Saturday, 2 June 2012

Obesity is multi-factorial, spectra and other stuff.

This post is a hotch-potch of thoughts that are currently whizzing around in my brain.

1) Obesity: Like just about everything in life, obesity is multi-factorial. Each factor may have only a small impact on obesity. Tackling one factor alone won't solve the problem. Every factor has to be tackled, one at a time.

So, New York City Mayor Michael Bloomberg announcing a ban on sales of sugary drinks larger than 16 ounces in restaurants, delis, sports arenas, and movie theaters won't solve the obesity problem, but it will help.

EDIT: In shops and supermarkets in the UK, tobacco products now have to be kept out of sight. I'd like to see the same thing happen to Crap-In-A-Bag/Box/Bottle (CIAB).

2) Spectra: As also mentioned in my first link, there is a spectrum of fatness in the general population which probably follows a bell distribution curve. From skinniest to fattest, there are people who are:-
Extremely skinny. Very skinny. Skinny. A bit skinny. Average. A bit fat. Fat. Very fat. Extremely fat.

If you take somebody in a category who isn't currently consuming CIAB and introduce CIAB to their diet, what happens? They move to a category to the right. Therefore, it's possible for there to be very skinny people who consume CIAB. Therefore, anybody who (or should that be Wooo?) states that the existence of very skinny people who consume CIAB is proof that Food Reward doesn't exist is wrong.

3) Other stuff: I am concerned with people overlooking postprandial (a.k.a. nonfasting) triglycerides (a.k.a. triacylglycerols a.k.a. TAGs a.k.a. TGs) after eating large amounts of fat. According to Fasting Compared With Nonfasting Triglycerides and Risk of Cardiovascular Events in Women, serum TGs 2-4 hours post-meal are very significantly associated with Cardiovascular Events (fully adjusted hazard ratio [95% confidence interval] for highest vs lowest tertiles of levels, 4.48 [1.98-10.15] [P < 0.001 for trend]).

After 4 hours post-meal, serum TGs are cleared from circulation by being burned by muscles and/or by being stored in fat cells. See Figure 3B in Extended effects of evening meal carbohydrate-to-fat ratio on fasting and postprandial substrate metabolism.

19 comments:

LeonRover said...

Well, Bloomberg is only too aware of the Zeitgeist - highly in tune with C&W songstresses!

http://www.youtube.com/watch?v=c7DbpaHgxPI

praguestepchild said...

Nigel, you seriously think that Bloomberg's idiotic regulation is going to help? Even liberal zombies recognize how ineffectual this legislation is:

"The proposed ban may not be the best way of dealing with the obesity problem, or the role that sugared drinks play in it. It may not work at all—actually, given the rather large loopholes it will contain, it may backfire. But at some point someone had to step in and do something, and for a number of reasons, that someone basically had to be Mike Bloomberg."

If you don't see a huge logic fail there then I'm no longer your virtual friend ;)

Nigel Kinbrum said...

Banning 16+oz sugary drinks isn't going to make anybody fatter.

I have no idea what effect the ban will have on obesity/tooth decay/w.h.y, but it's better than doing sweet F/A, which is usually what happens in the US.

I don't agree with Lustig's science, but anything that takes away power from the makers of CIAB is a good thing IMHO.

praguestepchild said...

I honestly find it hard to understand how an intelligent guy such as yourself (and a fellow EE) could be such a strong believer in govnm't intervention.

I imagine you have the same problems understanding my paradigm.

Nigel Kinbrum said...

How do you feel about Government intervention in the marketing and sale of tobacco products?

praguestepchild said...

Do you even need to ask that? Take a wild guess.

praguestepchild said...

I don't think it should happen.

Nigel Kinbrum said...

On BlackBerry, so gotta be brief.

Libertarianism is a great ideal. Unfortunately, it's a completely unworkable ideal, thanks to human nature.

Certain humans and groups thereof cause suffering to other humans and groups thereof. This will not do!

How many modern societies are currently successfully run on libertarian/anarchist principles?

