Is the mainstream starting to turn?

A couple of months ago I posted several times on an Israeli study published in the New England Journal of Medicine (full-text here) showing that low-carb diets brought about more weight loss and better lipid profiles than low-fat diets.   (See the various posts here, here and here)   Based upon how the press reported this study,   I figured that it would drift into the haze of history and never be mentioned again.   After all, this wasn’t a particularly good study – there are many others better done that show an even greater effect.   And they were all forgotten.   None made any impact on the mainstream docs.   Why should this one be different?

Imagine my surprise today when I got my emailed weekly version of Medscape Internal Medicine and found not just a lukewarm recommendation for the low-carb diet, but an enthusiastic one.

Medscape is a subscription service available only to physicians and is as mainstream as it gets. The lead article in this weeks issue is not really an article, but a video lecture.   One Dr. Sandra Fryhofer lectures the mainstream docs subscribing to Medscape on what the above study shows.   She points out the weaknesses of the low-fat diet and is positively enthusiastic about the low-carb diet.   She does issue a disclaimer, i.e., that the study was partially funded by the Atkins Foundation, but that’s about all.

She does get into the energy balance equation and the idea that it’s impossible to lose weight without exercise, but aside from that and he kind of condescending manner, the video is a real endorsement for the low-carb diet.   And – and I still can’t believe this – it’s being beamed out to mainstream physicians everywhere.

Since Medscape is a subscription service (it’s free, but you have to prove you’re a licensed physician to get the service), I figured they wouldn’t look kindly on my posting my username and password on this blog so that readers could see the video for themselves.   But I desperately wanted you all to see it.   So, I worked all afternoon trying to copy the video from the Medscape site and convert it to a form that I could post here.  After about four hours of trolling sites telling me how to do it in language I didn’t understand, I decided to see if I could somehow upload it onto YouTube.   Another zero there.   Finally, I called our youngest kid (he of the roughly sutured head) who is sort of a computer whiz and asked him if he could get ‘er done.   He fiddled with it for a while then put out the call to all his buddies for help.   A few moments ago I got an email from him telling me that his girlfriend found it already up on YouTube.   So, had I looked there first, I might have saved myself a lot of wasted effort.

Take a look and see if you don’t think Dr. Fryhofer is pretty enthusiastic about the low-carb diet.   I still can’t figure why this particular study would have rung her chimes, but I’m glad it did.   You can use this video as part of your armamentarium when you try to persuade your own doc why you want to go on a low-carb diet.

Enjoy.   Maybe the tide is starting to turn.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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48 thoughts on “Is the mainstream starting to turn?

  1. I think it’s because of the fact low carb improved blood lipids.
    It’s known that a lot of people favor low carb diets, the reason drs caution against it is the fear that TEH CHOLESTEROL will kill you. Now that this study has shown low carb is actually the best way to eat for cholesterol, this removes the road block a lot of docs have in recommending it to their patients. The dr narrating was probably one of those.

    I don’t know exactly how med diet beat lc in the arena of sugar control… I think if the lc diet were equal calorie to the med diet, this wouldn’t have occurred.

    LC diets are definitely becoming more mainstream. I don’t think anyone really thinks fat is bad for you anymore, and most people certainly don’t think pasta and bread is health food unless they are major carb junkies trying to justify their habit.

  2. Actually, she seemed much more in favor of the Mediterranean Diet, to me anyway. Doesn’t it seem unlikely that that would be the one resulting in the best glycemic control?

    Believe me, if you’re Dr. Mainsteam Physician and your choices are to let your patient’s blood sugars go crazy or let his/her cholesterol go up, you’ll opt for the former. Most docs (unenlightened slugs that they are) go nuts when their patients’ cholesterol levels rise even a little (if you don’t believe me, read some of the comments throughout this blog), but look rather benignly on an elevated blood sugar. Let your cholesterol go up, and the push is on to get you on statins; let your sugar go up, and you get the brief talk on diet.

  3. Indeed the tide in the diet-wars seems to be turning. I have been thinking about this quite recently – the low fat army think that the war is over and that victory is theirs – that low-fat diets, rich in complex carbs, are the only healthful diets. By extension, they feel that calorie counting is the only way to lose weight.

    Using this war analogy, the paleo model is viewed almost as a ‘resistance movement’ (and the Atkins is seen as a defeated insurgency). But, as with all resistance movements, those who support the paleo model are driven by a belief and conviction that is unshakeable.

    I say unshakeable becuase we can see the fruits of our labours – abs, lean muscle mass and generally great health. Whilst the low fat calorie counters have to battle us under the duress of yo-yo weight loss, carb crashes and poor body composition. There is no contest!

