FDA Approves Avantame (New Artificial Sweetener)

The FDA approved an intense new artificial sweetener, Advantame. Because of its chemical similarity, Aspartame now has a super sweet cousin. This sweetener, 20,000-37,000 times more sweet than table sugar (sucrose), is found in powder form and dissolves in water. However, it does partially break down when exposed to heat or used in heated drinks, so it may not be that great for cooking.
Similar to Aspartame, one of the breakdown metabolites is phenylalanine, implying that those with sensitivity to phenylalanine or PKU may need to avoid it, however, the amount of phenylalanine produced when ingested was felt to be fairly negligible.
My interest was peaked by the fact that Advantame does not raise blood sugar or insulin levels in the multiple animal and three humans studies reviewed here and here. This implies that it probably won't cause weight gain and the studies in animals actually revealed some negligible weight loss.
The FDA claims this is a very safe artificial sweetener due to it's intense sweetness and requirement for only small quantities to be effective. In fact, Josh Bloom from the American Council on Science and Health was quoted saying that, "About the only way this stuff could harm you is if you were run over by a truck that was delivering it."

From the perspective of weight loss, this may be another sweetener that could be used effectively on a carbohydrate restricted diet. 

How Does Stress Cause Weight Gain?

Had you been under a great deal of stress lately?  Have U. been struggling with her finances?  Job?  Relationships?  School?

Many of my patients working on their weight management have found that there weight increases or plateaus due to stress.  Patient's frequently ask how this occurs.  A simple answer is this: our bodies are designed with a "fight or flight" response.  If you're in the woods and you stumble across a bear, you will immediately experience a rush of adrenaline which includes cortisol, hormone that stimulates increased glycogen in your bloodstream from the liver.  Glycogen is a form of sugar, and the glycogen response raises her insulin level.  The adrenalin and cortisol, among other hormones, are released so that blood can be shunted from your stomach and intestines to your muscles and brain to more effectively enable you to either fight the bear, or run from the bear.

Most of us will never "stumble across a bear," however, your boss may drop an extra pile of work on your desk, you may run short on your finances this month, you may have a serious disagreement with your significant other, or someone may cut you off in traffic causing a near accident.  Any or all of these stimulate the identical "fight or flight" response. Whether the bear or traffic, the same adrenalin and cortisol response occurs.
The elevated cortisol causes a cascade effect raising your insulin levels.  Insulin will remain effectively elevated in the blood stream for 4-12 hours.  Insulin is the primary hormone driving and stimulating weight gain.  If you've had 2 or 3 stressful events throughout the day, and you have not had the opportunity to burn off these stress response hormones, your body will store and/or continue to gain weight throughout the entire day.
How do you prevent this from happening?  A simple 15-20 minute walk is enough to decrease the stress hormone surge that occurs from a "fight or flight" response.  Any regular exercise program will decrease these stress hormones.  Adequate sleep also decreases these hormones.
So, if your job is stressful, incorporating an exercise program as simple as a daily walk for 15-20 minutes will  notably improve your waistline.

Fat Thoughts . . .

As a bariatrician, I think about fat all the time.  I guess you could say I have a lot of "fat thoughts."

I frequently hear patient's tell me, "Dr. Nally, I'm eating RIGHT, but I'm just NOT losing weight!"

If you're not losing weight, your not eating correctly. 99% of your weight loss success is related to your diet. We have been poorly misinformed over last 40 years as to what a "correct" diet contains. We've been told to follow a low fat diet for the last 40-50 years.  However, it is very apparent as patient's follow a low fat diet that only a small percentage of them have success in weight loss, and the majority actually gains more weight and remains significantly hungry.  When you look at the body's physiology, fat restriction only stimulates increased hunger.  The intake of any form of carbohydrate, whether that be simple or complex, stimulates an insulin response.  Based on our genetics, that insulin response can be variable. some of us respond normally and others respond with between 2-10 times the normal insulin surge.  Insulin is actually the hormone that drives weight loss or weight gain.

You and I will not be able to effectively lose weight until we control the response of insulin, and this can only be done through carbohydrate restriction.

Artificial Pancreas . . . on the horizon

Montreal researchers are perfecting a dual hormone insulin pump that controls blood sugar through the release of insulin and glucose based on your blood sugar levels. . . now that's cool . . . and useful! I can't wait to see this in clinical practice . . .

