Lots of credentials, misleading lots of people

[figpiglet]

I copied the following from the blog of my medical group, The Palo Alto Health Foundation. No wonder my doctor thinks I look better at 200 lbs than 130 lbs and is suspicious of low-fat vegan diets. This is really annoying and I wonder about how good my medical care can be given this kind of presentation. The exercise information is not the problem as far as I know but he tells people to avoid carbs. By eating lots of carbs (starches) like beans, lentils, peas, corn, potatoes, and also fruits and veggies my last weigh in showed 129.4 lbs! This respected doctor lumps sugar and flour products combined with fats as being the same as starches. Anyway, if you are interested, read the following word for word, copied quote from PAMF website.

The most important hormone in your body that determines fat storage in your body is insulin, and the most significant cause of insulin release is carbohydrates in your diet. Ironically, fat does not cause insulin to go up. Foods that are carbohydrate-rich will make you fatter than foods that have excess fat. Many of my patients who have the most excess body fat are South Asian vegetarians who consume no meat or excess fat in their diet, but instead consume lots of carbohydrates in the form of rice, breads, lentils, beans and starchy vegetables like potatoes. Crispy snacks and sweets also worsen the problem. So, to lower that extra fat, lower your carbs!

The next step is to make sure you get your body moving. As a first step, take more steps. Get a pedometer and aim for an initial goal of more than 5,000 steps daily and then ultimately, at least 8-10,000 steps daily. On top of this, try to get in at least 2-3 sessions of cardio and 2-3 sessions of weights in per week. You can combine your cardio and weight sessions into one workout by doing interval or circuit training where you perform a series of exercises consecutively to maintain an elevated heart rate. This will simultaneously allow you to increase endurance and strength. You can check out my short video on cross training for examples.

If you do show signs of being ‘skinny fat,’ be sure to work closely with your doctor to reduce your risks. You may also benefit from a referral to see a PAMF nutritionist or a PAMF South Asian Health expert.

Ronesh (Ron) Sinha, M.D.

This blog post is contributed by Ronesh (Ron) Sinha, M.D., Palo Alto Medical Foundation Internal Medicine. Dr. Sinha works closely with the South Asian community to help reduce heart disease and diabetes risk, and provides corporate health lectures to promote wellness in the workplace. Dr. Sinha holds clinical faculty positions at UCLA; Stanford University School of Medicine; and the UCSF School of Medicine. He teaches Stanford and UCSF medical students.


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Welcome! This blog is is a forum for engaging patients, their families and the community in conversations about health care and wellness with articles and tips from our doctors and staff from different departments. We invite your comments, however, please remember that this blog does not address specific patient medical issues or provide personalized medical advice. If you have a specific medical question, please contact your doctor directly.Thank you for visiting our blog.
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[vgpedlr]

The way South Asian food is usually prepared nowadays (especially in the US) is with lots of oil. Indian vegetarians typically consume plenty of dairy in the forms of butter or ghee, cheese, and yogurt. That is a high fat diet.

[TerriT]

The way South Asian food is usually prepared nowadays (especially in the US) is with lots of oil. Indian vegetarians typically consume plenty of dairy in the forms of butter or ghee, cheese, and yogurt. That is a high fat diet.

Maybe, but that's not what this doctor is saying. He's saying the people he sees with weight problems are those who eat lots of carbohydrates and no meat or excess fats.

[plants-and-carbs]

Oh, Lord. What ignorance!!

It is scary that there are people of influence saying crap like that.

I am guessing the person is Indian and works with fellow indians. I can tell you from having eaten a lot of indian food, they use LOADS of fat! They use clarified butter (ghee) on almost everything like it was going out of style. They also like using a lot of coconut oil as well. Also, some of them even think of dairy as divine food since cows are seen as sacred in much eastern thought so they have no issue in consuming large amounts of things with dairy.

Lastly, they love sweets too. They use insane amounts of pure sugar in there deserts and often use butter in their sweets as well.

