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Monday, 13 May 2013

Letters to the Editor

     The letter to the editor is a miniature literary form like the haiku, and one more transient than the blog post. I have written a great many over the years; no-one taught me, I believe that no university or technical college teaches the art that I have acquired "by doing".
     When you write to the editor you are constrained in time; your letter must be promptly relevant to a published letter or article. You are constrained in subject; you must rehearse the points raised and your own must be relevant to them. You are constrained in space to a paragraph or so, and you are equally constrained in style. Admittedly a smaller newspaper which I read in Tauranga has taken to publishing text messages with all their barbarous orthography intact, but a letter to an august organ such as the New Zealand Herald, with a circulation of over 500,000, must be a regular English prose composition (though if you can't quite manage that but still have something to say, the sub-editor may be generous with their aid).     
     Grandstanding, quirkiness, abuse, bare-faced flouting of logic, use of the word teh, substituting $ for S, multiplication of the letter K, obscenities, gratuitous offensiveness, and all the other tools of the blogger's trade will not be countenanced by the ladies and gentlemen of the press.
     My recently published letter was in response to one on the subject "Tackling Obesity" by one Peter Davis. It was reasonable enough and noted as I have done the sad decline in our once-great nation's health. The writer wondered if our armed forces might one day run out of healthy recruits. My first impulse was to respond that, obesity epidemic or not, the New Zealand defense forces will always be able to find the 18 or so recruits they need each year from a population of 4,405,200 at last count. However, I decided to drop the cheap joke to focus on a better target, a reference to eating too much and not exercising enough as causes of obesity. Really one can build a great deal around a light slap at this notion.
     This is my letter as it was published on Monday, May 13th:

    Peter Davis is right to insist that the social and health costs of the obesity epidemic require action. 
    Any measures taken should first increase research, while in the interim promoting the most successful overseas interventions, at present low-carb and ancestral diets, and developing them to suit New Zealand's needs. 
   It is presumptuous to say that obese people have eaten more and exercised less than others. First, such behaviour does not always result in obesity. Secondly, if I weighed an extra 45kg I would automatically be exercising a great deal harder than I do today just to go about my life, and this would probably require extra nutrition.
    Perhaps it is the declining quality of food - particularly the substituting of cheap starches, sugars and oils for nourishing fare - which is more than anything responsible for the declining quality of health in this area.

Yours Faithfully,

George Henderson

Native Diet mussels dish

And this is the letter as I sent it. I am including this version so you can appreciate how lovingly the sub-editor refined and polished my points, erased my mistakes, and improved upon my style, still slightly imperfect after all these years.

Dear sir/ma'am,

Peter Davis is right to insist that the social and health costs of the obesity epidemic require action. To avoid making things worse any measures taken should first increase research, while in the interim promoting the most successful overseas interventions, at present low-carb and ancestral diets, and developing them to suit New Zealand's needs. It is presumptive to say that obese people have eaten more and exercised less than others. Firstly, such behaviour did not, and does not, always result in obesity. Secondly, if I weighed an extra 100 pounds I would automatically be exercising a great deal harder than I do today just to go abut my life, and this would probably require extra nutrition, especially if the food available was of poor nutritive quality.
Perhaps it is the declining quality of food, i.e. the substituting of cheap starches, sugars and oils for nourishing fare, that is more than anything responsible for the declining quality of New Zealanders' health in this area.

Yours Faithfully,

George Henderson

Notice that, as New Zealand went decimal in 1967, a fact I had forgotten due to my excessive reading of U.S. diet books and blogs, my reference to a round 100 pounds was converted to a rather clunky 45 kilos.
What I believe distinguishes this letter from my earlier published efforts is the sheer number of concepts I was able to address. Unintended consequences ended up on the cutting room floor, but I was able to retain
- scientific research as the proper basis for policy decisions
- the paramount effectiveness of low-carb and paleo (without claiming that current options are perfect)
- a subtle reference to "The Native Diet"* T.V. program and other local initiatives
- a Taubesian dig at CICO
- a reference to empty calories (food quality)
- a swipe at the 3 Paleo devils, grains, sugars and oils, ignoring the expected whipping boy, my buddy fat.
And really, that's enough to be going home with.

