Looks Like My Job Will Be Secure

All it takes to assure you will keep your local cardiologist employed is 19 strips of bacon and one egg and you've got yourself one heck of a solid bacon burger:

Having read about the difficulties people making such burgers have had keeping them together, I decided to add one large egg to the food processor along with the 19 slices of bacon. I ground the bacon and the egg together, then, using my hands, pulled the mixture out and used a hamburger press to make a burger. It is possible that my hands have been greasier at some point in my life, but if so I have (fortunately) forgotten it. I was not quite prepared for the raw burger to look like pure fat, and I must admit that it didn’t look very appealing. But it was for science, so I soldiered on!

I put the burger on the rack-Pyrex assembly and slid it under the broiler. Having learned a lesson from last week, I turned the stove exhaust fan to high immediately. I peeked in on it as it cooked, and it seemed to be cooking nicely, with tons of little fat bubbles sizzling on top. After seven minutes or so, I took it out to turn it over, and was pleased how easily it flipped. Five minutes later, it looked done, so I took the temperature of the inside (you need to be careful with pork, of course), and it registered at 160 degrees Fahrenheit, so out it came. Now it looked like food, and smelled delicious.

My family and I thank you, America!

-Wes

America's Favorite Pastime

... deep fried food.

Cardiologists everywhere thank you.

-Wes

Promoting Personal Responsibility

... through the arts.

Nice. (oh, forgive the pun...)

-Wes

Just In Case You Were Wondering...

... this is why you're fat.

-Wes

h/t: A faithful reader.

Thanks for Taking Care of My Family

Whoever invented this Bacon Explosion, cardiologists everywhere thank you.

-Wes

PS: At least it's Adkin's friendly.

Fat Chance That Trans Fat Ban Will Help

Let me see if I have this right:

"A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia" showed low-carbohydrate, ketogenic (high fat) diets were superior to a low-fat diets for weight loss and lipid management.

"A randomized controlled trial of a moderate-fat, low-energy diet compared with a low fat, low-energy diet for weight loss in overweight adults" demonstrated the moderate fat diet helped dieters lose weight faster than low-fat diets.

In a "Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women," the Atkins diet, with its high fat, won hands down at weight loss and lipid improvement in women.

And now, in the DIRECT Trial testing "Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet," we find that low carbohydrate (moderate fat) or Mediterranean diets are superior to low-fat diets at weight loss and lipid management.

So given all of this prospective, randomized data, why the heck is California so proud to be banning trans fats? Trans fats exist in many, many foods besides baking oils. Meats, butter, and milk all have trans fats. Given the available data above and the efficancy of LOW CARDBOHYDRATE diets to improve weight and lipid panels, might they be targeting the wrong thing?

No wonder patients are confused.

-Wes

Warning: Milk Might Be Harmful to Children

How would you like that headline on your dairy case? Or instead of "Got Milk?" on posters, they end up reading "Got Trans Fat?" No doubt the trans fat ban enthusiasts would love to extend the ban to include all things dairy and beef, if they could. The insistence by law that all bakeries in New York must ban butter due to its high trans fat content is having an interesting ripple effect with the public - maybe there's too much government intervention here at controlling people's diet. Maybe there's little data to support the claims that people, not lab rats, will have a lower incidence of heart disease with the implementation of a trans fat ban.

Imagine if the New York City government were to ban the Adkin's diet because it contains too much trans fat? Would we want that, too? I would find that intervention too excessive, alright, especially given the recent study that the Adkin's diet with its highest protein and fats (yes, trans fats, too) was the most effective at promoting weight loss and lowering blood pressure amongst four popular diets tested head-to-head over a 12-month period. Interestingly, other studies in 2002 have demonstrated that the Adkin's diet was also more effective at lowering serum cholesterol that the American Heart Association's recommended diet as well.

But how does one explain this? How could a diet high in fats and protein possibly promote weight loss?

