How much fat to eat to absorb vitamin D and how many total calories per day to lose weight. (To Anonymous)

In reply to your lovely questions I think it necessary to understand the premise of calorie (calorie=Kilocalorie) content of food: food calorie content is usually assessed by totaling the calories of the individual nutrients of a given food. For example the calorie production of protein is assessed to be 4 calories per gram, and that of fat as 9 calories per gram, and carbohydrates 4 calories per gram.[Food Energy [1]] These estimates for the individual food nutrients are done by direct calorimetry as follows: 

Merck Manual - Home Edition [2]

This to me this is a very imprecise, unscientific way of estimating calorie content in food as it translates into energy or fat storage for the human body. The body is not a bomb calorimeter and as such translating or equating 1 gram of fat to 9 Calories of energy that will be stored as fat is pretty naive (on the part of the authorities, scientific or governmental). The support for my statement above is evidenced by more than one study, but my favorite is in a study published in the Annals of Internal Medicine in 2010 where it was clearly seen that successful weight loss can be achieved with either a low-fat low-calorie or low-carbohydrate unlimited calorie diet when coupled with behavioral treatment.[3] Focus here on unlimited calorie intake of fat and protein. Another study in support of my statement included the Atkins diet where it was seen: women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets.[4] Therefore a low-carbohydrate, high-protein, high-fat diet, with good amounts of vegetables and fruit is in my opinion the best recommendation for weight loss. That being said the fats must be hormone free (rBST), and non synthetic. (I am not a full supporter of the Atkins diet because of its exclusion in certain phases of all forms of carbohydrate including vegetables and fruit, and the other part is not addressing the kind of fats allowed that may or may not include synthetic fats and fats coming from animals treated with rBST. To be fair though the latter happened more than 2 decades after his initial publication of the Atkins Diet Revolution. I admire the gentleman immensely for breaking the ‘Fat Barrier’.)
My direct message to Anonymous: Do not count calories to lose weight but AVOID refined carbohydrates (refined sugars, flour, rice, potatoes, etc.). Feel free to have unlimited amounts of healthy oils and a minimum amount of protein (hormone free) of 80 grams per day. This can translate into eating 1-2 pieces of fried chicken daily or equivalent (as long as there are no mashed potatoes, breads, pasta, lasagna, etc.) and this should be amply sufficient for absorption of your vitamin D supplement. Additionally you may have unlimited amounts of vegetables and use fruit as your dessert. Please continue the exercise and target sleeping 7.5 to 8.5 hours per 24 hour cycle.
I do realize that the calorie count concept will be hard to get rid of but the science just isn’t in favor of limiting fats and protein. 
 Also an opinion of mine not yet proven: I fear low fat is more in favor of cancer evolution than not, unless the fat intake has come from animals treated with rBST. I fear the last will contain said hormone (in meats) or higher levels of insulin growth factors (in milk and its products) both which will encourage increase in cell size and number artificially. This seems to me to be dangerous ground to tread.
I hope this answers your questions. Stay the course of health, it is very very worth it.

---

References:
[1] http://en.wikipedia.org/wiki/Food_energy
[2] http://www.merckmanuals.com/home/disorders_of_nutrition/overview_of_nutrition/calories.html
[3] GD Foster, HR Wyatt, JO Hill, AP Makris, DL Rosenbaum, C Brill et al (2010) Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet. Annals of Internal Medicine 153: 147-157. Doi:10.1059/0003-4819-153-3-201008030-00005.
[4] CD Gardner, A Kiazand, S Alhassan, S Kim, RS Stafford, RR Balise et al (2007) Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women: The A TO Z Weight Loss Study: A Randomized Trial. JAMA 297: 969-977. Doi:10.1001/jama.297.9.969.

