Why carb crashing is not the secret to weight loss

This article isn't meant to dismiss low carbohydrate diets for weight loss. Low carb diets can work but it is the reduction in total calories and eating below your maintenance calories which results in the loss of weight and body fat, not just a reduction in carbohydrates. A low-carb diet might also be better for some people for both fat loss and maintaining a healthy weight because it helps them adhere to a healthier way of eating (i.e. – making better food choices) and the increased fat and/or protein intake might increase satiety levels and prevent them overeating. Low-carb diets might also make some people feel more energetic and spritely, making their workouts more fun and something they look forward to. In contrast though, other people might feel utterly terrible: unable to concentrate (foggy head), no energy to perform adequately in the gym, make poor food choices, crave carbohydrates and be unable to adhere to their plan.

So, if it's not the diet we want to address then what is it? It is the idea that “carbs will make you fat” and the carb-phobia that some people now have. It is the number of calories you consume versus the amount of energy you expend over a prolonged period which will make you either gain or lose weight.

We also want to explain a process which all our bodies perform: de novo lipogenesis (DNL). This is the metabolic process by which our bodies convert excess carbohydrates into fatty acids which are then incorporated into triglycerides for energy storage in both the liver and adipose tissue (subcutaneous fat). So yes, carbs can be converted into and stored as fat in our bodies however the rate at which this occurs is much lower and less significant than people who see carbs as the enemy would have you believe. 

Numerous studies in which participants were over-fed and given excess carbohydrates show that DNL only makes a small contribution to any increase in total fat stores and does not account for the entire increase in body fat.

So, if the excess carbs are not turned into fat then does this mean one can eat unlimited amounts of carbohydrates? No, during overfeeding of carbs there is increased carbohydrate oxidation and a reduction in fat oxidation (or fat used for energy) resulting in a positive fat balance and an increase in the net storage of the fat consumed from one's diet.

Alternatively, an over-feed of fat will also increase fat storage. While one will burn more fat, the fact that there is more fat being consumed and total calories are still in excess means that the net fat balance is still positive and dietary fat will be stored. So unfortunately, regardless of whether the excess calories you consume come from the carbohydrates or fats, the fat balance in the body will be positive and you will gain body fat.

For both carbs and fat, the excess calories and resulting positive fat balance need to be present for a prolonged period to lead to significant increases in body fat. A single high-carb or high-fat meal or day might initially result in a transient positive fat balance and the storage of some dietary fat as body fat, but this will be balanced out throughout the rest of the day or coming days providing there isn't a prolonged excess of total calories.

Are low-fat diets better?

Are low-fat diets better than low carb diets for maintaining a healthy weight and not putting on excess body fat? No, again it is not so straightforward. If we overeat but consumed very little fat and mostly carbs, we might potentially get less body fat than if we ate a greater proportion of dietary fat. However, this is unrealistic as fats are important for other processes and are not just used for energy. We need them to produce hormones, cellular membranes, and for nutrient uptake. Although DNL increases when dietary fat is extremely low it might not necessarily be able to provide all the fat our bodies need. This is especially true in terms of the essential fatty acids that our bodies cannot produce and must be consumed through our diet. A prolonged extremely low-fat diet would lead to an unhealthy physiology and eventually death.

Now some might be asking: what about protein? The short answer is that an excess of total calories from protein will behave in a comparable manner to carbohydrates. Protein oxidation will increase while fat oxidation decreases leading to a positive fat balance and net storage of fat.

What do all successful weight loss diets have in common?

They all create an energy deficit over a prolonged period of time leading to a negative fat balance and a reduction in total body fat. As mentioned earlier, there isn't a single successful way of decreasing caloric intake and different approaches will work for different people. You don't need to be extreme or completely avoid consuming one of the macronutrients. Each macro has a unique effect on the body so altering the ratios will be beneficial for different people.

Other strategies such as increased fat intake or consumption of soluble fiber can help slow digestion and increase satiety, helping people eat less overall. Some people will need a more carbohydrate-rich diet to fuel their workouts while others, especially if they are obese, might benefit initially from consuming less.

There isn't a single way to diet but, evidence-based  dietary recommendations that are healthy and sustainable for the long term and we won't endorse extreme diets of any variety.

Men's Health: A Deeper Look at a Familiar Field

The study of men’s health began as the study of testosterone, erectile dysfunction, and male infertility. Since then, it has rapidly grown and changed. The ability to treat male-specific issues has spurred increased recognition of the study of men’s health, especially since population predictions show that nearly 2 billion men will be over the age of 50 by the year 2020. Furthermore, men’s health issues are not solely the concern of older men: all men can benefit from healthcare.

For one thing, recent research has proven that erectile dysfunction and men’s infertility can be the initial presenting symptoms of common medical conditions like diabetes, hypertension, coronary artery disease, obstructive sleep apnea, renal insufficiency, and even some forms of cancer. One of the primary roles that a men’s health center serves, beyond the treatment of erectile dysfunction and male infertility, is to help with the early identification of these other medical conditions. The paradigm of men’s health should focus on the delivery of comprehensive healthcare.

