The amounts of water, carbohydrates, fat, and protein lost during a 30-day fast

When it comes to losing fat and maintaining muscle, at the same time, there are no shortcuts. The process generally has to be slow to be healthy. When one loses a lot of weight in a few days, most of what is being lost is water, followed by carbohydrates. (Carbohydrates are stored as liver and muscle glycogen.) Smaller amounts of fat and protein are also lost. The figure below, from Wilmore et al. (2007), shows the weights in grams of stored water, carbohydrates (glycogen), fat, and protein lost during a 30-day water fast.

On the first few days of the fast a massive amount of water is lost, even though drinking water is allowed in this type of fast. A significant amount of glycogen is lost as well. This is no surprise. About 2.6 g of water are lost for each 1 g of glycogen lost. That is, water is stored by the body proportionally to the amount of glycogen stored. People who do strength training on a regular basis tend to store more glycogen, particular in muscle tissue; this is a compensatory adaptation. Those folks also tend to store more water.

Not many people will try a 30-day fast. Still, the figure above has implications for almost everybody.

One implication is that if you use a bioimpedance scale to measure your body fat, you can bet that it will give you fairly misleading results if your glycogen stores are depleted. Your body fat percentage will be overestimated, because water and glycogen are lean body mass. This will happen with low carbohydrate dieters who regularly engage in intense physical exercise, aerobic or anaerobic. The physical exercise will deplete glycogen stores, which will typically not be fully replenished due to the low intake of carbohydrates.

Light endurance exercise (e.g., walking) is normally easier to maintain with a depleted “glycogen tank” than strength training, because light endurance exercise relies heavily on fat oxidation. It uses glycogen, but more slowly. Strength training, on the other hand, relies much more heavily on glycogen while it is being conducted (significant fat oxidation occurs after the exercise session), and is difficult to do effectively with a depleted “glycogen tank”.

Strength training practitioners often will feel fatigued, and will probably be unable to generate supercompensation, if their “glycogen tank” is constantly depleted. Still, compensatory adaptation can work its “magic” if one persists, and lead to long term adaptations that make athletes rely much more heavily on fat than the average person as a fuel for strength training and other types of anaerobic exercise. Some people seem to be naturally more likely to achieve this type of compensatory adaptation; others may never do so, no matter how hard they try.

Another implication is that you should not worry about short-term weight variations if your focus is on losing body fat. Losing stored water and glycogen may give you an illusion of body fat loss, but it will be only that – an illusion. You may recall this post, where body fat loss coupled with muscle gain led to some weight gain and yet to a much improved body composition. That is, the participants ended up leaner, even though they also weighed more.

The figure above also gives us some hints as to what happens with very low carbohydrate dieting (i.e., daily consumption of less than 20 grams of carbohydrates); at least at the beginning, before long term compensatory adaptation. This type of dieting mimics fasting as far as glycogen depletion is concerned, especially if protein intake is low, and has many positive short term health benefits. The depletion is not as quick as in a fast because a high fat and/or protein diet promotes higher rates of fat/protein oxidation and ketosis than fasting, which spare glycogen. (Yes, dietary fat spares glycogen. It also spares muscle tissue.) Still, the related loss of stored water is analogous to that of fasting, over a slightly longer period. The result is a marked weight loss at the beginning of the diet. This is an illusion as far as body fat loss is concerned.

Dietary protein cannot be used directly for glycogenesis; i.e., for replenishing glycogen stores. Dietary protein must first be used to generate glucose, through a process called gluconeogenesis. The glucose is then used for liver and muscle glycogenesis, among other things. This process is less efficient than glycogenesis based on carbohydrate sources (particularly carbohydrate sources that combine fructose and glucose), which is why for quite a few people (but not all) it is difficult to replenish glycogen stores and stimulate muscle growth on very low carbohydrate diets.

Glycogen depletion appears to be very healthy, but most of the empirical evidence seems to suggest that it is the depletion that creates a hormonal mix that is particularly health-promoting, not being permanently in the depleted state. In this sense, the extent of the glycogen depletion that is happening should be positively associated with the health benefits. And significant glycogen depletion can only happen if glycogen stores are at least half full to start with.

Reference

Wilmore, J.H., Costill, D.L., & Kenney, W.L. (2007). Physiology of sport and exercise. Champaign, IL: Human Kinetics.

Hollywood's "Dilemma": Should "Gay" Jokes Be Censored?