The Pillars of Health:The Prelude: Preview "Fat Intake and Weight Gain"

The Pillars of Health:The Prelude: Preview "Fat Intake and Weight Gain"

Magnesium Low

Answering Nazek:
Disorders of Magnesium Balance (1)
Introduction Magnesium is the most abundant intracellular divalent cation and, after calcium, the most common divalent cation in the body. The majority (99%) of magnesium residing inside cells. Consequently, plasma magnesium concentration does not reflect total body magnesium. Magnesium plays an important role in neuromuscular coupling, largely through its interaction with calcium. Disorders of magnesium primarily reflect hypomagnesemia, with cardiac arrhythmias and other features similar to those of low calcium. Among the causes of hypomagnesemia are malnutrition, chronic alcoholism, kidney abnormalities and malabsorption. [Is she taking any laxatives?]
Magnesium Intake and Distribution Magnesium is found in many foods, including green vegetables and meat products, and the normal diet is usually more than ample. Approximately 5 mg/kg per day of magnesium is required for normal magnesium balance. Factors that control gastrointestinal magnesium absorption are unclear, but about one-third of ingested magnesium is absorbed.
Magnesium Excretion The distal nephron (part of the kidney), however, is the major site of fine regulation of magnesium excretion. Loop-acting diuretics predictably have a potent magnesium-wasting effect. [Is she taking any ‘Water Pills?], [One-Alpha should only be given to patients suffering from kidney disease. Is that the case here?]
Role of Magnesium The major role of magnesium is as a cofactor for hundreds of identified enzymes that produce or require ATP, such as kinases, ATPase, and adenylyl cyclase. Disorders of magnesium may lead to impaired energy production, substrate utilization, and synthetic processes.
Hypomagnesemia (Low magnesium) ESSENTIALS OF DIAGNOSIS
• Plasma [Mg2+] <1.7 style="color: rgb(255, 102, 102);">The numbers given satisfy this criterion.] • Cardiac arrhythmias, refractory potassium deficiency. [What was her potassium level?] • Features suggestive of hypocalcemia: tetany, weakness, increased deep tendon reflexes, altered mental status, and seizures. [Are there any symptoms like these?]
[Please provide also the laboratory reference levels for any result mentioned as this varies between laboratories.]
References
1. Bongard FS, STAT!Ref, Teton Data Systems. Current critical care diagnosis & treatment. 3rd ed. New York ;London: McGraw-Hill; 2008.

[Above doesn’t replace the input of a medical professional who interviews the patient and carries out a physical examination followed by a discussion of care – that is the premier method of obtaining medical advice at this time of medical science development].

Sleep Deprivation

My son’s friend expressed some medical concerns about sleep as follows:

"After a grueling term in school, entailing 14 weeks of little to no sleep, she slept around 15 hours a night for 3 days. She was fine until the 3rd day as she was hit with major dizziness. She thought it might've been low blood pressure so she started downing candy and sweets but that didn't help. After 2 or so weeks of trying different sleep patterns: forcing herself to sleep 5 hrs a night, or 8 hrs, or 10... It got better but it's still lingering."

Dear young lady,

Those 14 weeks of sleep deprivation are very detrimental to your health for the following reasons:

· You disorganized your natural sleeping rhythm which is regulated around the light and dark cycle of the day.[1]

· You decreased the opportunity for your body to produce many necessary hormones efficiently which are required for your well-being. Specifically growth hormone, thyroxin and increased other hormones such as cortisol putting your body in a ‘hyper-alert mode’ which is unsustainable long term.

· You increased your risk of hypertension[2-4], diabetes[5], depression[6], cancer[7], coronary artery disease[8-10], obesity[11], and increased risk of death[12].

· You decreased your ability to retain knowledge[13].

· And so on.

I believe you are getting the point I am trying to make. Sleep is too important to ignore. Please see the chapter on sleep for more information.

The dizziness happened because your brain chemicals, brain hormones, neurotransmitters and body hormones were in disarray so you had a lot of melatonin lingering around trying to get you to sleep and all the other systems were off whereby your serotonin was on the low side and trying to catch up and get back into a synchronized organized balance. (This paragraph is an assumptive description as to date we can't say definitively how exactly all these phenomena transpire).

The return to a good balance is by maintaining a lifelong 8 – 9 hours of sleep regularly every night and that is better if implemented at the same time every night.

The lingering of the dizziness for you should not last too much longer because I am under the assumption you are close in age to my son and in basically good health. Caution: if you continue doing the “sleep deprivation thing” you will exhaust your reserves and possibly end up with depression or fibromyalgia.

Oh, and by the way, the candy or sweets will just perpetuate the whole condition and increase the possibility of some of the risks I described above.

I am surprised you didn’t also have a headache during your recuperation.

