Saturday, December 12, 2009

The Obesity Epidemic

I find it interesting that last year there were 435,000 deaths from cigarette smoking. Last year, there were also 400,000 deaths from obesity related illness. Obesity is second only to smoking as a cause of death. That is significant.
I have spent the last year reading and researching everything available on weight control. For the last 10 years of my clinical practice, two things have been elusive. First, almost two-thirds of the patient's in my practice are overweight or obese. That correlates with the current figures in the united states. However, most of these patients are very closely watching their diets and are exercising. However, the average patient is only able to loose 5-10 lbs and then the weight seems to return. Despite the depth and certainty of our faith that saturated fat is the nutritional bane of our lives and that sedentary behavior and over-indulgence or over-eating are the cause of our nations obesity, there is, and always has been, significant and plenteous evidence that the above assumptions are wrong . . . dead wrong.
I have patient after patient that comes to my office limiting their intake of fat and limiting their calories (sometimes to less than 1000 per day) and exercising more than most triathletes and they are still gaining weight.
Second, these same patients continue to have a climb in their cholesterol levels. It seems that I just continue to raise their doses of cholesterol lowering medicine to chase the numbers as they increase in adiposity.
To quote H.L Mencken, "There is always and easy solution to every human problem, neat, plausible, and wrong." After, a year of reviewing study after study and reading every legitimate source of research I can get my hands on I have come to the conclusion, as have many others, that fat doesn't make you fat.
Case in point, obesity rates remained fairly constant in the United States from 1960-1980 and then around the time the surgeon general released his "Report on Nutrition and Health" recommending that we all cut the fat out of our diets, our weight has increased to almost 33% being overweight in 2009.
This surge in obesity seems to correlate extremely closely with the constant message that obesity, diabetes and heart disease are caused by fat. We have been told for the last 30 years that we should eat less fat and eat more carbohydrates. Our society has been bombarded by this message and for the most part, we have believed it and followed suite. And the proof is in the statistics. We are getting fatter and fatter.
However, seeing what I have seen in the last 10 years of my practice, a large number of people have turned to the message of Dr. William Banting published in his "Letter on Corpulence" published in 1863 after he lost over 50 lbs. This message has been republished and repackaged in a number of ways, but the physiologic message is the same: Eat Fat and Grow Slim(1958), Calories Don't Count (1961), The Doctor's Quick Weight Loss Diet (1968), Dr. Atkin's Diet Revolution (1972), The Complete Scarsdale Medical Diet (1978), The Zone (1995), Protein Power (1996), Sugar Busters! (1998), and The South Beach Diet (2003). All of these advocate that it is the carbohydrates that are the problem and not the fat. It is fascinating to me that these have all been dismissed by the American Heart Association, The American Medical Association, and multiple nutritional authorities as misdirected fads. I, myself, told patients for years that these were just "fad diets." However, we were wrong.
Claude Bernard explained it this way, "In medicine, we are often confronted with poorly observed and indefinite facts which form actual obstacles to science, in that men always bring them up, saying: it is a fact, it must be accepted." (An Introduction to the Study of Experimental Medicine, 1865) The fact of the matter is that body weight is set by a complex interaction of hormones regulated by the body to maintain a homeostatic balance. The urge to simplify this complex situation so that physicians and apply it and patients can embrace it seems to have taken precedence over the obligation of science to present the evidence with relentless honesty. Unfortunately, this is an area of science where an enormous amount of data has been theorized and instead of rigorously proving those theories, there has become a dedicated practice of convincing the public that those theories have already been tested and the answers are already known. This is an area of medicine that, in the words of Gary Taubes, "purports itself to be science and yet function like a religion."
We have understood the actual science of fatty acid metabolism since the 1930's when Rudolf Schoenheimer & David Rittenberg identified the stages of cholesterol in the metabolism.
In 1965, we had a clear understanding of which hormones stimulate fat mobilization and which hormones promote fat accumulation. Forty years ago, there was no controversy to this. And the facts have not change, in fact we know more about hunger and the hormonal balance of fat mobilization and fat storage than we ever did before. And in 1976, Stephen Woods and Dan Porte described the evidence that insulin is the primary factor in the drive to store fat as "overwhelming."
So what is the bottom line? It is this. When your body sees carbohydrates or sugars of any type, it produces insulin. Insulin is the driving force to store fat. Whenever insulin is present, the body is told to store fat. When insulin is not present the body will use is previously stored fats for fuel. The key then to weight management is management of carbohydrates. The fewer carbohydrates you eat, the less insulin you make and the less fat you will store.

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Thursday, October 15, 2009

Six Degrees of Obama

This is the direction that Obama seems to be taking us regarding health care. Keep your eyes open because I see this happening around us without any checks and balances on the Socialistic slide.