Recently I went to see "The Social Network". We watched several movie trailer previews, including the Ron Howard directed film "The Dilemma". The preview included a scene with Vince Vaughn exclaiming to a conference room full of colleagues, "Ladies and gentlemen...electric cars are gay". He goes on to clarify that he does not say "gay" to mean happy, instead he compares its level of "coolness" to your parents chaperoning a school dance. I leaned over to my husband and whispered, "I thought they were taking this scene out of the trailer?". I guess it had not yet been pulled (and was instead being seen by millions, as The Social Network was #1 at the box office that week).

The controversy regarding this quote began several weeks ago. CNN's Anderson Cooper was one of the first to draw attention to the preview when he appeared on the Ellen DeGeneres Show. His argument (especially in light of the recently publicized suicides involving gay children/teenagers) was that we must "make those words unacceptable cause those words are hurting kids". In addition, the Gay & Lesbian Alliance Against Defamation (GLAAD) put out a statement on the situation:

"When 'gay' is used as a pejorative, it frequently sends a message- particularly to youth and their bullies- that being gay is wrong and something to laugh at. We invite Vince Vaughn to work with us and help insure that gay youth and those perceived to be gay aren't put in harm's way by such jokes".

Last week, Vince Vaughn addressed the above concerns with his own statement that highlighted his feelings that the "gay joke" should be kept in the trailer and in the movie:

"Let me add my voice of support to the people outraged by the bullying and persecution of people for their differences, whatever those differences may be. Comedy and joking about our differences breaks tension and brings us together. Drawing dividing lines over what we can and cannot joke about does exactly that; it divides us. Most importantly- where does it stop?"

ABC's The View also discussed this during its "Hot Topics" show yesterday. I was actually pretty surprised that there seemed to be consensus and support for Vince Vaughn's statement. How can you censor a "character"? This was not about Vince making homophobic statements...but it was the statements of his character. What if the character is a jerk? Then he/she will sound like a jerk. Whoopi Goldberg spoke about recently watching "Roots" on TV and how much of the message was lost due to the censoring of the racist language.

I can see both sides of the argument on this one. Of course, people of all ages look to celebrities and movies to be role models and to confirm (or break) social norms. Therefore, statements using "gay" as a pejorative can absolutely influence the beliefs of an audience. However, I also understand the slippery slope of censorship and the concern that stories can no longer be told with the same honesty and depth of characters. It is also unclear how this censorship would be overseen and enforced. Can we always tell the difference between a statement of someone's beliefs and their attempt at a joke? And just because something is intended as a joke, does that really mean there are no consequences? If your boss "jokes" about how your clothes fit...it is still sexual harassment.

With tomorrow being "Spirit Day" to combat anti-LGBT bullying, it seemed very timely to toss this "dilemma" out to my readers for comment. I look forward to your thoughts.

Slow-cooked meat: Round steak, not grilled, but slow-cooked in a frying pan

I am yet to be convinced that grilled meat is truly unhealthy in the absence of leaky gut problems. I am referring here to high heat cooking-induced Maillard reactions and the resulting advanced glycation endproducts (AGEs). If you are interested, see this post and the comments under it, where I looked into some references provided by an anonymous commenter. In short, I am more concerned about endogenous (i.e., inside the body) formation of AGEs than with exogenous (e.g., dietary) intake.

Still, the other day I had to improvise when cooking meat, and used a cooking method that is considered by many to be fairly healthy – slow-cooking at a low temperature. I seasoned a few pieces of beef tenderloin (filet mignon) for the grill, but it started raining, so I decided to slow-cook them in a frying pan with water and some olive oil. After about 1 hour of slow-cooking, and somewhat to my surprise, they tasted more delicious than grilled!

I have since been using this method more and more, with all types of cuts of meat. It is great for round steak and top sirloin, for example, as well as cuts that come with bone. The pieces of meat come off the bone very easily, are soft, and taste great. So does much of the marrow. You also end up with a delicious sauce. Almost any cut of beef end up very soft when slow-cooked, even cuts that would normally come out from a grill a bit hard. Below is a simple recipe, for round steak (a.k.a. eye round).

- Prepare some dry seasoning powder by mixing sea salt, black pepper, dried garlic bits, chili powder, and a small amount of cayenne pepper.
- Season the round steak pieces at least 2 hours prior to placing them in the pan.
- Add a bit of water and olive oil to one or more frying pans. Two frying pans may be needed, depending on their size and the amount of meat.
- Place the round steak pieces in the frying pan, and add more water, almost to the point of covering them.
- Cook on low fire covered for 2-3 hours.

