I am back form the American Society of Bariatric Physician's Obesty & Associated Disease Symposium. Initially I was unsure what to expect, but thanks to the amazing people I met the past two days, my experience was nothing short of spectacular. Even from the day before I arrived, I felt welcomed, as a member of the registry who has lost over 100 pounds on a low carb diet (story coming soon) sent me an incredibly gracious email assuring me that there are plenty of low carb friendly physicians who echo our beliefs at the Ancestral Weight Loss Registry (AWLR).

Thursday

Thursday evening was the PhotoCalorie poster presentation, where I explained how we are trying to incorporate PhotoCalorie into Dietary Research, and replace the current gold standard of pen and paper. Right now the study subjects have to fill out their 3-day food record on self-selected days and fax or email it to the researchers, at which point the study dietitian, or more likely an unlucky graduate student, gets the opportunity to enter these paper food journals manually into the Nutritional Data System for Research (NDSR), which is an archaic nutrition software program with only 18,000 foods in it. This method is incredibly labor intensive, and only allows for self selected days to be assessed. Of course, the chance that people eat differently on the days they decide to fill out their food records is very high. 

With PhotoCalorie, the study subjects would simply take pictures of their food and enter a description, separating each food by commas and multiplying each item by its respective portion size. This information then queries our nutrition database of 60,000 foods, and returns the nutrition information to the user and the researchers in real-time, totally eliminating the need for data entry all together. This also offers the researchers (or physicians using this in their private practice) a never-before-seen window into the actual eating behaviors of their subjects or patients, allowing them to visually confirm that the subject's description matches the portions depicted in the photo. 

As I mentioned in a previous post, we are currently working with researchers out of Harvard Medical School to incorporate PhotoCalorie into their 5 year clinical trial, which to our knowledge is the first time in the history of dietary research that a photographic food journal is being used in a large study, and we are very excited about it!!


Friday

Friday was a full day of meeting doctors from around the world and learning about their new research. There are too many interesting people to name, but here are a few:

Dr. Jeffry Gerber, one of the experts on AWLR and a family doc in Denver who treats all his patients with low carbohydrate and paleo nutrition. He presented about food politics, the history of nutrition and agriculture, as well as the amazing success he has seen in his patients using low carb. 

Dr. Keith Runyan, also an expert on the registry, and a nephrologist who uses low carbohydrate diets to treat his patients, as well as himself. He has an amazing story, being diagnosed with Type 1 Diabetes in adulthood. Here is how he described his nutritional evolution towards paleo from his website:

"Ever since I was diagnosed with type 1 diabetes mellitus in 1998, the ADA has recommended a low fat diet in line with the dietary fat-heart disease hypothesis since heart and vascular disease is the most common cause of death of the diabetic patient.  Specifically, a dietary intake of 50 - 60% of calories from carbohydrates (carbs) has been recommended, some of which may be simple sugars.  In theory, I thought this seemed plausible, since the ADA recommended counting carbohydrate grams in the diet to be balanced with insulin, in my case, or other diabetes medications (for those with type 2 diabetes).  However, after 2 years of weighing my food or otherwise calculating the grams of carbohydrates eaten with each meal, there was no significant improvement in blood sugar control and no improvement in the number or severity of hypoglycemic episodes (low blood sugars)...

I transitioned to this low carbohydrate ketogenic diet to address both of my issues, namely diabetes control and fueling endurance exercise with excellent results.  My blood sugars are better controlled and hypoglycemia is quite unusual.  I have had several blood sugar readings in the range of 46 to 60 mg/dl without any symptoms of hypoglycemia.  Readings this low prior to the ketogenic diet would have caused symptoms of hypoglycemia.  On the ketogenic diet, however, these symptoms are absent presumably due to the use of ketones by the body and brain.  I am able to exercise with no apparent loss of energy or power while consuming relatively little sugar during exercise to prevent hypoglycemia.  I measure my blood sugar while exercising usually every 60 - 90 mins or if I feel my blood sugar might be low.  My blood tests have improved in the typical pattern seen on a ketogenic diet.  Triglycerides decreased from an average of 76 to 65 mg/dL, HDL cholesterol increased from an average of 61 to 90 mg/dL, the triglyceride/HDL ratio decreased from 1.31 to 0.72, the calculated LDL cholesterol increased from an average of 103 to 162 mg/dL."