* "The Native Diet is a concept derived from traditional Māori eating, activity and the 1920′s research of Dr Weston Price, who after visiting 14 indigenous nations including Māori, concluded the western world must look back at the traditional diets of these people groups for the future health of the next generation. Price advocated prohibiting processed foods from diets of Americans, something that has not been followed up."


Nigel Kinbrum said...

Hi George,

It's a good letter - concise and to the point. The only problem that I can see with it is the bit with the Taubsian dig at CICO.

Cheers, Nige

Puddleg said...

Thanks Nigel,
I thought of another way to put that; everyone who is prone to weight gain knows that they have to watch what they eat, and everyone who isn't, doesn't. If CICO played out as a scientific constant, we would have a level playing field where everyone would be equally prone to weight gain and weight loss. Ergo there are primary factors being overlooked when the secondary one of "ate more, moved less" is put before the horse.

Galina L. said...

There are a lot of people who seems to be not affected much by our obesogenic environment.

Puddleg said...

Indeed, or at least not affected in the direction of obesity.
I don't dispute the importance of energy, but I won't stand for it being proffered as an explanation for anything. Not least because interventions based on CICO alone don't seem to be very healthy.
The poorest people are the most prone to obesity, yet they have the least money to spend on food and comfort, and are the most likely to be malnourished and suffer degenerative illnesses compounded by past overwork.
A less nourishing diet combined with more exertion can't be the answer.

Nigel Kinbrum said...

I believe that the Energy Balance equation always applies. Unfortunately EE is almost impossible to measure accurately in free-living people (there is doubly-labelled water, but it's horrendously expensive).

Some (usually young) people's EEs shoot up when they over-eat, so their weight doesn't change.

Other (usually older and going into regular hyperinsulinaemic "comas") people's EEs drop like a stone when they over-eat so their weight (and bodyfat) shoots up.

Puddleg said...

Yes, that's about right. If what you're eating crashes your thyroid (not enough retinol, selenium, iodine, protein, calories, or too much gliadin in the wrong immune system) your EE might well nosedive (just for instance, not saying it's all about the thyroid at all). And if you eat more to get it up again, but don't fix the underlying deficiencies, it may be easier for adipocytes to store the extra than it is for mitochondria to burn it.

Imagine you are putting food in front of a pleading, starving animal in a cage, but that animal has no teeth and as soon as your back is turned a fatter animal wallows out of the shadows and gobbles up the food. The skinny animal is the mitochondria (perhaps especially the hepatic mitochondria), the fat one is the adipocytes. Well that's one hypothesis:

Nigel Kinbrum said...

To use your analogy:- To fix the problem, get some dentures for the toothless starving animal.

Now, how to fix the problem IRL? How about...

Right carbs, right amounts, right times = no hyperinsulinaemic "comas". People start to "Eat less & Move more" spontaneously. Moving more = dentures for toothless mitochondria.

Puddleg said...

To move more when you're starving may not be the best idea, you should probably fix those deficiencies, then hopefully you'll want to move more. Also, most mitochondrial diseases seem to involve defects at complex 1 and this part of the ETC is leaned on most heavily when glucose is used to generate ATP. We can basically rest this part of dysfunctional mitochondria, giving them more teeth to generate ATP, with a higher fat diet. (This I got from trying to understand Hyperlipid's series on the FADH2/NADH ratio).
If you have a disease that makes you gain weight much too easily, to store energy as it were, the disease needs to be treated. Altering the numbers of the energy inputs and outputs isn't dealing with the disease and may just make it worse. Improving the quality of the inputs, fine-tuning the macronutrients for their metabolic and (if you must) endocrine effects, and fine-tuning outputs (exercise) to those that are specifically likely to be therapeutic, not so much because they expend energy, but because they reinforce the physiological benefits of the other changes; this makes more sense to me as a first step because it is trying to treat the disease, which would, untreated, remain a disease regardless of the current weight as long as one was starving.