It is disturbing that this anti-carb ideology keeps gaining more and more momentum. I almost become unhinged reading that junk. If you hadn't copied the text, I almost would have thought you were exaggerating. Wow!! What ignorance.

[Theodore]

.

[BlueHeron]

I think the phrase "crispy snacks" is a giveaway here. Crispy snacks tend to be crispy because they're fried.

And as many have pointed out, Indian cooking can include lots of dairy and oil. It's the typical situation where the carbohydrate gets blamed for the company it keeps.

And, of course, weight loss doesn't equal health. As others have pointed out, chemotherapy and heroin addiction will also make you lose weight.

[rijman]

As far as credentials, my bigger concern is advocacy and biased information being passed off as honest unbiased research. In my industry you must remain unbiased and cannot perform duties in the industry as an advocate without risk of losing your license. Apparantly there is nowhere near the same level of transparancy or honesty in the nutrition business. Any hack can report biased claims while being financed by the very industry they are reporting on favorably. It makes me sick.

[ronald11103]

Interesting because just a couple of days ago I stumbled across an article (on Yahoo??) that said somewhat the same thing - that it's not sugar, per se, that makes you fat, but that sugar (and all carbs) cause the body to produce insulin and insulin is the culprit. It's insulin that makes you fat! The insulin somehow creates the fat (out of thin air??) and transports it to your cells (according to the article.) I was looking for it yesterday because I wanted to get the details but couldn't find it. I was curious because Dr. McD talks a lot about sugar but I can't find much (anything) from him on insulin response of the effect of insulin (except relating to diabetes.)

[plants-and-carbs]

Interesting because just a couple of days ago I stumbled across an article (on Yahoo??) that said somewhat the same thing - that it's not sugar, per se, that makes you fat, but that sugar (and all carbs) cause the body to produce insulin and insulin is the culprit. It's insulin that makes you fat! The insulin somehow creates the fat (out of thin air??) and transports it to your cells (according to the article.) I was looking for it yesterday because I wanted to get the details but couldn't find it. I was curious because Dr. McD talks a lot about sugar but I can't find much (anything) from him on insulin response of the effect of insulin (except relating to diabetes.)

Just to give you a little more info on the insulin theory of low carbers, they don't say the insulin makes you fat out of thin air, they claim out of control excess insulin created by carbs creates fat storage and that this fat storage makes it impossible to lean out and causes obesity.

That is the low carb theory, but we all know that is utter crap since many on here have lost over 100 lbs eating potatoes and rice every day.

[vgpedlr]

Insulin does push fat into fat cells. It also pushes carbs into your muscles. It also initiates protein synthesis, and as such is a banned performance enhancing drug. You won't hear Dr. McD dispute that because he explains in his presentations that he opposes insulin for diabetics since it tends to make the problem worse and interfere with losing weight.

[lmggallagher]

figpiglet:

When I moved back to the Bay area I was confronted with too many options on which Medical Facility to select. Ultimately, I choose Kaiser and gritted my teeth hoping it would work for me.

I was pre diabetic at the time ( I reversed that on this diet) and was immediately put into a nutrition class on carb counting for pre diabetic and diabetics. Although, what they taught in the class was more informed by far then this blog you posted - they were still trying to convince us to limit carbs obviously. But these were real dieticians/nutritionists and they didn't "falsify" carb information. They also did stress whole food carbs, potatoes, rice, veggies and fruits as very important for a variety or reasons mostly nutirentional but also the insulin flushing virtue of fiber.

Since then I have moved from Kaiser Redwood City to Santa Clara. I went to my new doc there for our third meeting with Esselstyn's book in hand and said this is what I am going to do to reverse my pre-diabetes. There are other plant-based books specific to diabetes treatment - but I thought it would be helpful to have pictures of cleared arteries just for fun and just in case my doc turned stubborn on me. All I wanted was assurance that I could get her help with lab panels on request to mark my progress.