Dr. Eric Westman - The president elect of the ASBP, and the co-author of The New Atkins For a New You, was incredibly nice, invited me to dinner, and introduced me to tons of people.

Dr. Warren Willey - Bodybuilder turned osteopathic doctor, with a non-traditional skills and unmatched knowledge of how the foods you eat change your serum, urine, and saliva levels of hormones, metabolites and proteins. 

Dr. George Bray - One of the biggest names in Obesity research in the world.

Ancestral Weight Loss Registry Talk

At 4:30, I spoke about AWLR and small portion of the data collected from the first 3,000 people who have registered from all 50. U.S. States and over 52 countries around the world.

There were hundreds and hundreds of amazing stories submitted, the majority of which followed a similar theme: What it was like eating a low fat, high carb diet, and how their lives changed once they switched over to a high fat, high protein, calorie unlimited diet. 

• 87% reported "rarely" or "never" feeling hungry between meals, while 0.8% said they "always" felt hungry.
  
  
• 70% of people eating paleo/low carb did not count their calories at all. They simply listen to their bodies internal regulation mechanisms, eating when they are hungry and stopping when they are full. The only difference is that they don't eat grain, wheat, or sugar.

In these thousands of stories, as soon as they switch over to a paleo diet, it's as if a hunger switch turns off in their brain. As one registry member describes it, "I tried it and the first day I walked around in a daze because I wasn't hungry or thinking about food."

This is likely a major contributor to why these people are losing such massive amounts of weight. They feel satisfied, happy, healthy, and as soon as they are hungry, they eat. Simple as that. It also likely explains why when people in clinical trials are told to eat a high fat high protein, calorie unlimited diet, they usually lose more weight. 

The talk was recorded, and will be posted as soon as I receive it. 

On Thursday morning, I am flying to Orlando, Florida to present PhotoCalorie and data from the registry to a big group of bariatric physicians at the American Society of Bariatric Physician's 62nd Obesity & Associated Conditions Symposium (PDF). I will be giving a poster presentation on Thursday evening on ways PhotoCalorie can be incorporated into dietary research, and a 15 minute talk on Friday about the Ancestral Weight Loss Registry.

From the looks of the final program, it seems like there will only be two presentations related to low carbohydrate diets: This one, and Dr. Jeffrey Gerber's talk. It will be interesting to see the responses I get as a medical student, especially from the doctors that have been treating their patients with low calorie diets for decades. Whether they applaud or throw tomatoes at me, it will be a memorable experience I'm sure. 

The crowd-sourced research model that is the basis for this registry will surely be a change from the conventional, high cost, low efficiency studies that will be presented. While much of what I say will likely be controversial, I am just reporting what gets reported to me, in aggregated form. The sample size is approaching 3,000 people, representing all 50 U.S. states and over 52 countries around the world. 

The talks will be recorded, and will be posted as soon as possible. In the mean time, you can follow the experience from our point of view on twitter: @AncestralWLR.

I started a carb-restricted diet after a good friend of mine told me that she was having some success with weight loss on Atkins and sent me an Atkins book. I read it from the beginning, and was so enthused that when I got up to the list of what I could and couldn't eat, I got up, cleared out my cupboard and threw away all the crap, and then went shopping. 

I started eating low-carb from that day onwards and didn't look back. I suffered no "Atkins flu", I just started feeling better and better with each passing day. I started noticing weight loss very quickly, but it was more than just that... I started noticing health improvements right away, in ways I'd never expected. 

