose metabolized to AcCoA. This inevitably leads to an excess of AcCoA, that can not be metabolized to two CO2, two H2O and 15 ATP in the already overloaded Krebs’s cycle. The excess of AcCoA is thus polymerized in the liver to saturated fat of up to nine AcCoA modules which will then be stored in our fat depots.
Insulin has many actions that will restore the normal blood glucose level of 3-6 mmol/L. So it is an ample supply and production of insulin that keeps us from dying prematurely. Patients with diabetes have insufficient insulin production to meet the demands of the extreme amounts of carbohydrates now recommended by the authorities. On the other hand, patients with diabetes fare much better on a low carbohydrate and higher fat diet, some of them can even get rid of all their drugs, including insulin. This was the regular method of diabetes treatment before the advent of insulin 1923. That method was still recommended up to about 1980 when all of a sudden it was decreed that patients with diabetes should not be treated differently from the healthy population.
If we have more than 30-50 mmol/L (>15-25 grams) of glucose in the blood it is a lethal concentration of glucose. Yet, the authorities recommend a diet containing 381 grams of carbohydrates per day (60 % of 2 605 kcal). Carbohydrates are neither essential nor necessary to us, as the liver can make all the carbohydrates we need. This is common scientific knowledge for more than a hundred years.
The old pig farmer knew how to get a fat pig for Christmas. He fed the pig boiled potatoes with fat and coarse milled grain with a lot of fibres, both good sources of carbohydrates and added fat to be stored as the old physiologists knew. Today we feed our children milled grain with a lot of fibres, now rebranded to Fibre rich pasta, and oil cooked potatoes, now rebranded to French Fries (British Chips). This is why our children get fat, we offer them the same old fashioned pig farmer’s weight gaining food. Only, rebranded with new names.
The modern pig farmer knows how to get a slender pig, just feed the pig protein and ample amounts of fat and small amounts of carbohydrates.
All weight reduction diets have one thing in common. Just look at the two extremes,
- Standard famine diet with 600 kcal and 50 E% carbohydrates contains 75 g carbohydrates, 23 g protein (113 g meat) and 23 g fat per day.
- Low carbohydrate high fat (LCHF) diet with 2500 kcal and 12 E% carbohydrates contains 75 g carbohydrates, 94 g protein (470 g meat) and 203 g fat per day.
Both diets have the same amount of carbohydrates and give the same weight reduction in a short time perspective. This has been shown many times in the past [, , ,  ] but are not reproduced in the modern clinical literature, as this would be contrary to the politically correct “conventional wisdom” of the Dietary goals from 1977. In the Mc Govern Select Committee Nick Mottern, a former labour journalist and vegetarian [], almost single handed wrote the Dietary goals which are still recommended by authorities like EFSA in Europe and Livsmedelsverket in Sweden.
The famine diet is bound to fail and must end in a few months. The body craves more nutrients and the person is forced to start eating more food to survive or the person will die of famine due to too little energy, too little micronutrients, too little fat and too little animal protein.
The LCHF diet gives satisfaction, all nutrients come in ample amounts and the diet can be eaten until the person dies of old age.
We need a diet with high energy density as our brain requires 20 % of our basal metabolism.
We need a diet with high energy density as we then do not need long eating times like herbivores.
Fat has the energy density of approximately 9 kcal/g required to feed the brain with enough AcCoA. Natural animal fat is also shown to be non-toxic in all amounts/concentrations up to more than 400 kg body weight.
Protein in the form of meat has about 0.8 kcal/g meat so animal protein sources are energy scarce and excess of 0.5 g/kg bodyweight is usually deaminated to carbohydrates.
Carbohydrates (excluding grain) have just fractions of a kcal/g vegetable. Cucumber has just 0.14 kcal/g. Fruit has about 0.4 kcal/g fruit so they are not good enough for energy production.
Dried grain has maximally 3.5 kcal/gram flour but carbohydrates causes havoc in our body and can be toxic or even lethal at higher amounts. We cannot deal with too high an intake of carbohydrates without causing disease, including obesity and diabetes. The upper level of carbohydrates should not be more than 100 g carbohydrates per day or a healthy adult. Persons with a metabolic diagnosis must consume even fewer carbohydrates [].
Also, there is an excellent article about weight loss among patients with diabetes showing that a decrease of carbohydrate from 400-500 g to 100 g gave a weight reduction of 11.5 kg in six months . The control group decreased 1.8 kg during the same time. Half the control group switched over to the low carbohydrate diet and repeated the experiment within the experiment. The weight loss was stable during 44 month.