    I see a lot of evidence on various forums of paleo eaters trying to push the message and it is really inspiring. Here is one such ‘battle’ – which relies heavily on evidence supplied by your good self:

    http://www.ukclimbing.com/forums/t.php?t=321646&v=1#4752462

    The message is spreading. Keep up the good work ‘General Eades’!

    Regards,

    Thanks. I don’t really view it as a war. I view it more as trying to show people the folly of their ways. I always tell them that if they are slim, trim and healthy, then keep on following whatever diet they’re following. If they’re not, however (and most aren’t), then it’s time to think about a change.

  4. This is indeed heartening and thanks for taking the trouble to find a way to get this to us. I guess the next big hurdle would be for recognition of this as a viable lifestyle choice rather than just a transitory, weight-loss solution…..but I guess we should simply be grateful for small steps!

  5. On the subject of the mainstream starting to turn, I was excited to see Pfizer’s announcement that they are going to stop developing new cholesterol drugs.

    Yeah, that kind of took me by surprise, too. I guess they figure there is more money in cancer than in the overcrowded cholesterol-lowering market.

  6. Have you seen Scribner, et al. PMID: 18780772? Very interesting results (at least from the abstract).

    Yes, I saw it. This study came from David Ludwig’s lab. He’s been doing these kinds of studies for years. I’m not sure they’re applicable to humans, however because, as I’ve said before, mice aren’t just furry little people. What applies to them may not apply to us.

  7. As you say, the study had many flaws. I don’t consider 120 grams of carb a very low carb diet. Still, I would be interested in reading the feedback from the physicians.

    MM

    I’ll see if I can get it. When I tried to log on to the physician’s discussion site, I couldn’t get in. Medscape wants me to send a copy of my medical license and a picture ID to them to ensure that I really am a physician. I already had to do that to subscribe to their site in the first place, so I’m kind of torqued that I have to do it again. If I do, I’ll post the physician feedback.

  8. Dr. E, Slightly off topic, but this was posted yesterday on one of the sites that I regularly visit. Now there are people actively trying to get the developed nations to reduce meat consumption to really unhealthy levels! They want to get govt to start rationing meat, poultry and pork. All in the name of global warming…

    See the article here http://tinyurl.com/3vralt

    This is scary! To say the least.

    I particularly liked this line:

    Ms. Garnett, who says “we cannot assume [the consumer] will necessarily make the right choice”, advocates large-scale government intervention to ensure targets are met.

    Ms. Garnett should take the time to read Frederic Bastiat’s The Law. It would do her good. (In fact, everyone should take the time to read that small book.)

    I plan a post on this entire fiasco. Every time I read something like the above, it makes my blood boil.

  9. Thanks for the heads up. Before i read your entire post I decided to watch the video first. I went to the medscape website and registered. They didn’t ask me if I was a medical professional and in fact they had a choice of profession labeled “consumer”. This may be a change in their policy and I imagine that consumers only have access to select content.

    Here’s where i found this video. http://www.medscape.com/viewarticle/578486

    Just thought I’d let you know for future reference

    Thanks for the heads up on this. I went to the consumer site, which is different than the physician’s site. I wish I had known – it would have saved me a ton of time.

  10. Dr Mike, I came across a blog which mentioned the Diogenes Project (http://www.diogenes-eu.org/) – an EU funded project aimed at finding a diet or diet-trend that will help people keep weight off in the long term. Have you heard of it?

    Apparently it was led by Professor Anne Astrup from the University of Copenhagen and the results of the study were to be disclosed at the European Congress of Obesity (ECO) on 14th May 2008.

    Any thoughts?

    Cheers,

    I think it’s Arne Astrup, not Anne Astrup. Dr. Astrup is one of the biggest lipophobes around. If you see a commentary attacking the low-carb diet, odds are it was written by Astrup. He is the George Bray of Europe. He is totally anti-low-carb, so I can’t imagine that his project would give low-carb diets a fair shake.

  11. I have just watched the video and noted that the Mediterranean Diet contained ‘more good fats’?

    Such loaded phrases are incredibly annoying. I can tell you straight off the bat which fats SHE would describe as ‘good’ and which ones she would describe as bad. Her bias merely re-emphasises existing bias and obfuscates support for the Atkins diet (which by implication must contain ‘more bad fats’).

    Jeez….!

    Regards,

    Yes, but even with all the ‘bad fats’ the low-carb diet managed to reduce lipids, which is the be all and the end all for the mainstream.

  12. Thanks for the video Mike. I wonder where this person got the definition of the “Mediterranean” diet. Olive oil is not really the ‘core’ of the Mediterranean Diet. If I remember correctly, you posted on this during your trip to Italy and it turned out that pork fat was more abundant in that kind of food than olive oil.