I was completely stunned to find from her that Esselstyn had been to that campus recently (a year and one-half ago) lecturing the docs and that she was thrilled for me to be going plant-based. She is now one of my biggest cheerleaders on this adventure and is thrilled with all my labs as I progress.

I was also pleased to hear Dr. McD say at one of the 3 day or 10 day series that he has recently started working with Kaiser Santa Rosa. He also said they are showing sincere interest in the benefits of this WOE.

Anyway, my point is not to try and get you to consider Kaiser, I doubt that all there docs are like mine across the board, but that plant-based is making in roads here in the Bay Area and beyond. As Dr. McD said about Kaiser, if they see a way to keep costs down they will pursue it. I hope too, if they have any medical ethics at all others will begin to follow. At least, that's what I would like to believe - when I am day dreaming

PS I personally would be tempted to leave a comment on the blog asking him to compare his findings regarding insulin with those of the "The China Study" (per New York Times the most important book on nutrition ever or something close to that).

I wish I hadn't loaned my copy out or I'd look a quote up right now - pretty sure Campbell covered this territory as well.

[chris.]

I have a few South Asian friends from college, and they're always mentioning something about their parents having lots of health problems.

After visiting their homes a few times, I can safely conclude that it's all the refined sweets, ghee/oil, and soft drinks that make them sick.

Obviously, being vegetarian is not good enough. But how doctors can still point their fingers at starches and whole grains as the reason for everybody's health problem is beyond me...

[Vegan Hunter]

What is "skinny fat"? I have heard that term batted around, but seems silly. Is it even enough of an issue for health professionals to mention?

[KensCircus]

The most important hormone in your body that determines fat storage in your body is insulin, and the most significant cause of insulin release is carbohydrates in your diet. Ironically, fat does not cause insulin to go up.

I have extensive personal experience to the exact contrary. I am a type 1 diabetic. That means that my body cannot produce any insulin, so I have to inject it myself to stay alive. This requires meticulous blood sugar monitoring, meal planning and exercise to keep my blood sugar normal and stable. The insulin requirement of each food type is very clear to me.

What I discovered is that fat raises blood sugar and requires more insulin than any other food type (it’s worse than a glazed donut). The misconception is due to the slow, persistent effect rate. The effect is latent, taking about 12 hours to start and continues for another 36 hours. Therefore I am on a fat free diet. My max fat tolerance is 45 calories per day. If a meal happens to include 100 calories or more, my blood sugar will rise into the 350-450 mg/dL range and requires double or more normal insulin level to get it back down to something livable. But it still doesn’t work because the insulin action rate does not match the fat action rate. So, it is a wild see-saw blood sugar chase. It saps my energy and I feel like crap. It is also cumulative. Too much fat (greater than 45 calories) in the following day extends the 36 hour period almost linearly. In contrast, living on starches – carbohydrates – maintains a steady, easily manageable normal blood sugar level.

I believe the primary source of confusion is the latency of the effect. Testing blood sugar two hours (considered standard food effect period) after a high fat meal will return a normal level. In fact, it will remain normal even the next day, in people with a functioning pancreas, because it is slow enough for the pancreas to respond in step. With the pancreas already running in high gear to counter the fat, introduction of any faster calories will push it over the top and make it look like the starch is the culprit.

I have been through this for the past 25 years. It is very definite and repeatable. There is no question to me that fat is the stand out greatest offender to excessive insulin production.

I would like to add that I am very happy to be a type 1 diabetic. It has forced an education, diet and lifestyle on me that not only saved my life, but has given me more life than my years!

Ken

[erin]

Thanks for the insight Ken, this ties in nicely with the concept that it is the effect of a high fat diet on cellular insulin receptors that leads to inflammation and over time results in chronic cellular insulin resistance and type 2 diabetes.

http://www.nature.com/ni/journal/v12/n5/fig_tab/ni.2022_ft.html

~ Erin