I hope you get better soon. [Above doesn’t replace the input of a medical professional who interviews the patient and carries out a physical examination followed by a discussion of care – that is the premier method of obtaining medical advice at this time of medical science development].

DA Jan. 10, 2010

References

1. Wyatt JK, Cecco AR-D, Czeisler CA, Dijk D-J. Circadian temperature and melatonin rhythms, sleep, and neurobehavioral function in humans living on a 20-h day. Am J Physiol Regul Integr Comp Physiol. 1999 October 1, 1999;277(4):R1152-63.

2. Gangwisch JE, Heymsfield SB, Boden-Albala B, et al. Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey. Hypertension. 2006 May 1, 2006;47(5):833-9.

3. Goncharuk VD, Heerikhuize JV, Dai J-P, Swaab DF, Buijs RM. Neuropeptide changes in the suprachiasmatic nucleus in primary hypertension indicate functional impairment of the biological clock. The Journal of Comparative Neurology. 2001;431(3):320-30.

4. Cappuccio FP, S. Stranges, et al. Gender-Specific Associations of Short Sleep Duration With Prevalent and Incident Hypertension: The Whitehall II Study. Hypertension. October 2007;50(4):693-700.

5. van Cauter E, U. Holmbäck, et al. Impact of Sleep and Sleep Loss on Neuroendocrine and Metabolic Function. Hormone Research. 2007;67(Suppl. 1):2-9.

6. Vgontzas AN, Bixler EO, Lin H-M, et al. Chronic Insomnia Is Associated with Nyctohemeral Activation of the Hypothalamic-Pituitary-Adrenal Axis: Clinical Implications. J Clin Endocrinol Metab. 2001 August 1, 2001;86(8):3787-94.

7. McClain J. Association between physical activity, sleep duration, and cancer risk among women in Washington County, MD: A prospective cohort study., 2008.

8. Liu Y, Tanaka H. Overtime work, insufficient sleep, and risk of non-fatal acute myocardial infarction in Japanese men. Occup Environ Med. 2002 July 1, 2002;59(7):447-51.

9. Schwartz S, W. M. Anderson, et al. Insomnia and heart disease: a review of epidemiologic studies. Journal of Psychosomatic Research. 01-OCT-1999;47(4):313-33.

10. Shankar A, W.-P. Koh, et al. Sleep Duration and Coronary Heart Disease Mortality Among Chinese Adults in Singapore: A Population-based Cohort Study. Am J Epidemiol. 2008;168(12):1367-73.

11. Spiegel K, Tasali E, Penev P, Cauter EV. Brief Communication: Sleep Curtailment in Healthy Young Men Is Associated with Decreased Leptin Levels, Elevated Ghrelin Levels, and Increased Hunger and Appetite. Ann Intern Med. 2004 December 7, 2004;141(11):846-50.

12. PATEL SR, N. T. AYAS, et al. A Prospective Study of sleep duration and mortality risk in women. Sleep. 2004;27(3):440-4.

13. Grunstein R. Insomnia. Diagnosis and management. Aust Fam Physician. 2002;31:1-6.

My Brutal Stance on Sugar

Please note that “sugar” in this context is concerning the processed forms of sucrose (table or cooking sugar) in addition to high fructose corn syrup. The former comes mainly from cane, beets or dates. The latter comes from corn.

Sucrose is a disaccharide (a double molecule made up of glucose and fructose)^[*11], and high fructose corn syrup is composed of 50 percent fructose and 50 percent glucose in similar percentages to sucrose^[*12].

Both of said products enter the body and from the intestine will be absorbed as glucose molecules, and fructose molecules. Glucose will actually be in the blood stream from mouth to blood within 12 minutes on an empty stomach^[*13]. Fructose will have to take a longer pathway and be transformed into glucose first. This latter process from mouth to blood stream is about 45 minutes on an empty stomach. Their ultimate fate is stimulation of insulin secretion, cell entry and storage as glycogen (animal starch) to a limited degree but mostly as triglycerides (fat). The only portion of glucose from above intake process which doesn’t get stored would be the molecules that get burned off directly in muscle and brain which don’t require insulin to enter the cells. Always remember: insulin is a storage hormone and doesn’t play much of a role in energy production, if any at all. The net effect of this hormone is storage of carbohydrate, protein (from other protein sources which are absorbed as amino acids), and fat^[*14].