    Anyway, you may already know this, but there is a website where you can copy/paste any video link from you tube and then it will convert it into an MPEG4 movie, which you can then download into your hard disk, for example, to include the movie itself, not the link, within a PowerPoint presentation. I’ve done it many times for my lectures.

    The website is: http://www.keepvid.com

    Now, PowerPoint may not run MPEG4 movies directly, at least hasn’t done it for me as I can’t run QuickTime movies there. I don’t know if it works with a Mac. I have another program (Pinnacle Studio) that I use for video editing and I’ve used it to convert the files I download using KeepVid into AVI movies that I can easily insert in my PowerPoints. I already downloaded the video you provided for a future lecture!

    Cheers,

    Thanks for the site, Gabe. I can use it in the future for Power Point slides myself. It doesn’t help with this one, though, because I wasn’t trying to download it from YouTube, but from the Medscape site into which it was embedded. The address is as follows:

    rtmp://flash.medscape.com/ondemand/26067/flv/videoblogs/fryhofer/weightloss.flv

    If anyone can tell me how to extract that and convert to a video format for the Mac, I would greatly appreciate it. I’m sure I’ll be able to use the advice in the future when I come across other videos.

  13. Wow, she was rather perky! Still, it’s great to see that study get some more exposure in the medical community.

    BTW, I’ve added you to my blogroll. I’ve been blogging for over six years, but mostly cultural and political commentary. I’ve just started blogging on nutrition and exercise, albeit only on occasion; I’m going to make it a regular feature on Saturdays. My first two posts are here:

    “The New Diet” — on the changes that I’ve made to my diet over the past few months — mostly eliminating all grains, sugars, and modern vegetable fats — with stellar results:

    http://www.dianahsieh.com/blog/2008/09/new-diet.shtml

    “Experiments in Eating” — on the process of finding out what foods work well for one’s body using three personal examples:

    http://www.dianahsieh.com/blog/2008/09/experiments-in-eating.shtml

    Based on the volume of comments on those posts — over 150 so far — my readers do seem interested to hear more. Of course, I’ll be liberally linking to the insanely helpful information here, but please do feel free to chime in if you like. I’ve been reading voraciously, but I’m still very much a novice.

    Thanks for adding me to your blogroll; it puts me in with a pretty illustrious crowd. Enjoyed your blog, too. Especially the political part.

    It’s funny. You have what is basically a political blog, and when you put up a nutrition post, you’re inundated with comments. I have a nutritional blog, and when I venture to put up a political post, the same thing happens to me.

  14. Hi Dr. Mike –

    It’s great to see the endorsement, but I was a bit put off by the video. You were right, her manner is a bit condescending. She sounds like a school teacher talking to a third grade class, not adult physicians. Aside from that, I have to ask, is this how the mainstream cadre of practicing physicians get their information? If so, no wonder I seem to have such trouble finding a doctor willing to work with me, and not against me. I would have hoped that many of the professionals watching that video already knew about the study and didn’t need her synopsis. I would also have hoped that many would already be aware of the other studies that you have pointed out that were better. I guess what I’m saying is I feel a little like Dorothy in the Wizard of Oz, where the curtain is pulled back to reveal that the great Oz is nothing but a guy pulling a few levers.

    OK – I’ve gone on enough. I do want to thank you for posting this. And I’m overdue on thanking you for the information on how to talk with your doctor about the low-carb approach to diet as well. Now, if you could offer some help on finding a doctor like you or MD, that would be fabulous!

    It’s a sad but true fact of life: physicians don’t read the medical literature. Physicians (other than academic physicians) almost never read medical/scientific studies. They don’t like to dig the truth out, they want to have it summarized for them. This summarization is usually done by the drug reps or by textbooks, which are always long out of date.

    This realization was brought home to me a few years back when I was called as an expert witness in a trial (the trial never took place, so I didn’t end up testifying). One of the other experts was a practicing hepatologist (hepatology is the study and treatment of liver diseases) who was to testify that a particular drug did damage the liver. He had no experience with this drug, and was basing his testimony on what he had read in the leading hepatology textbook. Another expert was an academic physician who had about 20 recent papers from the hepatology literature showing that the drug in question in multiple studied did not damage the liver. The hepatologist said: I don’t care how many papers you have, I’m not going to go against what it says in (I can’t remember the name of the Hepatology textbook). Here was a guy with a medical degree, a residency in internal medicine, and a fellowship in hepatology who could neither read nor understand the medical literature. Sadly, he is not alone. I think I can safely estimate that under 1 percent of practicing physicians ever read the New England Journal of Medicine.

  15. Hi Dr Mike

    There is a Dr. Jerry Walton who does a radio show called medical line from Sioux Falls.SD.
    He Said we were wrong about the fat causing the high colestrol it is the carbs.
    So you are making headway.

    I’m glad to hear it.