Since you will be cooking with low fire, the water will probably not evaporate completely even after 3 h. Nevertheless it is a good idea to check it every 15-30 min to make sure that this is the case, because in dry weather the water may evaporate rather fast. The water around the cuts should slowly turn into a fatty and delicious sauce, which you can pour on the meat when serving, to add flavor. The photos below show seasoned round steak pieces in a frying pan before cooking, and some cooked pieces served with sweet potatoes, orange pieces and a nectarine.

A 100 g portion will have about 34 g of protein. (A 100 g portion is a bit less than 4 oz, cooked.) The amount of fat will depend on how trimmed the cuts are. Like most beef cuts, the fat will be primarily saturated and monounsatured (both very healthy), with approximately equal amounts of each. It will provide good amounts of the following vitamins and minerals: iron, niacin, phosphorus, potassium, zinc, selenium, vitamin B6, and vitamin B12.

Courteney and David: A Poorly Designed PSA That Makes Me Want to "Scream"

So Courteney Cox and David Arquette are having a tough week. First they announced their separation and now I have to highlight the poor design of a recent public service announcement (PSA) in which they starred. I must say- they made a much better team on the set of their "Scream" movies.

A recent Newsweek article entitled "Can PSAs End Domestic Violence?" discussed the Cox/Arquette PSA and outlined the challenges of using this particular health communication channel to address the public health problem of domestic violence. The article quotes a wonderful professor of mine (thank you Dr. Emily Rothman for posting this link), so I decided to check the PSA out for myself. Overall, my impression was not good. Let's compare the PSA to some best practices and/or guidelines and see how it holds up. A great resource on this (and all aspects of program planning) comes from the Community Toolbox:

1. PSA Length
A typical PSA runs about 30 seconds. This video runs 1 minute, 50 seconds. And the viewer does not even know what the video is about (cue a random segment about "furry" sex) until the timer hits 1 minute, 25 seconds. They could have very easily lost viewers by that point (either due to boredom, confusion, or because they were offended by the "furry" segment).

2. PSAs Should Have a Clear Message and Call To Action (i.e., what do you want the viewer to do after they see your video?)
So I was a little surprised that the video did not include any specific hotline numbers. In case the audience included victims of DV, you would think that it would be a priority to list those resources. Instead, the only "action" that I could see outlined was how to donate to "OPCC"...and it was unclear what that organization was. So I followed the instructions at the end of the video that gave their Facebook address. Again, there is a huge logo that says "OPCC" (still not sure what that is, so I probably won't give money) and finally (in much smaller writing) some hotline numbers on the left. I went one more step and went to the Ocean Park Community Center (OPCC) website, where it still wasn't immediately clear how this organization supported domestic violence prevention. Apparently, this PSA was to support one of the community programs called Sojourn (a women's shelter)...but geez- how hard was that to figure out!!!???

3. Like any good health communication product, there should be a clear target audience
I have no idea who the audience was for this PSA. This is a direct result of the lack of a clear "call to action". This video had no idea who they expected as an audience or what they wanted those individuals to do. Before the video starts, we are told "this is not for kids" (again- due to the "furry"). So kids are excluded as a possible audience- which is a shame because young adults are also victims of domestic violence. I'm assuming that domestic violence victims themselves are not the audience, since the video did not include any links to DV hotlines/shelters. I doubt the audience was supposed to be DV perpetrators, because I doubt that they would be giving donations. So maybe the intended audience was just potential donors? It is unclear.

4. Evaluation
Ahh! I know I'm a broken record about this issue on my blog. As Dr. Rothman states in the Newsweek article, "there haven't been that many well-designed, rigorous evaluations of the ad's effectiveness". The OPCC spokesperson says that it has been effective because "people are talking about the ad" (how do we know?) and Facebook traffic was up (as of tonight, just 365 people had "liked" the page). But even if "talk" is increased, is that really changing the attitudes or behaviors that were (maybe) targeted by this PSA? If they had clearer goals and a call to action (e.g., The audience for this PSA is women who are victims of DV and the behavior we want to see is an increase in calls to our hotline)- it would be much easier to evaluate. And that evaluation would go well beyond "awareness".