Kade Storm said...

Heh. Politics and libertarian idealisms, again. Well, I'm grateful for my NHS and civic support concepts. At least there's not anarchist aliens involved this time. [/troll]



Nigel,

I am interested in the subject of blood glucose control and glycation. I've always been of the thinking that keeping blood glucose low, but stable -- especially postprandial -- is probably helpful.

Having that said, I am still intrigued by the results people achieve on some of these very low fat vegan diets where the majority of their calories come from glucose. I mean, even if we can play the glyceamic index card, the glycaemic load is still something to consider. Sure, weight loss helps, but what about those who already have poor glucose tolerance despite having athletic body fat levels? I don't even know if this is a question more than an expression of my doubts over how well mainstream wisdom has scrutinised some of these successful 'very low fat, animal-free, plant based' dietary recommendations.

praguestepchild said...

So the fact that no societies operate under a perfectly libertarian paradigm means it's an unrealistic.

The fact is, there is a strong correlation between a country's rank on the Index of Economic Freedom and it's wealth.

But this isn't really relevant to governments regulating what we can ingest. A better example would be the utter disaster that was Prohibition and the War on Drugs. That's if you believe in looking at outcomes.

If you believe in innate personnel liberty then people ought to have the right to put stuff in their body even if it *is* bad for them. This includes sugar, fructose, mj, heroin, or monkey shit.

Nigel Kinbrum said...

Kade Storm said...
"Nigel,
I am interested in the subject of blood glucose control and glycation. I've always been of the thinking that keeping blood glucose low, but stable -- especially postprandial -- is probably helpful."
Me, too. The study on nonfasting TAGs stated that taking glycated haemoglobin into account didn't change the results significantly. This suggests that fasting hyperglycaemia is probably not a significant contributor to CVE.

"Having that said, I am still intrigued by the results people achieve on some of these very low fat vegan diets where the majority of their calories come from glucose. I mean, even if we can play the glyceamic index card, the glycaemic load is still something to consider. Sure, weight loss helps, but what about those who already have poor glucose tolerance despite having athletic body fat levels? I don't even know if this is a question more than an expression of my doubts over how well mainstream wisdom has scrutinised some of these successful 'very low fat, animal-free, plant based' dietary recommendations."
The proof of the pudding is in whether or not they have major health problems later in life. I wouldn't enjoy such diets. I like meat with my veggies!

Nigel Kinbrum said...

praguestepchild said...
"So the fact that no societies operate under a perfectly libertarian paradigm means it's an unrealistic."
I actually wrote "unworkable", but yes. If it worked, somebody somewhere would be doing it.

"The fact is, there is a strong correlation between a country's rank on the Index of Economic Freedom and it's wealth."
I thought that a country's wealth depended on its natural resources. Disclaimer: I am not an economist.

"But this isn't really relevant to governments regulating what we can ingest. A better example would be the utter disaster that was Prohibition and the War on Drugs. That's if you believe in looking at outcomes."
So, because Governments sometimes completely fuck things up, they should never be allowed to regulate anything? Without any regulation, there'd still be price-fixing cartels, snake-oil salesmen and salt in beer, to name a few. The whole raison d'etre of companies is to make as much profit as possible without harming their customers short-term (as they would sue). Harming their customers long-term (so that they can't sue) is fine and dandy. Fucking with people's brains by the use of marketing is a useful tool for maximising profits. Bribing Governments to subsidise their raw materials and tax the opposition's is another.

"If you believe in innate personnel liberty then people ought to have the right to put stuff in their body even if it *is* bad for them. This includes sugar, fructose, mj, heroin, or monkey shit."
I agree. What I disagree with is the constant brain-washing of people via marketing through the media & at point-of-sale to buy CIAB that will harm them long-term.

Hiding tobacco products from sight won't stop the determined buyer, but it will deter the casual one. I believe that confectionery & sugary drinks should be treated likewise, along with a ban on all advertising of them in all media.