  16. “…Since Medscape is a subscription service (it’s free, but you have to prove you’re a licensed physician to get the service),”

    It didn’t use to make you prove your credentials. I was briefly a doctor myself, if only to Medscape. It was interesting to see what passes for continuing education for doctors…

    When I originally signed up years ago I had to send them the name of my medical school and my date of graduation along with my state medical license number. I assumed they checked it all out before initiating my subscription. Maybe one could enter anything in these boxes and it worked. I think Medscape has been purchased by WebMD, so maybe they have reduced their entry scrutiny since.

    I do know that when I tried to sign up for the physician’s discussion group yesterday, they wanted me to fax them a copy of an active medical license and a picture ID before allowing me to join.

  17. This got attention because of the principle (attributed to Gene Fine who is an MD) that MDs prefer a large study that isn’t so good to a small study that is. I think this study may not have been reported well in that, first, it treats the “diet” as the independent variable whereas there was great variation in food intake, so they should show results as a function of actual carbohydrate consumed. Also, like traditional studies it reports group statistics rather than showing individual behavior (again, ideally as a function of carbohydrate consumed) so that one can see how many people did really well. What you want to know is what is the potential payoff; nobody loses an average amount of weight.
    RF

    I agree 100 percent. How can I disagree – this man is my biochemistry mentor. Except to say that most MDs prefer no studies – they prefer to be told by someone else what to do. A drug rep, perhaps. I know this is true because I used to be a doctor. I’ve lived among them and studied them. It comes from the intensity of a medical education, during which one must memorize literally thousands of new terms and facts. And the ways these are presented leaves little encouragement for independent thinking.

  18. About two months ago, I finally convinced my 72 year old diabetic mother to try low carb to get her sugar levels down. I bought her Dr. Bernstein’s books for reference. She was close to 300 lbs. and gaining, suffering the highs and lows of trying to balance the wild highs and lows with insulin, and beginning to experience major complications, primarily with infections in her feet, high blood pressure, high cholesterol, etc. Her doctor had given her a statin prescription in February that she didn’t fill (she’d already taken Lipitor, with all of the muscle issues and quit). She was nervous about the low carb, as she had to go in for a checkup. I was pumping her full of info about LDL, HDL, triglyceride levels, and so on, and printed out the short study of the aviator on the low carb plan. Bottom line: she’s lost 18 lbs., her cholesterol is 170 (don’t know the breakdown), and her doctor is thrilled and began a discussion about how many carbs my mother was eating and how much insulin she was taking (since my mother cut it down herself). The doc was obviously not new to the benefits to low carb. Now, I’m relieved that her doctor didn’t go ballistic, but I’m highly annoyed that she’d let my mother go on and on, gaining weight, injecting insulin, all while following the ADA diet and never once mentioned trying low carb. Why the heck not??

    Also, I must take exception to the claim that it’s impossible to lose weight without exercise. I have muscular dystrophy and have lost with 70 lbs. on Protein Power without doing more than my occasional stroll around the house and the grocery store (not to say that exercise isn’t a good thing to do). I’m beginning to do portions of Slow Burn, though, in hopes of staying as strong as I can.

    I don’t know why your mother’s doctor acted as she did. Perhaps she was afraid of presenting the low-carb option at the outset and was simply delighted when your mother came to it with your help. The doc could never get sued for what she did because – as unbelievable as this sounds – it is the standard of care. If, as a physician, you adhere to the standard of care, you can’t be found guilty of malpractice even if the outcome of your treatment is horrible. If, on the other hand, you opt for the low-carb approach and something goes wrong, you could be hung out to dry. Mainstreamers would probably line up to testify against you. A sad state of affairs indeed.

    You are on the money on the exercise issue. There is a new study out that I may post on soon showing that fat people are almost always sedentary, but sedentary people are not always fat. Remember, the calories in/calories out parts of the energy balance equation are not independent variables.

    Just think, you are more enlightened than the doctor in the video. 🙂

  19. “If anyone can tell me how to extract that and convert to a video format for the Mac, I would greatly appreciate it. I’m sure I’ll be able to use the advice in the future when I come across other videos.”

    There are a number of software programs that will easily convert a video or audio file to all of the common formats. The problem with some is that they are far more robust and complex that what is necessary to do a specific task. I am currently using a module based program called AVS4You (www.avs4you.com) that lets you download modules you need for specific tasks as you need them. You subscribe for about $60/year. This gives you access to a broad array of modules. I suggest you check out the modules offered. I find AVS4You dead simple to use with a minimal learning curve.

    Thanks very much. I would have gladly spent the $60 just for the time I spent pulling my hair out yesterday. One question, though. Does it work with a Mac?