It's simple: because weight loss is not dependent on the fat content of our food. Rather, it is most associated with the presence of the anabolic hormone insulin. Insulin is a major determinant of the sensation of hunger and converting carbohydrates to fat. Adkins knew this. He promoted it for years. But many wouldn't listen. His theory flew in the face of the various dietary groups promoting quick, ready-to-eat, nutritious breakfasts with lots of vitamins and nutrients (and carbohydrates). Remember Carnation "Instant Breakfast?" Stirred with milk, you had the fast and furious super-sweet breakfast that gave you the energy and nutrients to conquer the day! And enough carbohydrates (24 grams even in their no added sugar variety) to stimulate the additional secretion of insulin to stimulate hunger after the bolus of carbohydrates was resorbed so you'd want to eat more and pack on the pounds!

Obesity and weight gain are directly correlated to the development of hypertension, diabetes, and the "metabolic syndrome," and as such, are significant contributors to the development of cardiovascular disease. Certainly genetics play a role, too. But whether the trans fat ban will have any effect on the improvement in the obesity epidemic by promoting increased carbohydrate consumption in America remains doubtful.

-Wes

The Dawn of the Food Narcs

As food bans spread rapidly across the country in the interest of public health, one is left wondering how they will be monitored. With the multiplicity of difficult public health issues before us, it seems that governments nationwide have found a new way to deflect more pressing issues by implementing food bans – and there is a willing cadre of starry-eyed idealists standing by to assist. The dawn of the Food Narcs is upon us.

Some of you might not be aware that Chicago has banned foie gras from our local eating establishments by an ordinance passed by the ever-public-minded Chicago City Council. Since this is difficult to enforce, the overstretched city is relying upon – guess who: concerned citizens. And, indeed, nine restaurants have been warned because people dining at adjoining tables, in their psychologic delicacy, have filed complaints with the city. These offending restaurants, “believed” to have served fois gras, according to the Chicago Tribune, were sent warning letters from the Chicago Department of Public Health after receiving a citizen complaint. A visit by the Department of Public Health occurs after a second citizen complaint, and visits that turn up evidence of the banished dish can result in fines of $250-$500.

While multiple large companies have moved to ban trans fats from their recipes, will other smaller companies risk litigation by not following suit? Certainly the Big Boys will be under careful scrutiny by the legal community because they have deep pockets. But what of the little guy? Who will be overseeing the corner hotdog stand to assure they’re serving trans fat free bagels? Now we know who: fellow community-minded citizens. Isn’t it reassuring to know that if you cannot control yourself, or are victimized by making politically incorrect choices, others will be there to save you from your own behavior?

If people cannot be responsible for behaving correctly, then perhaps the only alternative is for other citizens to monitor them. Maybe they can be sent to food reconditioning camps – Chairman Mao anyone?

-Wes

Waistlines with Helplines

A recommendation by European metabolic researchers to place obesity helpline numbers on clothes for fat people appeared yesterday and caught my attention in part due to the concerns of obesity in England, but mainly due the discriminatory nature of the labels. To me, it is yet another example of government and academics overreaching into the private lives of our patients. Unfortunately, with the world-wide distribution of these stories, it is frightening to think that other government officials might think this is a good idea. With this logic, why stop with labels for the obese? Why not place labels appear on the flies of trousers or the thongs sold at Victoria's Secret that say, "Promiscuity is a high risk behavior and could kill you." Or why not put a warning label inside baseball jerseys that says "Excessive beer consumption can be hazardous to your health?" And staying completely mundane, when was the last time you read your pant or shirt label anyway?

Will such labels change eating behaviors? Doubtful.

I have never met an obese individual who didn't know they were obese. Many of them have very real reasons they are obese, including psychosocial issues that are far more resistant to intervention that any warning label will correct. Some of these people are unhappy, others are indifferent, others eat for nurturance, for others it is a compulsion. Others are just exasperated at their inability to gain control over their situation. Whatever the root cause, the psychodynamics of obesity are too complicated to be solved with garment labels. Do we really think government intervention with "labels" will solve these deep seated and very personal issues? On the contrary, these labels might reinforce the very negative perceptions they intend to help, catalyzing the compulsion still further.