The main responsibilities of The Obesity Steering Group are to:
- Produce a strategy on the most effective and coherent way to tackle obesity
- Produce a recommendation report to form part of a wider Obesity campaign by the last quarter of 2012.
Ad item # 1.
There are several steps that would be recommended to try to combat the obesity epidemic, outlined below.
1. The most important thing of all is to understand the physiological, biochemical and endocrinological background to the obesity epidemic. That background can be retrieved from the metabolic science and knowledge from before the second half of the 20th century. Most of the research before the 1950th was done in Europe, most of it in German writing countries but also both France and United Kingdom were participating in the scientific research.
2. Next comes that The Obesity Steering Group has to educate the senior advisors in the health care system.
3. The next step is to convey the knowledge from the senior advisors to all medical staffs
4. The last step is to educate the whole population the new directives.
These steps would not take long as you can use modern video education including publishing on the Internet
Ad item #2
Be straight and just show that meat, fish, eggs and animal fat is good for us. Protein and fat are essential (we have to eat that kind of food) and they contain enough with minerals and vitamins. It is enough to have 0.5 g/kg (or 175 g meat or fish) per day of animal proteins. Eating vegetable proteins that often are missing some essential amino acids why you usually need at least double amounts of vegetable protein or more.
Eggs are very nutritious and we can have several eggs per day. Remember that a fertilized egg that is hatched under a hen contains everything (but heat, oxygen and water) inside the eggshell to produce a complete chicken in three weeks, so there is no better food for us.
Regarding animal fat and vegetable hard fats, a normal person needs around 200 g per day.
Carbohydrates, including grain, starch, sugars and High Fructose Corn Syrup (HFCS), can be eaten in moderation but they are toxic. This means a maximum of 50-100 grams of carbohydrates per day for healthy persons. You can have as much vegetables and tubers as the person want up to two kilograms per day. Limit the potatoes to 300-600 grams/day or grain products (bread, pasta, pizza, cereals and similar grain products) less than 100-200 grams per day. But potatoes and grain should be summarized as carbohydrates.
Industrial unsaturated trans fatty acids should be avoided as they are toxic.
Rumenoid trans fatty acids, also called Conjugated Linoleic acid (CLA) are safe for us and should be encouraged to eat.
We need to eat essential food (animal protein, fat, minerals and vitamins) like the old French kitchen and old fashioned local food like the Swedish “husman” (“Master’s”) diet from before 1960.
Carbohydrates are toxic and even lethal and nonessential. So we should avoid processed modern food as they usually contain a lot of carbohydrates replacing the animal fat. The processed food also often contain vegetable oils containing omega-6 rich fatty acids which causes inflammation and even cancer .
Avoid fiscal measures as they usually backfires, education of the population is much more efficient and cheaper.
Exercise is known for generations to increase the appetite, so I do not understand how the advice to “run more and eat less” actually works. That advice has been recommended to obese patients for decades and there have never been any long standing results of that piece of advice.
A high-level government official, preferably the prime minister, should make a public statement on a highly-visible occasion bravely admitting that we were wrong to blame the obesity epidemic on saturated fat and cholesterol in the diet, and that, instead, people should focus on reducing carbohydrates including dietary sugars and processed foods. People are going love to be allowed to have real and natural food. So there will be no problems.
There are three excellent books that should be required reading for all nutritionists and government personnel involved in the anti-obesity campaign:
- Gary Taubes, Good Calories Bad Calories by A Knopf, NY, NY, USA, 2007
- Barry Groves, Trick and Treat Hammersmith, London, UK, 2008
- Weston A. Price, Nutrition and Physical Degeneration
A good lecturer for each book (can be a lecture film on the Internet) can be a shortcut as these books take a considerable time to read and understand. In the first two books there are about 400 pages plus about 200 pages with references. So actually every word written in these two books are excellently referenced with both old as well as modern references.
Carbohydrate containing beverages should be non-recommended or at least restricted in size in public.
The whole population and especially our children should be educated on the benefits of real unprocessed food and the dangers of fast food including the cost and taste benefit of real food compared to carbohydrate rich food.
An aggressive advertising campaign should be initiated to promote foods containing healthy animal fat and cholesterol, such as meat, fish, oysters, eggs, bacon, butter and whole milk.
Mora June 06, 2012.
Former Senior Consultant in Paediatrics.
Ph.D. in Biochemistry
Independent scientist in Nutrition.
792 91 MORA
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