  20. Low carb is always linked with weight loss, but i was wondering if you could help me out with weight GAIN? I eat low carb because of the health benefits, and i know the easiest way to gain weight is to eat more carbs. But i’m very underweight and i want to gain about 10 lbs without sacrificing the health benefits of low carb. How can i do this???

    Get plenty of L-leucine and consume a lot of calories. And do resistance training. I have a friend who is underweight (6′ tall and about 125 lbs) who started this regimen, and he has gained 10 lbs over the past two months.

    Good luck.

  21. Sweet!
    You know, it’s not just in Dr. Land that the tide is turning. I’m on the lookout and I get LOTS of magazines. It’s not just in the health magazines that I’ve noticed recently mention something about low carbing here or there in a positive way, there was something in the latest People and some others. They aren’t covering it over with “exercise” anymore, most are telling it like it is b/c seriously, how long can the truth be hidden?
    And even if the key words ” low carb” aren’t in the article, they list the diet or food that are avoided. All the famous awesome bods know what to do. No sugar & no flour = ?? Hint, it’s not Low-Fat or Mediterranean!

    Great. I hope you’re right.

  22. Oh, and BTW, I passed the video on to my “Friends in Low-Carb Places” group on Facebook and to my Weight Loss forum (a group of us who complain when our size 6 or 8 jeans are too tight). Wanted to say I’m happily back in my college jeans thanks to your motivating blog and books. I LOVE WHAT YOU’RE ABOUT! THANKKKKKYOU!!!!!!!

  23. The advice to consume plenty of leucine to gain weight is solid. I have gained alot of lean muscle by consuming a diet rich in L-leucine in combination with the other essential amino acids. In case Kady Willis doesn’t know, foods rich in leucine are essentially low-carb staples like meat, almonds, cashews, eggs, fish, chicken, and liver. As for resistance training, what i’ve found works for me is a bout of short but very intense weight training followed by many days of rest, anywhere from 5 to 21 days of rest. I used to workout far more frequently, but i discovered that it was counterproducitve. Not to mention, i also found sufficient evidence indicating that muscles will not atrophy from long periods of languidity (i added the ‘ity’ to the word languid). Real-life provides support to this data, too. For instance, some of the biggest bodybuilders back in the day, such as Mike Mentzer and Dorian Yates, used to train their body parts very infrequently.

    Agreed on all counts, especially the brief bouts of intensive exercise followed by a long rest period. The intense exercise sets the stage for the real work of muscle building, which is actually done while the body rests. Intense exercise too often never allows the real work to get done. Light exercise never sets the stage.

  24. New short letter in NEJM, Oct 2, 2008.
    The Statins in Preventive Cardiology
    Daniel Steinberg, M.D., Ph.D.

    The discovery of the statins by Akira Endo and colleagues in 1976 opened the door to a new era in preventive cardiology.1 The importance of this discovery was recently underscored by Endo’s receipt of the 2008 Albert Lasker Clinical Medical Research Award. By inhibiting the biosynthesis of endogenous cholesterol, the statin drugs lower elevated blood cholesterol levels much more effectively than any of the dietary or drug regimens that were available before Endo’s discovery. Moreover, they have proved to be remarkably free of serious side effects.

    The hypothesis that elevated blood cholesterol levels represent an important cause of atherosclerosis and . . . [Full Text of this Article]

    Dr. Steinberg is a professor emeritus, Division of Endocrinology and Metabolism, University of California, San Diego, School of Medicine, La Jolla.

    Steinberg is a lipophobe of the deepest dye and probably the foremost promoter of the lipid hypothesis. Take what he says with a large grain of salt.

  25. here’s another doctor commentary on that study:
    http://www.youtube.com/watch?v=nKH0FMyxdX0

    it takes a different tack, talking about drugs to counteract obesity as similar to diuretics and statins for HTN and cholesterol

    This guy is from the George Bray school that says: Obesity is a disease, diseases don’t respond to lifestyle changes, they need to be treated with drugs, therefore, obesity needs to be treated with drugs. A sorry state of affairs in my opinion.

  26. Mike,
    Thanks for bringing these documents to us.

    I am 38, a Type II Diabetic for the past 10 years. I always had my BG highs and lows. In fact in 2005 I was diagnosed as having Fatty liver (NAFLD) and Micro-albuminurea in urine. In spite of all those things, my endo suggested only Metformin 500 and gave the same advice of Low Fat (and High carb diet). In fact I was sent to a nutritional classroom session and there I got the same sermon as well.