Legend Has It . . . How Diabetes Was Discovered and How That Makes Me Fat

The German physiologist Oskar Minkowki was the first person to identify the role of the pancreas in diabetes.  Legend has it that on a momentous day in 1889 Oscar  noticed that urine collected from his pancreatectomized dogs (dogs that had surgical removal of their pancreas) attracted a very large number of flies.  He is said to have "tasted" the urine and to have been struck by its sweetness.  (Only in 1889 could you get away with tasting dog urine.)  He then made a very astute observation and realized that the pancreas controlled blood sugar concentration and was a key factor in diabetes mellitus.
Thirty years later, Fredrick Banting and Charles Best identified insulin as the key hormone produced by the pancreas controlling the level of blood sugar.  However, what Oscare Minkowski couldn't taste was the very high level of acetone in the urine which is produced by the liver in the conversion of fat to ketone bodies.  Had Oscar lost his sense of taste, instead of noting the sweetness to the urine he might have noted the pungent smell of acetone.  He would have then concluded that the removal of the pancreas causes fatty acid metabolism to go awry.  He then would could have extended his hypothesis and concluded that the preeminent role of insulin was not in the control of blood sugar alone, but in the control of fat metabolism.
We have become fixated upon the function of insulin and its effect upon diabetes, and in doing so, we have neglected the fact that insulin has even greater effect upon the storage and use of fat and protein in the body.
A series of discoveries from the 1920s-1960s let to a revolution in the understanding of the role of insulin in fat metabolism.  At that time, fat was assumed to be relatively inert and carbohydrates were seen at the primary fuel for muscular activity (which is still commonly believed today).  The belief was that fat is used for fuel only after being converted in the liver to suspiciously toxic ketone bodies.  Forty years of research overturned this assumption, however, it had no influence upon mainstream thinking about fat gain and obesity.  In 1973 when all the details of fat metabolism had been worked out, Hilde Bruch, the foremost authority on childhood obesity, stated "it is amazing how little of this increased awareness . . . is reflected in the clinical literature on obesity."
JAMA just released it's compendium on obesity research and the simple science of insulin's effect on fatty acid metabolism is STILL being ignored. Instead, main stream medicine is starting to push patients toward a very expensive and risky gastric bypass surgery. This scares me.
Hippocrates said, "Let food be your medicine and let medicine be your food."  The body responds with hormonal effect to what we feed it and the science explaining this has been ignored. We have been brainwashed with the dogma that the "calorie is king."

Mayor Bloomburg eating donuts
two days after trans fat ban

Based on this we are now legislating food behavior.  New York has now banned trans fats by the New York City Board of Health and has legislated all soda sizes to no larger than 12 oz. We are creating health policy on bad science.  Let's go back and look at the science before we let our legislators start cooking for us, or soon our grocery stores will look like our government run school cafeterias offering school lunches.

Low Carbohydrate Diets Finding Great Success

Spent part of the morning reviewing 20 years of journal articles on the "Science of Dietary Carbohydrates, Glucose and Insulin."  Fascinating reading. It is interesting that prior to the advent of insulin as a treatment for diabetes, the most common treatment from 1915-1920 used by William Osler for diabetes was significant carbohydrate restriction.

In 1999 a study was published in Pediatrics looking at twelve obese teenage boys.  They were randomly fed low glycemic equal calorie meals followed by high glycemic index meals or vise-versa.  The fascinating result was that when fed following a low glycemic meal, the boys at 81% more if the meal was high in glycemic index.  The fascinating factor is that their insulin levels were much higher which would correlate with notable weight gain and cholesterol rise based on other research.
Another study completed in 2005 helps to quash safety concerns about low carbohydrate diets and shows them to be just as effective in weight loss and more effective in lowering triglycerides, raising HDL in patients with type II diabetes then low fat diets.

My patient's in the office have had tremendous success with low carbohydrate dietary changes over the last 12 months. Every patient in my practice following a very low carbohydrate diet has drastically improved their cardiovascular risk, lipid profile, and significantly reduced their weight. In those patient with type II diabetes, they have additionally had significant improvement in their blood sugar control, average blood sugars (HbA1c) and there triglycerides (on of the lipid measures placing these patients at risk for heart disease). This correlates closely with recent studies reflecting similar results in the medical literature.  It is essential, however, to be monitored regularly on these types of diets, as rapid and significant metabolic changes can and do occur. Medications, blood pressure, and blood sugar control need to be closely monitored when following a low carbohydrate diet. Close follow up with your physician is highly recommended.

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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