An un-solvable medical disease?

You know what befuddles me?

Clinical nutrition confuses the heck out of me. The adjective ‘clinical’ implies that I’m talking about the medical aspects, the science of nutrition, not the basics.

Of course, you know what constitutes basic nutrition. Everyone does. The simple rules seem well…so simple. (With JMM-to-patient commentary in italics.)

• Consume fewer calories. It’s amazing how little food our bodies need.
• Drink fewer calories. Nothing helps create a negative calorie balance like limiting liquid calories–beer, wine, spirits, soda and sweetened sports drinks. My rule on drinking Coca-Cola: one can is allowed after a bike race or 60 mile-training ride. My rule on beer and wine: I don’t have one. Use an obvious meter here.
• Eat less stuff that comes in packages or from the middle aisles of the grocery. Potato chips, Fritos, cookies, Pop-Tarts. Well, you get the picture. Need a rule: If a caveman ate it, then it’s probably good for you. Caveman didn’t order up PapaJohns or stop in for donuts or snack on Doritos. (Plus, they chased down (or gathered) their food. But that’s another post.)
  
• Eat no trans-fat. These man-made conveniences are worthless and inflammatory. They seem silly to put in the body.
• When eating, try to eat more plants, nuts, and fish. Not only do these foods provide valuable nutrients but they are also filling, slowly digested and associated with less insulin release. (Insulin is a hormone released to metabolize calories. Excess insulin creates trouble because it fosters fat storage and enhances atherosclerosis.)
• Eat slow and enjoy the food. I just made that one up because it makes sense.

So what’s so confusing about clinical nutrition? What’s my problem?

Why do clinical people make the root cause of obesity so complex?

PEB = positive energy balance. Or, consuming more calories than burned seems the simple issue with obesity. Eat more than the body needs and the excess gets stored as fat. Even the prestigious medical journal, JAMA says so. Researchers from LSU overfed 25 volunteers and guess what happened: the overfed study subjects gained weight. The first sentence of their commentary says it all:

The key finding of [our] study is that calories are more important than protein while consuming excess amounts of energy with respect to increases in body fat.

Maybe it’s hopeless for me? I do not see McDonalds as a problem. I like McDonalds, that is, once in a while and without the biggie fries and coke. Did you know McDs has a grilled chicken sandwich? Did you know a hamburger without cheese and special sauce isn’t that high in calories? Likewise, a slice of pizza isn’t problematic; eating the whole pizza is. Same with cookies, and pie, and beer, and wine, and yes…even exercise can cause problems when consumed in excess.

I’m so dumb; I don’t even see the evil in having junk food in the hospital. One time, long ago, I wrote about the nutritionist who showed that he could lose weight, lower body fat and improve his cholesterol numbers by eating only junk food. He simply restricted calorie intake. (No, I am not advocating the Twinkie diet.)

Dumb. Un-nuanced. Uninformed. Crass.

These describers are often invoked when someone attempts to simplify obesity.

I know obesity is a struggle. It’s hard to eat well. Our societal success has created a near constant buffet. The US is not Europe, where stores close after dinner and quickie marts don’t exist on every corner.

I can’t offer my over-eating patients easy solutions. There are none. I over-eat too. Perhaps we medical people could offer a clearer explanation of the root cause.

The (positive energy balance) problem is dire; wasting energy on futile strategies, like banning junk food, and recommending complete abstinence from tasty treats seems nonsensical.

Successful people, particularly doctors, all have one trait in common: their ability to identify the problem.

Let’s start with simplifying the problem. It’s about PEB. Right?

JMM

Full disclosure: My family enjoys riding on a bike team sponsored by a pizza company. As a cardiologist, I don’t feel conflicted.

Penance: The other night I ordered (online) a PapaJohns pizza–did you know you can specify less cheese and extra green veggies? (Wait, now I am sounding conflicted.)