Puddleg said...

I think one can use addiction as an analogy. Note: analogy; I do not think that obesity = food addiction is a useful idea overall.
Addiction is drug dependence with features of neurological, immunological and metabolic disease.
It is caused by exposure to the substance, and the obvious thought is that removing the substance will therefore cure it.
Junkies go to detox or prison and completely rid themselves of the drug, yet the disease persists and the rate of relapse is very high. Abstinence introduces new dangers and deaths often occur with re-exposure.
But if the underlying disease can be successfully treated, recovery through abstinence may be more or less spontaneous. Age alone is often a curative factor if the addict survives. Ibogaine seems to be able to address the underlying disease, and supplements such as acetyl-n-cysteine, probiotics, and NAC can alter the immunological and metabolic aspects of the condition enough to ease recovery.
Understanding and treating the underlying disease before trying to force a change in the symptom (i.e. drug use and drug seeking-behaviour in the case of addiction, or energy intake in excess of output in the case of obesity) is likely to be the most effective and least harmful strategy in all but the most short-term and superficial cases.

Anonymous said...

Nice letter, George.

Teh Sid.

Puddleg said...

Damn Nigel, I deleted your last comment by accident trying to get to it!
This guy (on the right) thinks that the weight-loss industry is harmful to people.
A case in point might be Ajay Rochester, the Australian host of The Biggest Loser, who has gained 48Kg and reportedly fears "eating herself to death".
Clearly her eat-less-move-more efforts and all the expert nutritionists she had contact with on the show have not helped her, and there are good physiological reasons why they may have harmed her.
I don't think you and I disagree at base Nigel - eat less crap and move more outdoors. Probably we disagree about carbs a bit. The liver quite clearly gains and loses fat in a very simple Taubesian way, with an extra role for PUFA and fructose, and there is a metabolic advantage (but why does it produce less fatigue or rebound hunger than other energy deficits, is the most interesting question), so I tend to trust such low-carb articles of faith despite the currently incomplete explanations.

Nigel Kinbrum said...

George! How could you? ;-) :-D

Liver's don't "go to the gym". Stuff goes in & stuff comes out. It's stuff going in faster than stuff coming out chronically, that causes problems.

Bill Lagakos tweeted a new study.

Cliff Notes:- NIDDM: moderate to vigorous physical activity (>15 mins ONCE/wk) = -17% all cause mortality.

The Biggest Loser = Massive Facepalm. This doesn't invalidate ELMM. Humans just have a knack for f*cking things up!

I am pro low-carb diets for everyone. I am pro very-low-carb diets for slim people only.

Puddleg said...

In my fatty liver post I mention research where vigorous exercise (only) helps shift liver fat.
Vigorous exercise upregulates the same genes as carbohydrate restriction does.
i often watch shows like America's Next Top Model where underfeeding is on diplay. I have never thought "that girl needs to move less, a rest would do her good". I wonder if anyone does.
There are sometimes good reasons for re-introducing carbs on very low carb diets, but my personal bias is that "re-introduction" is the apposite word. You don't know what you've got till it's gone and everyone should experience a well-fed ketogenic state at least once in their life. I'll go back there if anything is unsatisfactory, like pressing the restart button. Not everyone needs to live there full-time, by any means.
Which is why I link to pro-carb sites like Perfect Health Diet and Archevore before others in the sidebar.

Nigel Kinbrum said...

That's why I recommend "Right carbs, right amounts, right times."
For some people, the right amount = 50g/day.

I'm still concerned about people who have obviously fat bellies. I don't think that they should go on VLC (~50g/day), due to lack of serum NEFA suppression.

LC (~100g/day) is safer for them.

honora said...

Good to see you in print, George. Interested in the link to the Native Diet. What Maori ate in classical times was fascinating. This included quite a variety of fermented food e.g. toroi No wonder they had such magnificent physiques in early photos and that's including the old folks! We didn't need to practice genocide, we just gave them the opportunity to adopt our dreadful diet instead.