    2007 and early 2008 – My BG control got worse and I was struggling to do and this time I was checking with a different endo – he too gave the same sermon of Low Fat and some other medicine instead of Metformin.
    Mar 2008 – I came across your site, Protein Power book, Bernstein’s book and took a shot at Low Carbing on June 2008. When I went for Labs in Aug 08 and subsequent follow-up – the Dr was amazed at the results and told me “You have cured your Diabetes” – then I told that I am Low Carbing – His reaction was “Ah, I know this is not new – it is called as Atkins Diet”. I was about to shout on top of my voice – I do not care whose/what diet it is – why did not you even share with me that there is an option like this? I gave a wry smile and walked out.
    Sorry to say this – the medical (healthcare) establishment is ‘slowly killing’ Diabetics with the medication and nutritional advice.

    Atleast now it is happy that mainstream medical folks are trying to see reason.

    Thanks a ton for getting this to us,

    Venkat

  27. Nice to see the tide turning a bit, but the grain-pushers will never stop. Here’s the latest salvo from Prevention:

    http://health.msn.com/health-topics/heart-and-cardiovascular/articlepage.aspx?cp-documentid=100216586&GT1=31013

    I haven’t eaten cereal in so long, I literally can’t remember my last bowl of the stuff. And yet my lipid profile is outstanding. What’s wrong with this picture?

    God help us all. I can’t remember my last bowl either.

  28. “Thanks very much. I would have gladly spent the $60 just for the time I spent pulling my hair out yesterday. One question, though. Does it work with a Mac?”

    No, sorry about that. I forgot you are on mac. I am on macs too. But I still have a Dell PC running XP Pro.

    I started my computer life on macs back in 1986 and laughed at those who struggled with Windows. But I got involved in a project where everyone was using Windows 95. I switched and have cursed the day I did ever since. Now I have 3 macs. This time I am staying on mac. While low carb diets are amazing, not even a low carb diet can cure the stress of Windows and Vista.

    I’ve got VMfusion on my Mac, which lets me make the Mac into a Windows machine, but it’s still a pain in the rear. And whenever I do toggle over and see the Windows screen, I get hives.

  29. Sir:

    FLV is Flash. Perian and MPEG Streamclip, both free, will convert that sucker to something useful.

    However, it looks like streaming only, so you would have had to have dealt with that issue, and there may not have been anything you could have easily done with that.

    Thanks. But it seems as if there has to be a way to capture streaming video. But maybe not – I certainly couldn’t do it.

  30. Re: the Prevention link touting cereal as ‘healthy’ (Tom Naughton above)– I had to check it out. Yep, as usual, the cereal has to be whole grain, no sugar, no sweetener, high fiber. For “cereal lovers”? Does anyone really want to eat anything with the above description, even with fruit added? I doubt it. I’ve always wondered where one even finds cereal that fits these parameters; certainly not with the major cereal manufacturers. Health-store varieties have cane sugar or something similar in it. But the health claims are what make me crazy: “A new Harvard health study found that those who consumed whole grain cereal seven or more times per week had the lowest incidence of heart failure.” Compared to whom? What else did they eat? How do they know the whole grains are the source of the alleged benefits? This sort of junk is precisely why I finally cancelled my subscription to Prevention. It’s so frustrating to have them ignore all evidence of a heart-healthy low carb program.

  31. Posts like the following make my day:

    “When I went for Labs in Aug 08 and subsequent follow-up – the Dr was amazed at the results and told me “You have cured your Diabetes”” Venkat.

    Good on you Venkat!

    When I was diagnosed with diabetes in 2005 the first thing I did was kick myself in the ass for getting myself into the mess I was in. Then I did the most logical thing I could think of. I reduced all sources of sugar in my diet including starches. I didn’t even know anything about low carb diets at that time. Carb reduction just made sense to me. My 12 hour fasting BG in my initial battery of lab tests was 300. I was getting 2 hour post prandal readings of 500 – too high for accurate glucometer readings. I knew I was in big trouble. And I knew it was my problem and no one else’s.

    Fortunately my MD was a friend of mine. He knew me well enough to get out of my way and let me take responsibility for my condition and my course of treatment. I did my own research. I made a list of the lab tests that I wanted. My MD signed the requisition for me.

    Six months later I had follow up lab tests done. A few days later I called the clinic to see if the results were back. The receptionist told me they were indeed back and they were all normal. She made copies for me. My lab tests have been great ever since.

    Everything in life that we do in life has options. Everything we do involves choices. When we make bad choices, we can recognize and accept this. Or, we can abdicate responsibility and leave it to someone else to treat us when we get sick. But we have an option to play a central role in our treatment.

    “Sorry to say this – the medical (healthcare) establishment is ‘slowly killing’ Diabetics with the medication and nutritional advice.”
    True. But diabetics who go this route are choosing this option whether they are conscious of it or not. They have no one to blame but themselves for the outcome.

  32. Mike wrote:

    “If anyone can tell me how to extract that and convert to a video format for the Mac, I would greatly appreciate it. I’m sure I’ll be able to use the advice in the future when I come across other videos.”