Wednesday, October 14, 2009

More Success Occurs When Behavior Changes are Fun!

The video below shows that just some simple behavior changes can make a difference and making those behavior changes occurs more often when it is enjoyable or fun.


Thursday, October 8, 2009

Weight Loss Tips - You Can Be Successful

I am asked daily about weight loss. At last count there are over 17,000 different diets all claiming to help you loose weight. There are a few things you should know about loosing weight and doing it appropriately.

First, 65-70% of those with weight problems have some form of insulin resistance. This is a precursor state to diabetes. It doesn't mean you will become diabetic, however, it means that if you continue to gain weight (the average America continues to gain an additional 1-2% of his or her body weight each year) you have a 15% chance of becoming diabetic in the next 5 years. This is why two thirds of people can only loose a small amount of weight over the short term and then see a rebound in the weight almost immediately. Our societies current approaches to weight loss with the "low fat" diets will only be truly effective in 30-35% of people. This is why most people feel like they are going to DIE, as this is the first part of "diet."

Therefore, if you are overweight, you should see your physician and get checked for insulin resistance or impaired fasting glucose (another term that is used interchangeably with insulin resistance) or see our website to make an appointment at

If you are not insulin resistant, the low fat approach is important and will be successful if applied correctly. If you are insulin resistant, then an appropriate carbohydrate limiting approach will be the only way you will see success.

Second, in either case, it is important that you body does not think it is hungry or starving. When your body is hungry it thinks it is starving it will turn on the storage of fat for up to 24 hours. To solve this problem, it is important to eat five to six small meals per day every three to four hours. This helps keep your body feeling fed and turns of the drive to store fat.

Third, drink enough water. Water is key to weight management. If your body is thirsty it thinks it is starving and turns on fat storage. It is important to hydrate yourself regularly. I recommend drinking 64 oz of water per day as a base. That is eight 8oz glasses of water per day. You should know that drinking anything more concentrated than water (soda, juice, tea, coffee) will dehydrate your body. So, chase these drinks with a glass of water.

Fourth, some form of exercise regularly is essential. I recommend that if you are not participating in a regular exercise program, start a simple walking program. Start out walking for 10-15 minutes three times per week. You can increase the time you walk by a few minutes every two weeks. It is important, however, that you get checked out by your doctor before you engage in any moderate or vigorous exercise program.

Last, it is important to know that being overweight and obese are diseases that are treatable. It is important to understand that recent science shows that your body releases hormones that cause very strong cravings and appetites in response to both physical and psychological stimuli. Keeping a dietary journal is important. Write down what you eat and record why you ate it. After a while, you will see patterns to why you are eating and when. Habits of eating are some of the most challenging to break and a diet journal is a key to unlocking these habits, both good and bad.

I have heard many physicians state that the only reason people can't loose weight is because they just don't push away from the table. For the majority of people weight control is possible as you appropriately regulate your hormones. I know very few women who can just concentrate or focus their will power and stop their menstrual cycle for a few months. Why they would anyone think that just pushing away from the table will reduce their weight?

You can loose weight and you can be successful. Start with these simple tips and follow up with your doctor if you are not seeing the success you desire.

Thursday, April 30, 2009

Swine Flu and You

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in the animal and specifically the pig populations. The Center For Disease Control has reported that between April and August, 2009, there has been a surge in hospitalization of school aged children due to infection with Influenza A, novel H1N1 virus. This virus has not been as problematic as suspected in persons older than 20 years old ( Swine flu or Influenza A viruses have been reported to spread from person-to-person.

In late March and early April 2009, cases of human infection with swine influenza A (novel H1N1) viruses were first reported in Southern California and near Guadalupe County, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well.

What are the signs and symptoms of swine flu in people?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include low grade fever (99-101 degrees), cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people, however, like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions. If you are having any of the above symptoms, Dr. Nally recommends you get evaluated for the flu.

Many patients have been extremely concerned about the constant media coverage of the recent documentation of increased numbers of swine flu cases. Please do not be alarmed by all the “Media Hype” and “Shock Tactics” used by television and radio.

What should I do to keep from getting the flu?
First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

There is a vaccine that will be available in mid-October to help prevent the spread of this virus. This vaccine will be given to school-aged children, pregnant women, and the health care providers that treat them first, then as the vaccine is made available, it will be offered to the rest of the community.

See your doctor for further information about the flu or if you suspect you may have the symptoms above.

Sunday, April 12, 2009

Super Size Me?

I appreciate the message in this documentary. I see these exact side effects of fast food indulgance and gluttony in my office daily. Since I originally saw this video four years ago, I have not been able to bring myself to eat in a McDonald's or Burger King since.