Therefore from above take the message: if you don’t burn off the sugar quickly then it will be stored, mostly as fat. So unless you are underweight then that isn't desirable.

Also from above you may deduce that if you are able to control your refined sugar intake and burn it off expediently then there is less danger from its intake. This is true, but there is another aspect here which I would like to explain which makes the principle of intake control much more complicated.

The aspect I am alluding to is the addictive properties of refined sugar. Addiction, is defined as the repeated compulsive use of a substance despite negative health consequences, and can be produced by a variety of different drugs^[*15].

The phenomenon of addiction is associated with the reward system in the brain, and particularly within an area in the brain designated the nucleus accumbens. The best studied addictive drugs are opiates (such as morphine and heroin), cocaine, amphetamine, ethyl alcohol, cannabinoids from marijuana, and nicotine. I firmly believe, with very little doubt, that refined sugars should be added to these substances.

All of them (the substances in the previous paragraph) affect the brain in different pathways, but all have in common the fact that they increase the amount of dopamine (a chemical in the brain which functions as a signaling messenger) available to act on receptors in the nucleus accumbens, which will translate into the feelings of joy, comfort, calm, and other “feel good” sensations. In a nutshell, they rapidly stimulate the reward system of the brain.

This rapidly rewarded activity (refined sugar intake) will also establish another phenomenon whereby there is an immediate reward (feel good sensation) in the brain as soon as the sugary food is in the mouth. This is accomplished by what is called a conditioned reflex. (A conditioned reflex is a reflex response to a stimulus that previously elicited little or no response, acquired by repeatedly pairing the stimulus with another stimulus that normally does produce the response. In Pavlov's classic experiments, the salivation normally induced by placing meat in the mouth of a dog was studied. A bell was rung just before the meat was placed in the dog's mouth, and this was repeated a number of times until the animal would salivate when the bell was rung even though no meat was placed in its mouth. In this experiment, the meat placed in the mouth was the unconditioned stimulus (US), the stimulus that normally produces a particular innate response. The conditioned stimulus (CS) was the bell-ringing. After the CS and US had been paired a sufficient number of times, the CS produced the response originally evoked only by the US. The CS had to precede the US. This is so-called classic conditioning^[*16].)

Therefore from the preceding take the message: if you eat refined sugars regularly then you (most people) will become addicted to it even to the degree it elicits “a reward in the brain” as soon as it enters the mouth (possibly even before that). Hence you will enter into “the repeated compulsive use of a substance despite negative health consequences”^[*15].

Another aspect to fear with long-term addiction would be the development of tolerance, i.e., the need for increasing amounts of a drug (refined sugar) to produce a “high”. So you may end up eating larger and larger quantities of refined sugars over time.

Also don’t ignore the fact that withdrawal from substances a person is addicted to produces psychological and physical symptoms^[*16]. An easy test to see if you are addicted to refined sugar is to stop eating all products containing it for a minimum of 7 (seven) days, and observe your uncomfortable feelings, sensations, craving, restlessness, lack of concentration, anxiety, and others if you are addicted. The addicted person will have varying degrees, different combinations, and/or other symptoms of withdrawal, as the previous sentence was a non-exclusive, non-encompassing statement.

The direct dangers of refined sugars are:

• Inhibition of release of adrenaline^[*17] by the impact of rapid release of insulin, which is an element, I believe in the development of atherosclerosis^[*18] (artery clogging).
• With regularity of carbohydrate (refined sugars are refined carbohydrates) intake (which is not burned off) the overall (absolute magnitude) output of insulin increases until the pancreas gets overwhelmed and exhausted^{[*19, 20]} and diabetes mellitus type 2 will probably ensue (this is an elemental part of the development of this disease).
• Unless burned off rapidly then storage of the substance will be in the form of fat. Obesity will result.
• Becoming addicted to refined sugars (which doesn’t appear to occur with sugars present in fresh fruit).

The Corn Refiners Association in the United States claims: “No single food or ingredient is the sole cause of obesity. Rather, too many calories and too little exercise is a primary cause^[*21].” From above you may see this is not the whole story as relates to the role of sugar in obesity or the dangers of sugar.

In summary: if you are disciplined enough to keep your intake of refined sugars to a minimum and burn off physically what you take in, then go for it. If you are not, like most of the human race, then my recommendation is drop it from your diet.