    Mike, the ‘rtpm’ part of the address to the embedded video makes it impossible for KeepVid to download it. I suppose you can only see it but not downloaded. There are freebies outthere that allow video capture just as one can get a snap shot of a screen or part of it. That would be one possibility.

    Anyway, with respect to your question about converting to a video format for the Mac, when downloading videos from YouTube using KeepVid, one has two choices, download the video as flv or as MPEG4. I only download videos as MPEG4 because my flv player only does that and doesn’t convert to other formats. The MPEG4 file, however, can be opened with QuickTime. That should work with your MAC and if I’m not mistaken, you could incorporate them into movies and the like using using things like iMovie.

    I use a third party software (Pinnacle Studio), to edit movies imported from my camera, AVI files or MPEG files that I can then convert into other formats when I need them.

    Hope this helps!

    It does help, Gabe. Thanks a lot for taking the time to write it all out.

    Best–

    Mike

  33. I saw something on BBC that said “doctors weren’t sure about the long term affects of high protein diet” about the worlds fattest man losing half his weight on the Zone diet.. definitely gotta be aware of the long term affects of good health…

  34. In an addendum to my previous post and your response, i would like to make a point about your statement that “Light exercise never sets the stage.” For years, i used to workout with relatively light weights, that is, weights where i reached muscle failure anywhere between 10-15 reps. While the weights were light, i worked out very intensely, sometimes holding the weight in a static position for ten seconds or so before having to allow the weight to slowly descend. This protocol allowed to me gain a decent amount of muscle and strength. However, recently, i have been working out using very heavy weights, that is, weights that allow me to complete only one good rep, followed by a few partials in the top contracted position and a fight against letting the weight descend. These heavy workouts make me feel great, probably because it makes me feel powerful to lift heavy weights, or rather, masculine. Moreover, since commencing heavy, but brief weight training sessions, i’ve noticed that i can drive a golf ball much further and push my brothers around easier that when i lifted lighter weights. Now, I’ve often wondered, does a person who lifts light weights using maximum intensity generate less benefits in terms of muscular and strength accrual than someone who lifts heavy weights using maximum intensity? I’ve come to think that the person who lifts heavier weights achieves better results, because, well, they are lifting heavier weights. In other words, if a person’s muscles can lift, say, 100 pounds, why should that person bother lifting lighter weights for more reps if their aim is strength and muscular accrual? In other, simpler, words, i think that it might be better to increase poundage instead of increasing the number of repetitions.

    It’s a function of taking the muscles to failure, which happens easier with the heavier weights. It’s the failure that sets the stage for more muscle growth during the rest period.

    When I first started Slow Burn, I used what I thought were heavy weights, and I took my muscles to what I thought was failure. Then I did a workout with Fred Hahn and learned what heavy weights and failure really were. When Fred put me on the chest press machine the first time and asked me to press, I thought he was joking around with me because I couldn’t even budge the weights. He told me to keep on pushing, hard. I finally gave it my all and barely got the weights moving. I struggled mightily to press the thing out and slowly let it back, and as I got it back near its starting point, he said, do another rep. There was no way. But I tried, and slowly was able to move the weight. But I reached a point at which no matter how hard I pushed, the weight wouldn’t move. That was failure. I thought I had reached it with the lighter weights I had been using, but I really hadn’t. You’ve got to use the heaviest weight you can move for about one and a half reps before you simply can’t go on. the failure is what tees you up for the muscle building during the long rest period after the workout.

  35. I would agree that in resistance training working fairly heavy is ideal, and skip as much time as possible without losing strength.

    But as I grow older (now 50) I find that although my muscles can still take the heavy bench presses, the joints and connective tissue is starting to complain. I’ve shifted from 4-6 reps to 6-10. Works great and much easier on the joints.

    With regard to working to failure, I find that it is fine for benches, but to do heavy squats to failure on a regular basis would be pretty nasty. They still are effective if you can get “close” to failure without actually reaching it. And MUCH less painful.

    Ultimately, the most important thing in resistance training is simply doing it consistently, remembering rest and diet are as important as the workout. Making your workouts miserable or too frequent will only make it more likely you’ll skip them altogether.

  36. if you eliminate all grains, sugars, starchy foods including starchy veggies, and eat only meat fish,poultry, veggies, eggs, greek yogurt and 1/2 cup berries, or apple a day (to thicken a whey protein shake for brkfast) would your carbs be low enough to be considered following low carb diet? Am trying to see if I can change my lipid profile from small dense-90% + to large fluffy through low carb diet. Must add that i am not a big fan of red meat so poultry, fish predominate with occasional red meat. Also, whole milk not agreeable to digestion(am over 50) so would you suggest Soy with no sugar, or skim milk. Thanks for you input.