A week after I started, the chronic pulsatile tinnitus that had been plaguing me 24/7 for the last 6 years suddenly went quiet one evening. I was so shocked I just sat there, blissfully enjoying absolute silence, something I'd not heard for longer than I could remember. That first time, it only went quiet for 5 minutes, but it continued to go quiet and over the next week, became less and less until it was gone entirely. And that wasn't all. The eczema on my face that had embarrassed and made me miserable most of my adult life started clearing up, more quickly and startlingly than I'd ever expected. The gastro issues I'd suffered with most of my life and just assumed were "normal" for me cleared up and I stopped feeling sickly after most meals, stopped having dreadful troubles on the toilet or constant flatulence.

I also noticed that I stopped getting the "sleepies" after every meal, and then I stopped also getting hot flushes that used to come regularly a few times a week for no apparent reason. Even the spider veins on my legs started to clear up and fade away! I had more energy and I finally felt motivated to go walking, and to try exercising regularly, something I'd never had the energy to do before.

Unfortunately a couple of months into my low-carb excitement I developed a chronic illness, which had all the appearance of Chronic Fatigue Syndrome, and it really derailed me. I spent about six months basically in bed and exhausted, unable to do much of anything. I kept to my low-carb diet as best I could during this time, and I maintained my initial weight loss for the first couple of months, but bad things crept into my diet due to be too tired to think about it properly, and I was more sedentary than anyone has any right to be, and the weight started to creep back on.

The illness has now been resolved -- it turned out that all my symptoms were in fact side effects on an anti-depressant medication I was taking, and when I stopped taking it, I got better. I've lost a lot of trust in doctors as a result, since for all the complicated tests and things they did to try and help me, nobody figured out it was the medication until I checked the US side effects list for my meds (hich differ from the local side effects list, go figure) and decided to stop taking them myself.

But I'm now feeling "normal" again, so I'm in the process of cleaning up my diet and putting into practice the things I learnt in the beginning, as well as all the things I've read since then. I'm working more with the Primal Blueprint these days, as it makes the most basic sense to me. And I'm currently doing the Whole 30 and loving it.

What was the biggest challenge to adopting a carbohydrate-restricted or paleo diet?
The amount of crap (sugar! wheat! additives! veggie oils!) that is in processed foods, and how hard it can be sometimes to buy fresh foods easily. If you walk into a convenience store, chances are the only thing you'd actually be able to buy is bottled water. 
That, and the way that people can't believe you'd give up bread, pasta, or rice (I lived in Japan when I started low-carbing, and rice is so damn ubiquitous), and particularly why you'd voluntarily give up sugar, and keep trying to push you to eat carbs again, as if they are doing you a favour. Working every day with people who refuse to get it, even when you're always smiling and polite about it, can be frustrating at times.

What advice (if any) would you give to someone interested in trying a carbohydrate-restricted or paleo diet? Were there any obstacles that you overcame that could help future dieters?
Go for whole foods as much as possible, and find recipes to make them interesting. There are tons of fantastic recipes available online for free, and there is so much that you can do with fresh meat, fresh vegetables, and some herbs and spices. When you're eating fresh, wholesome food that's not just filling but also really delicious, it's so much easier to appreciate how well this way of eating works. Also, load up on fat and don't be afraid of it! And finally, read lots of literature and learn from it, but listen to your body and figure out what works for you. We're all different.

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For those reading this in their e-mail, here is the video link.

The new school lunch regulations, which first lady Michelle Obama championed and a Democrat-led Congress passed in 2010, set a maximum calorie limit for high school lunches at between 750 and 850 calories. Under the old rules, cafeterias served a minimum of 825 calories per lunch. 

While well intentioned, the food is unfortunately the same low fat, high carbohydrate cuisine that simply isn't filling enough. Anyone who has joined the registry and contributed to the hunger testimonials will assuredly attest to this. The video is a parody of ‘We Are Young’ by the band Fun.