Bloomberg's regulation won't stop the determined buyer from swallowing loads of sugar, but it will deter the casual one.

Lerner said...

Then you'd be interested in the Homburg Cream and Sugar study from last year.

"Cream and Sugar Study sheds light on triglyceride interpretation"

http://www.theheart.org/article/1269389.do

In normoglycemic 2ndary CAD Pts, "... the hazard ratio for the primary end point was 3.10 (p=0.04) for those in the highest tertile of fasting triglycerides (compared with lowest), and 4.45 (p=0.02) for those in the highest tertile of postprandial triglycerides."

Ryan T Rogers, MD said...

Alright Nigel, sorry for the delay, this is my take on the post prandial TAG study. First, I think we both agree on the dangers of glycosylation and fructosylation. Once you have insulin resistance (supraphysiologic levels of insulin in response to food and fasting, this is how I like to think about insulin resistance) you are in trouble. This study accounted for this variable, which was good.

I would like to know what the make up of the meals where in the non fasting groups. Also, the post prandial insulin levels and blood glucose would also be nice to see in the non fasting TAG's group who had coronary events. If you want my raw evolutionary take on whats going on its this..

The people with elevated fasting TAG's with insulin resistance had an increased risk of a CAD, this is self explanatory, they have chronic inflammation, leads to atherosclerosis, heart disease, done.

The non fasting elevations are an interesting case, I suspect the ones with heart disease ate high carb/sugar meals with high fat. That's a bad combo, you get elevated post prandial blood sugar (which causes microtrauma to endothelial cells of vessels) in conjunction with high levels of atherogenic lipoprotein remnants from the metabolized fat from the meal and you've got all the ingredients for plaque formation.

Now, I am not going to claim that eating an entire stick of butter by itself for breakfast everyday is safe for your vessels. Nor will I say eating a surgery cereal with skin milk every morning for breakfast is safe for your vessels.

I know that eating a high carb and high fat breakfast everyday like a supreme croissant from Jack n the box is not safe for your vessels. I think moderation is key, Moderate fat/protein with a carb source that is low GI like scrambled eggs cooked in butter with a few handfuls of berries is probably the least atherogenic according to this line of thinking.

Ryan

Nigel Kinbrum said...

Ryan T Rogers, MD said...
"Alright Nigel, sorry for the delay, this is my take on the post prandial TAG study."
Hi Ryan. Thanks for dropping by. Don't worry about the delay. You have work to do - unlike me.

"First, I think we both agree on the dangers of glycosylation and fructosylation. Once you have insulin resistance (supraphysiologic levels of insulin in response to food and fasting, this is how I like to think about insulin resistance) you are in trouble. This study accounted for this variable, which was good."
I agree that excessive glycosylation (Dr Ayers prefers the term glycation) and fructosylation are bad for health, as is Insulin resistance (see my posts on IR if you get some spare time).

"I would like to know what the make up of the meals where in the non fasting groups. Also, the post prandial insulin levels and blood glucose would also be nice to see in the non fasting TAG's group who had coronary events."
Unfortunately, that information is unavailable in the study I linked to.

"If you want my raw evolutionary take on whats going on its this..

The people with elevated fasting TAG's with insulin resistance had an increased risk of a CAD, this is self explanatory, they have chronic inflammation, leads to atherosclerosis, heart disease, done."
I agree.

"The non fasting elevations are an interesting case, I suspect the ones with heart disease ate high carb/sugar meals with high fat. That's a bad combo, you get elevated post prandial blood sugar (which causes microtrauma to endothelial cells of vessels) in conjunction with high levels of atherogenic lipoprotein remnants from the metabolized fat from the meal and you've got all the ingredients for plaque formation."
Is there simultaneous hyperglycaemia and hypertriglyceridaemia after eating a carb+fat meal? Gretchen didn't test that particular combo.

"Now, I am not going to claim that eating an entire stick of butter by itself for breakfast everyday is safe for your vessels. Nor will I say eating a surgery cereal with skin milk every morning for breakfast is safe for your vessels."
You'd better have a word with Jimmy Moore, who's eating an awful lot of fat due to a certain Mr Taubes telling everybody "You can be as gluttonous as you like on protein & fat, provided you don't eat carbohydrate."