    Sounds to me as though your carbs would be low enough. The only problem I have is with the soy milk – I don’t really think soy is something that should be consumed in large amounts on a daily basis. I would find another drink.

  37. Great description of your workout, doctor. It sounds like Fred would make a great training partner. I find that training with heavy weights while using fewer reps causes far less wear and tear on my joints in comparison with using light weights. just out of interest, since i started training heavy with lots of rest, my bench press has gone up from 135 pounds to 200 in a short timespan. I had been stuck on 135 for, well, what felt like 135 years.

  38. Sounds to me as though your carbs would be low enough. The only problem I have is with the soy milk – I don’t really think soy is something that should be consumed in large amounts on a daily basis. I would find another drink.

    Would skim milk be ok to add whey protein powder to instead of soy, or is there to much carbs and sugar in it? Plain water with protein powder not as filling.

    Thanks for the input! Will see if the LDL profile changes to large particles from low carb route!

    In my opinion, skim milk with added whey is better than soy if you can tolerate it. It don’t think it’s any higher in carb than soy milk.

  39. Hi Dr Eades! lets say my goal is to consume around 1800 calories a day for weight loss purposes. Does it make any difference to eat 3 or 8 meals a day keeping that 1800 calories? Sometimes I am not hungry at all and would rather have a piece of something here and there. From a metabolism point of view in your opinion is it better to just eat 3 square meals or eat as many times as I want as long as calories are within range and carb are low?

    Most of the studies I’ve seen indicate that skewing caloric intake toward earlier in the day seems to promote better weight loss. I’m not sure that spreading 1800 kcal between many small meals or three regular ones would make much difference.

  40. Why not 1/4 cup of heavy cream added to those whey protein shakes? Low in carbs and adds some heft and staying power to the shakes.

    I use the whey protein powder, 1/4 cup heavy cream, 1 or 2 egg yolks, and a smidgen of vanilla extract and nutmeg. Tastes just like eggnog.

  41. here’s a video that might be of interest: “Dr. Beatrice Golomb, UCSD Department of Medicine discusses her work with cholesterol drugs effects on other aspects of health and well-being…”

    It’s from around the year 2002, but at roughly minute 10 she talks briefly about carbs being bad, and TG, and LDL particle size. The video is about an hour, and seemingly is one of the efforts that doctors do to get trial volunteers. I wish she had a more recent one out.

    http://www.youtube.com/watch?v=FG-IARKXS4Q&feature=related

    In my opinion, a slight nod to reducing high-glycemic carbs can’t overcome 59 minutes of pro-statin/the lipid hypothesis is right blarney.

  42. Medscape, bless them, will allow you to sign up for their newsletters as a student – and what’s more, as a student in a particular specialty – without any corroborating evidence at all. I get their endocrinology, nursing and med student newsletters. Whilst I have no plans to become any of these things, I’m completely comfortable about admitting to a student’s interest in all of them! Plus, I’ve never had spam as a result of the Medscape account.

  43. This is great news!!! I have just started the paleo diet and it seems to be working really well. I am feel the tides are slowly changing also. Although the mediterranean diet did well too but thats ok because I have lots of olive oil, nuts, fish etc.

  44. “Sounds to me as though your carbs would be low enough.”

    Just a passing comment. Both from my own experience and from, for instance, the Israeli study, it appears that the low-carb approach is a very forgiving diet.

    I myself lost about 35 pounds in a few months earlier this year by just cutting the high-carb ingredients (pasta, rice, etc.) from dinner every day and laying off snacks and sweets. This largely happened during a period when my exercise habits went south (I got started again towards the end of the period).

    As you have also pointed out, the Israeli diet wasn’t terribly strict at all with regards to carbs. And still it works. That’s perhaps the greatest advantage of the low-carb approach: It seems pretty damn robust.

    Also, an aside directed to the commenter above describing the whole low-carb vs. low-calory back and forth as a “war”: That kind of attitude and prestige-laden thinking is what got us in this spot in the first place. Let’s all just try to relax, read the data, and draw appropriate conclusions.

  45. “Get plenty of L-leucine and consume a lot of calories. And do resistance training. I have a friend who is underweight (6′ tall and about 125 lbs) who started this regimen, and he has gained 10 lbs over the past two months.”

    Dr. Mike, please post more about this! Also, what about minimum protein requirements to build muscle? I’m sure it isn’t as high as what bodybuilders typically consume (2 grams of protein per lb of weight).

    I’m glad you pointed out the l-luecine as it is a ketogenic amino, something I learned a lot about when I couldn’t figure out why I wasn’t in ketosis after 5 days. I was taking 2 grams of l-arginine (for NO), 2 grams of l-glutamine (for increased HGH production), and 4 grams of beta-alanine, all glucogenic aminos! I stopped taking these and sure enough, my urine had ketones in it two days later.