Sunday, December 1, 2013

A Doctor's View on Obesity

I just read this very honest article by an Australian physician about her experiences with obesity, both as an attending doctor in a hospital and specifically as the doctor that does the pre-surgical evaluation of potential bariatric surgery patients (link shared by Crossfit HQ's Facebook).
Fat City - What can stop obesity?
It's a brilliant read. She covers the dilemma of having to point out that a patient's weight is negatively impacting their health while knowing the kind of shame she is inflicting on them (on average fat shaming is counter-productive and just plain wrong).
To me the most interesting parts is about the bariactric surgery. If I remember correctly gastric banding has a success rate ~50% and a gastric by-pass has a success rate ~75%. Death from complications is about 0.5%. From my friend, who's an anaesthesiologist and has worked on a number of these surgeries, this is pretty bad but the challenge is that any time you put the morbidly obese through any surgery you run a number of risks that are absent from "normal" surgery. So in addition to the high risk of bursting stitches there's also a risk associated with general anaesthesia. But if you decide not to do the surgery then you still get morbidly obese patients under the scalpel at some point.
I usually hate the whole IIFYM mentality (If It Fits Your Macros - a concept that you eat anything as long as the three macro-nutrients hit your target) but for someone like the 200 kg young man she describes, who literally doesn't have anything enjoyable in his life apart from junk food, I think it is actually a better option than Paleo. Phew, too long sentence. But when someone can't even leave their bed some days then asking them to cook all their meals and ignore all junk is probably a bridge too far. Someone like that needs to manage how many calories are going in and he needs to do it in the simplest way possible. If he gets that working then he might learn that he can eat more food if he goes for a healthier option. Let's do some math! I love numbers. He could probably stand to lose 120 kg. There's ~7.2 kcal/g in adipose tissue (that's probably not the most precise number btw). So he has 864,000 kcal to lose. If we guess that his metabolism turns over 3000 kcal per day (yes, the bigger people are, the higher their base metabolism is). That might be low. Let's say 4000 because that's definitely too much. Then he has stored enough energy for more than 216 days. Without any calories from outside of his body. So basically, this dude needs a diet that is sustainable for about 3 years. Not a "Lose 5 pounds in 7 days with this skinny bitch we hate"-Cosmo-cover-diet. I don't like to admit it but Brad Pilon's Eat Stop Eat or Martin Berkhan's methods would probably be the best for him (both are intermittent fasting approaches with calorie restriction). Of course any successful weight-loss diet is simply a set of ways of acting that allows a person to eat fewer calories than their body needs without experiencing hunger (and preferably without a down-regulation of thyroid function).

My only issue with that article is that she thinks you can't be hungry when your stomach is full. It's a terrible feeling but perfectly possible. It's true that the stomach being full sends one signal to decrease the sensation of hunger but if you are in calorie deficit then that's another signal to increase hunger. Protein deficiency increases hunger. High concentration of fats and monosaccharides override satiety. I'm sure there's a lot more. Now I'm hungry.

Saturday, November 9, 2013

BMI categories

Less than 18.5 : Underweight
18.5 to 25     : Scrawny
25 to 30       : Overweight
More than 30   : Obese

Because your weight is wrong and your height is wrong and you'll get sick and be a burden to society.
And no one will ever love you. Least of all you.

Even Wikipedia has a nice section on the problems with BMI.

Wednesday, October 16, 2013

But it's so tasty!

Great! Let's eat everything tasty.
Tasty, tasty ethylene glycol, diethylene glycol and lead sugar (it tastes like sugar but it's lead! Amazing!).

By now you have hopefully figured out that I am being sarcastic. There are plenty of things that aren't good for us that still taste nice. And you already knew that. But instead of spending so much energy on "Oh, it's so naughty but so good. I know I shouldn't." spend some energy on "Oh, this is yummy and good for me. Score! *nom*nom*nom*.". Guilt is the best spice but leave it for your freaky sex games with your consenting partner.

Sunday, June 9, 2013

Midway between Paleo Nazi and eating like a child

The Paleo drummer did a really good piece on finding your balance between eating well and eating fun (though personally, I think paleo food is very enjoyable or I wouldn't be eating it, see gluttony, but there are things that are sociable and just very high in reward).

The basic tenet is that everyone is a special little snowflake and you should listen to your body, blah blah. Sound advice.