Personal responsibility and real medical and social interventions are needed to battle the obesity epidemic. Socioeconomic stressors also play a significant role. Only improved awareness, education, increased physical education and support programs paired with regular physician follow-up will help guide people to lifestyle modifications that will insure a safe, long-term solution to this problem. There is no quick fix.

Significant challenges lie ahead for governments and healthcare providers dealing with the obese. For starters, few individuals see mild or even moderate obesity as a health issue - after all, most of us chubby soles feel fine. We (doctors and educators) have done a poor job educating the population regarding what's good and what's bad: mixed messages abound. We make deamons of trans fats, saturated fats, high-sugar content foods, creams, Oreo cookies, and on, and on, and on, while placing soda machines in our schools and feeding high carbohydrate junk at lunchtime in schools. Exercise, although touted, is seldom granted time to perform in workplaces fixated on productivity. The relentless buzz regarding low-carbohydrate diets, sugar-free diets, and others becomes background noise: blah, blah, blah. They've heard it all, and nothing works for them.

But there are success stories. Some people really do lose weight. Some really do lose their diabetes, hypertension, and chronically painful joints. But most of these successes are due to active intervention by family members, caregivers, and a healthy dose of self-realization of one's situation. Pants labels just aren't in the mix here. Only when each of us takes responsibility, doctors and patients alike, will there be success in this war on fat.

-Wes

So Much For the Trans Fat Ban

One Arizona restaurant's answer to New York's trans fat ban.

This should serve as a dose of reality as to the ban's effectiveness nationwide.

-Wes

On the Trans Fat Ban in NY

"Are we going to start to outlaw what everyone should eat in the city of Chicago? The City Council will be sitting in your kitchen to determine what you should eat on Sunday after church." - Mayor Richard Daley, Chicago

The recently announced and much anticipated ban of trans fats in New York restaurants reminds me of the fois gras ban here in Chicago earlier this year. No one was there to enforce it and it looked like special interests (animal rights activists) got to tie up Chicago legislature with something that meant little to the general population, while ignoring other more pressing public health and safety issues. It was repealed a little over a month after it was signed into law. Will this new trans fat ban spread across the country or will the ban eventually be repealed? Right now, it's tough to know.

Now please understand that I tow the party line: trans fats are bad for you. There, I said it. They raise low density lipoproteins (LDL) and lower high density lipoproteins (HDL or "good cholesterol"). And trans fats are ubiquitous fixtures in our culinary landscape, adding plenty of calories to our diet.

But how many of us really know what fats our foods are cooked in? How many people inquire about this in restaurants? How many know a "good oil" from a "bad oil" in their kitchen? Will it matter to our obesity epidemic? Do you realize those Girl Scout cookies you love each year are cooked in trans fat oils? Will you care when a doe-eyed little girl asks you to purchase her cookies? No, you will purchase them to help her. Will you care if she can't raise funds for her cause selling cookies door to door in New York due to a ban on trans fats? You bet.

But like seat belt requirements in cars, there are occassionally good ideas that come from governmental regulation and legislation. Certainly adding seat belts to cars, and later air bags, has saved countless lives. Perhaps trans fat bannings will lower coronary deaths, but unlike tallying deaths from car accidents, proving cause and effect of heart attacks as they relate to trans fat consumption will be nearly impossible to prove. Will doctors look over the recently deceased in the Emergency Room and say, "Damn, we lost him from a trans fat overdose!" I think not. Dietary intake is just one risk factor for premature coronary deaths.

And most people don't even know the difference between a trans fat and a mono- or polyunsaturated fat. Sorry, they don't. But fat of any kind burns at 9 calories per gram while carbohydrates and protein burn at 4 calories per gram. Eating too many calories (including fat) of any kind means you're still likely to get fat.

But food companies can now pander to the uninformed. Already there are "trans fat free" food labels on your store shelves ... even when food companies still have their foods loaded with TONS of other forms of fats and calories. Another fad is born.

Now I ask you, what has the New York Health Department accomplished, really?

-Wes