As part of our recognition for male-directed health, of course, it is important to ensure that we do not take away from women’s healthcare. A look at the numbers, though, shows the obvious importance of men’s healthcare:

  • According to the Massachusetts Male Aging Study, 52% of men have erectile dysfunction. This number rises to above 70% in men over 70 years old.
  • In 2013, the annual sale of testosterone supplements in the U.S. was an estimated $2.4 billion.
  • 233,000 men are annually diagnosed with prostate cancer.
  • In 2011, nearly 2.7 million men in the U.S. had prostate cancer.
  • According to the American Heart Association’s 2013 update, 52% of men 55-64 years old have been diagnosed with hypertension. This number rises to 72% in men over 75 years old. *
  • According to the 2009-2012 National Health and Nutrition Examination Survey, 15.5 million men in the United States have diabetes.

Male-directed care is an exciting field that requires healthcare providers to stay current with rapid changes in technology and research.  It may be most prominent in the context of urology, but the study of men’s health has implications for all areas of medicine.

 

Vitamin B12 deficiency can be sneaky and harmful.

methylcobalamin-vitamin-b12-injection.jpg

What harm can having too little of a vitamin do? Consider this: Over the course of two months, a 62-year-old man developed numbness and a “pins and needles” sensation in his hands, had trouble walking, experienced severe joint pain, began turning yellow, and became progressively short of breath. The cause was lack of vitamin B12 in his bloodstream, according to a case report from Harvard-affiliated Massachusetts General Hospital published in The New England Journal of Medicine. It could have been worse—a severe vitamin B12 deficiency can lead to deep depression, paranoia and delusions, memory loss, incontinence, loss of taste and smell, and more.

What does vitamin B12 do?

The human body needs vitamin B12 to make red blood cells, nerves, DNA, and carry out other functions. The average adult should get 2.4 micrograms a day. Like most vitamins, B12 can’t be made by the body. Instead, it must be gotten from food or supplements.

And therein lies the problem: Some people don’t consume enough vitamin B12 to meet their needs, while others can’t absorb enough, no matter how much they take in. As a result, vitamin B12 deficiency is relatively common, especially among older people. The National Health and Nutrition Examination Survey estimated that 3.2% of adults over age 50 have a seriously low B12 level, and up to 20% may have a borderline deficiency.

Are you at risk?

There are many causes for vitamin B12 deficiency. Surprisingly, two of them are practices often undertaken to improve health: a vegetarian diet and weight-loss surgery.

Plants don’t make vitamin B12. The only foods that deliver it are meat, eggs, poultry, dairy products, and other foods from animals. Strict vegetarians and vegans are at high risk for developing a B12 deficiency if they don’t eat grains that have been fortified with the vitamin or take a vitamin supplement. People who have stomach stapling or other form of weight-loss surgery are also more likely to be low in vitamin B12 because the operation interferes with the body’s ability to extract vitamin B12 from food.

Conditions that interfere with food absorption, such celiac or Crohn’s disease, can cause B12 trouble. So can the use of commonly prescribed heartburn drugs, which reduce acid production in the stomach (acid is needed to absorb vitamin B12). The condition is more likely to occur in older people due to the cutback in stomach acid production that often occurs with aging.

Recognizing a B12 deficiency

Vitamin B12 deficiency can be slow to develop, causing symptoms to appear gradually and intensify over time. It can also come on relatively quickly. Given the array of symptoms it can cause, the condition can be overlooked or confused with something else. Symptoms may include:

  • strange sensations, numbness, or tingling in the hands, legs, or feet
  • difficulty walking (staggering, balance problems)
  • anemia
  • a swollen, inflamed tongue
  • yellowed skin (jaundice)
  • difficulty thinking and reasoning (cognitive difficulties), or memory loss
  • paranoia or hallucinations
  • weakness
  • fatigue

While an experienced physician may be able to detect a vitamin B12 deficiency with a good interview and physical exam, a blood test is needed to confirm the condition.

Early detection and treatment is important. “If left untreated, the deficiency can cause severe neurologic problems and blood diseases,” says Dr. Bruce Bistrian, chief of clinical nutrition at Harvard-affiliated Beth Israel Deaconess Medical Center.

B proactive

It’s a good idea to ask your doctor (or your Blueprint Health nurse) about having your B12 level checked if you:

  • are over 50 years old
  • take a proton-pump inhibitor (such as Nexium or Prevacid) or H2 blocker (such as Pepcid or Zantac)
  • take metformin (a diabetes drug)
  • are a strict vegetarian
  • have had weight-loss surgery or have a condition that interferes with the absorption of food

A serious vitamin B12 deficiency can be corrected two ways: weekly shots of vitamin B12 or daily high-dose B12 pills. A mild B12 deficiency can be corrected with a standard multivitamin.

In many people, a vitamin B12 deficiency can be prevented. If you are a strict vegetarian or vegan, it’s important to eat breads, cereals, or other grains that have been fortified with vitamin B12, or take a daily supplement. A standard multivitamin delivers 6 micrograms, more than enough to cover the average body’s daily need.

If you are over age 50, the Institute of Medicine recommends that you get extra B12 from a supplement, since you may not be able to absorb enough of the vitamin through foods. A standard multivitamin should do the trick.

Not a cure

The Internet is full of articles lauding the use of vitamin B12 to prevent Alzheimer’s disease, heart disease, and other chronic conditions or reverse infertility, fatigue, eczema, and a long list of other health problems. Most are based on poor or faulty evidence.

Take Alzheimier’s disease as an example. “Although there is a relationship between low vitamin B12 levels and cognitive decline, clinical studies—including those involving people with Alzheimer’s disease—have not shown improvement in cognitive function, even doses of the vitamin as high as 1000 micrograms,” says Dr. Bistrian.

For now, it’s best to get enough vitamin B12 to prevent a deficiency, and not look to it as a remedy for what ails you.