Every year, the American Society of Bariatric Physicians puts on a conference, and as part of that conference there’s a one day intensive sponsored by the Nutrition and Metabolism Society.

The Nutrition and Metabolism Society exists to help fight information about the effectiveness of carbohydrate restriction on fighting diabetes and obesity. According to their website, they believe that the therapeutic potential of low carb diets for the treatment of diabetes and obesity is “under-investigated and under-utilized”. People who present at the Society’s annual meetings tend to be top-level researchers who are sympathetic to the low-carb approach.

I attend the society’s annual meeting as often as possible, and recently attended their meeting in San Diego, where I learned a number of interesting things from the sterling list of presenters which included such superstars as…

• Gary Taubes, author of Why We Get Fat.
• Jeff Volek from the University of Connecticut
• Donald Layman from the Department of Food Science and Human Nutrition at the University of Illinois
• Patty Siri-Tarino of the Children’s Hospital Oakland Research Institute.

In this blog post, I’d like to pass on the highlights of what I learned at the conference. I hope these lessons are as valuable to you as they were to me.

1. Percent protein in the diet is meaningless. We need to measure protein in terms of absolutes, i.e. how many grams a day do you need, not what percentage of the diet they are. A diet that sounds like a high protein diet—i.e. “40% protein”—may not be. For example, 40% of a 1000 calorie diet is nota high protein diet.  Protein only matters in terms of absolute numbers, not percentages.
2. It takes 30 grams of protein per meal to create muscle turnover. Less, and you’re just adding calories. If you want protein to do the job of building muscle you need 30 grams per sitting. This doesn’t mean saving it up and eating 60 or 90 grams at dinner, which is the typical American way. It means divided doses during the day, at two or three meals. Donald Layman, PhD, one of the outstanding researchers who presented at the conference, calls this amount the “Protein Threshold”. The protein threshold explains why many women who are eating an egg at breakfast with their cereal and think they’re having plenty of protein are actually not losing weight or changing their bodies. It’s just not enough. And although you won’t look like Mr. Olympia just by eating protein, body composition studies do show that there’s a slight amount of change in body composition favoring lean tissue over fat when higher protein diets are consumed, even in the absence of exercise.
3. Obesity is driven by snacking.Period. It’s not the “three squares” it’s the stuff in between. And the old gym mythology about the need to “eat every two or three hours” is thankfully being re-examined. Americans don’t understand the concept of “mini-meals”, and in any case, most people do not require constant refueling every couple of hours. Give your body a chance to relax and your blood sugar and insulin a chance to normalize. If you eat the right stuff at your meals, you shouldn’t be hungry for snacks anyway. And packaged snack foods, with few exceptions, rank right up there with sodas, French fries, trans fats and sugar as the worst things you can possibly put into your body.
4. If you’re hungry between breakfast and lunch it was because your breakfast sucked. Seriously, and that’s the exact words used by the professor presenting this information. He’s right. Higher protein breakfasts with lower carbs (i.e. bread, potatoes and cereal) and more fat will keep you satisfied till lunch. Especially when there are eggs involved.
5. Observational studies are ALWAYS going to confirm the conventional wisdom.What happens is this. Researchers lump a bunch of stuff that everyone believes is healthy—i.e. fruits, vegetables, whole grains, legumes—and then they ask people how many times a week they eat like that. And surprise: the people who eat like that tend to be healthier. Bam.But people who listen to the standard recommendations and follow them are health conscious people, and they alsotend to follow recommendations to exercise and not smoke. This is called the “healthy person” effect. So surprise, the people who follow health recommendations tend to be healthier, even when some of these recommendations (i.e. don’t eat cholesterol) are pure BS.Lumping all that supposedly “good” stuff together doesn’t really tell us much about any one of them and tends to paint some questionable stuff with the “halo” effect from the reallygood stuff. Whole grains, for example, could have absolutely nothing to do with these folks being healthy, but they’re going along for the ride cause they’re lumped with fruits, vegetables, fish and exercise all of which are undeniably good. Similarly, on the other side, saturated fat might have nothing to do with being unhealthy, but it gets lumped in with things like smoking, eating processed meats and not exercising (i.e. “people who smoked, didn’t exercise and ate more saturated fat tended to have more heart disease”.)So maybe we should start evaluating these things in a new light and not assume that because something like “grains” gets classed with the real winners it’s necessarily a real winner by default, and something like saturated fat that gets classed with the real losers is necessarily a real loser as well.
6. Patterns mean more than food groups. This may seem to contradict what I said in number 6 about evaluating foods and habits separately, and maybe it does a bit. But it’s becoming more and more clear that food patternsmatter more than any one thing you eat. It’s not necessarily the blueberries, but the blueberries plus the spinach plus the grass-fed meat plus the three times a week exercise that’s making the difference. Lots of studies just look at food frequency—how many times a week did you eat eggs.But food frequency studies frankly suck. People who eat free range eggs together with a ton of vegetables and lots of grass-fed butter are not the same people who are eating eggs from McDonald’s with a double side of fries and toast. Both may score the same in the “egg frequency” category but their patternsof eating (not to mention their lifestyle) are vastly different, and it’s those patterns that are appearing to be most important in health outcomes.
7. Next huge topic in weight loss and health: microflora.  Just a week before the conference we had had that big controversial red meat study that essentially said, OK guys, it’s not the fat and cholesterol in red meat that’s bad after all, it’s other compounds that are worked on by gut flora that create cancer causing compounds like TMAO. That study—flaws and all (and there were a lot of flaws!)—did us a great service by shining a light on a neglected component of health that is turning out to have a huge influence on weight gain and obesity. Evidence was presented at the conference that shows how important this new avenue of research on gut flora is going to be.Dr. David Williams, whose newsletter I read regularly, reported this month on a study suggesting that a gastric bypass patient’s weight loss isn’t caused by the stomach not being able to hold as much food, but rather because the surgery changes the types of microbes in the gut. Dr. Williams writes: “In the study, after performing gastric bypass surgery on about a dozen obese test animals, researchers observed the characteristic loss of body fat, and it stayed off even when the animals were fed a diet that should have resulted in weight gain.” He’s one of my favorite health writers.)That microbes in the gut would affect your weight makes a lot of sense when you think about it. As Dr. Williams points out, “The less efficient your body is at converting food into energy, the more you have to consume to stay alive”.And keeping your gut flora healthy seems to me the most basic level of maintenance and prevention you can do. Surely as research accumulates, we’ll know much more about what particular strains of probiotics are involved in what particular metabolic operations and in what particular ways and how they might affect weight gain or loss; but while we’re waiting for that research to translate into practical advice I think it makes sense to supplement with probiotics on a daily basis.I do myself, and for those who are curious, I use  HLC high potency powder by Pharmax which I sprinkle over full-fat yogurt, berries, dark cherries, almonds and coconut just about every day.)

So there you have it. This conference—like every other one I attend—just underlines the fact that we don’t have all the answers yet, and that anyone who thinks we do doesn’t know what he’s talking about.

And maybe “the answer” doesn’t exist. Rather, maybe the “answer” to any particular health concern may turn out to be a highly individual one that depends on many different factors.

And maybe the best way to find that “answer” is to keep learning, keep an open mind, and be willing to throw out ancient, encrusted theories—like the one that says saturated fat and cholesterol cause heart disease.

These theories have outlived their usefulness, and as long as we cling to them with eyes firmly shut, we won’t see the real answers as they slowly emerge.

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