"I know that eating a high carb and high fat breakfast everyday like a supreme croissant from Jack n the box is not safe for your vessels. I think moderation is key, Moderate fat/protein with a carb source that is low GI like scrambled eggs cooked in butter with a few handfuls of berries is probably the least atherogenic according to this line of thinking.
Ryan"
I'm generally in agreement with you on this. Foods made out of grains that have been turned into dust are not good for health IMO, although I do eat a couple of slices of Burgen Soya & Linseed bread/day. I like to live dangerously! Cheers, Nige.

Lerner said...

wrt "glycosylation", that is enzymatic and so "glycation" is correct - though I've read that "glycosylation" has been incorrectly taught in med school

wrt pp TAG, the Homburg C&S shows no correlation to events in diabetic and prediabetic Pts - maybe because their risk was already so high

wrt to inflammation, I'd say that inflammation is far more involved in plaque rupture than in plaque formation. E.g., the Masai have extensive atheromas on autopsy, but little to no events.

JUPITER certainly did provide a dramatic change to thinking. Yet OTOH there was also a recent ER registry study in Italy et al showing that ~40% of STEMI cases had normal or low CRP.
http://www.ncbi.nlm.nih.gov/pubmed/22152952

There was also a recent review saying that there is no correlation between gum disease and coronary events - which contradicted previous studies about the chronic inflammation from bacteria colonies in gums leading to CVD.

So things aren't exactly clear, as usual these days.

But wrt inflammation and plaque formation, I recall a study with knockout animals lacking the protein chemotactic gradient that normally leads macrophages into the subendothelial region. Those animals did not form significant atheromas, and of course made no foam cells.

wrt bad consequences of meals, the most immediate is probably the "single fatty meal" phenomenon, wherein fat irritates the endothelium into releasing tissue factor which leads to clotting Factor VII and so on to thrombosis formation.

wrt to long term effects of meals, a sub-analysis from the MESA study shows that it is LDL particle number (LDL-P) that counts, not size - which is bad news for Taubesian fat-overeaters who think they are immune.
http://www.athero.org/commentaries/comm564.pdf

Oh, and there's also some research from the Pritikin group showing that the small LDL seen in high-carbers is not so oxidizable after all. One argument against small LDL has been that the small diameter results in the encircling Apo B-100 protein being misshapen, thereby lessing binding affinity with the LDL receptors in the liver, thereby resulting in delayed clearance and more opportunity liver time to become oxidized.

and wrt to restricting soda: there was a recent study showing that kids in schools where soda and juice vending machines were banned weren't any less fat - though they probably just swilled more once they got out of school :)

Anyway, the above points about heart disease are interesting to me and so I throw them out to see if there is any response. These things unfortunately don't get discussed much, and get lost in all the talk about weight loss per se.

George Henderson said...

Multi-factorial.
Here's my favourite new factor.
What's the difference between an obese carb-grazer and a fit Kitavan?
Could it be in the timing (as well as the food toxins)?

http://www.salk.edu/news/pressrelease_details.php?press_id=560

Your mention of post prandial lipids vs fasting lipids - very interesting subject. Any good papers on the differentials?

Nigel Kinbrum said...

@Lerner: There's a helluva lot of information in your post, which is why I haven't written a specific reply.

@George: I saw that study some time ago. "Meals" of Crap-In-A-Bag don't satisfy for long, making Intermittent Fasting virtually impossible.

Meals of meat & vegetables satisfy for much longer, making Intermittent Fasting doable. Getting carbs from whole vegetables (including rice) is much better than getting them from grains that have been ground into dust (foods made from flour).

RE Good papers on the differential between fasting and nonfasting TAGs: Did you click the blue link Fasting Compared With Nonfasting Triglycerides and Risk of Cardiovascular Events in Women? That's a good paper.

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