I just figured I would take the opportunity to post my personal list of the things in the borderlands for me.
Potatoes: no! Boiled, mashed, or roasted they make my keratosis pilaris worse but rarely make me break out. Deep-fried potatoes or potato powder is just awful. Gives me zits. Reminds me of the Clearasil tv adverts of my youth where kids would share pizza and make fun their classmates' acne behind their back. Good times. Clearasil is fantastically useless against acne btw.
Wine and grapes: Not really good for me, digestion-wise.
Gluten, in beer and home-made cakes: Surprisingly, not that much of an issue. The sugar and alcohol both lead to cravings sometimes but it's not really an issue. And too much alcohol is too much alcohol. Same as too much sugar is gross mouth-feel, bloated, drowsy, fucked.
Store-bought or "semi-homemade" cakes and other treats: No no no no no no. God no. Just when I think I might have figured it out (like macaroons) I find that I have in fact not. Semi-homemade is the worst because you feel like you can't say no when "they made an effort" and you don't want to be the dick who points out that they could just as well have picked up 5 doughnuts for 65p in Tesco. Because that's how shit their cake is.
Rice: I eat it when I'm out and there's not real "meat and veggies" option. Which is slang for cock and balls apparently. I don't mind, I like all four. Rice makes me overeat carbs and that then kills my appetite for the next couple of days. So good for carb-loading and also good because I love sushi. Which I really do overeat and it's glorious. Joy. *Note Carb-loading is generally once a week at most. That follows the turnover rate of thyroid hormones pretty well.
Milk: There doesn't seem to be much difference between when I do dairy and when I don't. Milk, some Greek yoghurt or skyr, ice cream. Ice cream is a treat of course and one of the few I buy ready-made (though I am pretty good about checking whether it was made with vegetable oil or dairy - vegetable oil ice cream is a gross concept). I do not like cheese. From descriptions it sounds like people eat it as mindlessly as potato chips.
Chocolate: This might depend on the brand but if there's a bar in the cupboard I'll end up eating it and regretting it. No matter if it's 56% or 85%. A leftover bit or the little ones you get with coffee is fine. If it's milk chocolate it just goes in the bin. Ew.

So there it is. Gluten might not fuck me up like it does to so many people but wheat is still really addictive and is usually in a context where I die from eating too many carbohydrates. Splat. So I don't. Eating my veggies instead keeps me rock-steady.

Sunday, May 19, 2013

More on cravings

I've made a handy little chart of how some parts of your brain are messing with other parts (and subverting your consciousness).


Something sets you off. You're at the coffee shop "Oh, they have cake!". Totally unexpected, I know, and a second ago you didn't want cake, you weren't even thinking about cake. But now the craving has been triggered and you really want cake. Now it can go two ways: you buy the cake or you don't. If you buy it and eat it you will experience a moment of joy (because cake is what we called hyperpalatable) and your brain will respond with a craving again the next time you see cake. If you don't buy and eat the cake things get interesting. Because the next time you experience the trigger the craving actually becomes stronger. Your brain is trying harder since the last time the craving wasn't strong enough to elicit cake. And if you then give in you are reinforcing stronger cravings. But if you don't your brain will at some point give up. Cravings turn out to be fruitless and there's no point in making you experience them.

tl;dr If you have bad cravings and you want them to go away then you can only have sweets if you don't want them. It sucks, I know.

To be honest I don't think you can get entirely rid of cravings. They are probably tied in with the normal hunger system and helps you make sure you get enough to eat. And I only really think they are a problem when they have you eating things you don't actually want. When I can say yes and no to treats based on how I know they affect me in the long term then I'm happy. And when I can't that's when I know I have to reset the system and ditch all the treats so I can function normally again (no, an apple or similar isn't a treat but based on how I respond to grapes I would have to say that they are).

Additional reading: What Shamu Taught Me About a Happy Marriage an article about positive reinforcement and extinction in everyday life (there's a book too). All of Stephan Guyenet's blog on food reward.

Thursday, April 18, 2013

Sugar dragons

Think of your brain as a dog. Or your body or your tooth or basically whatever part of you that you think is responsible for sugar cravings. Just like a dog begging at the table that part of you craves chocolates and candy and cake and SUGAR! Do you think your dog is going to stop begging at the table if you only give in once in a while? No, what you are doing then is called random reinforcement or intermittent reinforcement and it is more efficient than regular positive reinforcement (yes, even if you are unintentionally training an undesirable behaviour it is called positive whenever it includes reward).

So basically, if you want to get rid of your sugar cravings you have to starve them out. The process is called extinction. Whenever your brain misbehaves, and tries to make you eat something you've chosen not to eat, you have to ignore it and/ or go do something else. Like eating some good food. Cravings are stronger when you are hungry. Melissa Hartwig recommends not going to fruit to satisfy the craving but eating something less sweet, but preferably going without snacks and rather eat at mealtime. Makes sense to me.

Friday, February 8, 2013

Treat: European banana pancakes

Yeah yeah, Americans and the French call them crêpes but pretty much everyone else call them some variation of pancake and make them without baking soda.
Spanish: panqueques
Dutch: pannenkoeken
Danish: pandekager
German: Pfannkuchen
Czech: palačinky
British: pancakes

No flour or sugar added but it still a delicious treat so you will keep eating these even if you aren't hungry. A sometimes food.

fat for frying (butter, coconut oil, ghee, whatever you have)
1 banana
2 eggs
½ tsp cinnamon or pumpkin spice mix
pinch of salt (unless you use salted butter for frying)

Put fat on pan and set on hot.
Blend ingredients gently (in a blender, food processor, or with an immersion blender).
Knock some of the air out.
Pour on hot pan. If you pour enough to cover about half the radius of the pan you should be able to tilt the pan and cover the rest of it while getting the pancake nice and flat.
Re-grease between each pancake.
Serve with whatever depending on what you eat. Fruit, nuts, various dairy products etc. Or just eat 'em as they are. Mmmmm.

Extra reading: The Paleo Mom has a recipe with plantains which apparently means that you get a pancake with no banana taste and if you use green plantains you should turn down the sweetness completely, useful for savoury pancakes http://www.thepaleomom.com/2012/09/paleo-crepes-with-nutella.html