Giuliana and Bill: A Reality Show Addressing the Real Stigma of Infertility

Talking about infertility makes people uncomfortable. Those struggling are uncomfortable because it is extremely personal. Perhaps they feel like they've failed at something that should come naturally...something that seems easy for everyone else. Perhaps it is difficult to explain why they cannot bring themselves to go to a friend's baby shower. Perhaps people at work ask them "when are you going to have a baby?"...not realizing that it is an incredibly painful question because they have been trying for years.

With this as the current state of affairs, you can imagine my surprise to see Giuliana and Bill Rancic come on The View two weeks ago and tell their story about trying In Vitro fertilization (IVF) and suffering a miscarriage. Their ordeal is also documented on their reality show: Giuliana & Bill. I just finished watching my DVR copy of their season premiere which follows them on their IVF cycle. What I really appreciated was the honest display of how difficult the cycle was. Were they both on board with this next step? How scary were the bags and bags of medication!? How would they coordinate their work schedules to make it happen? How could they keep it a secret from their work colleagues and their families? Who would stay home with Giuliana for her 48 hour bed rest? And of course it was difficult to watch them get the happy news of "you're pregnant!" at the end of the episode, since we already knew what was to come nine weeks later.

But what I really want to talk about are the huge strides they've made in reducing the stigma of IVF and miscarriage in just a few short weeks since they've come forward. I've spoken in previous posts about the importance of celebrity role models in reducing stigma of various conditions. Besides their appearance on The View and their very honest portrayal on their show, they have also partnered with key professional organizations like Fertility Lifelines and Resolve- The National Infertility Association. They have created a PSA for Fertility Lifelines encouraging couples to visit a fertility specialist. They offer statistics to help normalize the struggle to conceive and to build a community by letting viewers now that they are not alone.

Just three days ago, Access Hollywood reported that actor Kelsey Grammer came forward to say that the pregnancy he and his girlfriend had just announced in August had ended in a miscarriage. It is hard to imagine that the culture is changing this quickly...in all my entertainment news watching, I can count on one hand how many celebrities have shared this type of story.

I also think that having a "spokescouple" increases the effectiveness of their message. The stigma of infertility so often falls to the woman. "What is wrong with her?" The woman also has to endure the physically and emotionally difficult treatments. Having a couple remind us via this PSA that it can be 50/50 as to which person (or both!) is leading to the infertility helps take the stigma off the woman alone.

This situation also makes me think about the systems (or lack there of) that exist to support couples once they make the choice to see a specialist. Are these types of specialists/procedures even covered by their health insurance? Is it difficult for couples to take time off of work to deal with the physical/emotional demands that come along with this process (which is so often completely inflexible in its scheduling)? Are human resource departments/managers supportive of making accommodations and/or keeping this information confidential for their employees? Are there enough mental health professionals that specialize in infertility to help couples/individuals with the emotional challenges that go along with the physical?

As more couples wait longer to have babies and science moves forward to offer more treatments for infertility, we're going to have to grapple with these questions on a broad system level. However, that conversation is easier to have when stigma is reduced and more couples come forward to ask for what they need and offer to help each other.

Bullying: Is Technology Helping Us or Hurting Us?

Like many of you, my heart broke when I heard about the suicide of Tyler Clementi last week. Unsure of exactly how I wanted to focus my blog on this topic, I took a little time and read the comments coming through on Facebook and Twitter. I talked to colleagues and friends. And something that really struck me was that many people expressed that technology was the problem. All this new technology can only lead to bad things. Right? I agree that new technology has played a large part in our discussions around bullying the past few years. There seems to be an assumption on the part of the bullies that they can be protected by technology- that their identity can be kept "anonymous" in the cyber-world. Perhaps more kids bully online because it is easier to insult or hurt someone at that distance- versus right to their face. Of course, these hurtful comments or videos now have a much broader reach. They can be disseminated through the school, city, state, or even country in just minutes. And you can't take them back. I also think that technology is evolving so quickly that we don't always understand the new boundaries for privacy.

But even with all the new challenges and channels to bullying that technology brings, I still do not believe that it is the root cause. As a friend of mine tweeted this week (yes- Beth G you get a shout out here) "Thinking on the Tyler Clementi case. Tired of hearing that technology is to blame. I'm pretty sure Dharun Ravi and Molly Wei are, actually". Let's not forget the role of personal responsibility- I believe that gets lost when the blame falls squarely on technology.

So with all of that as a backdrop for this discussion, I decided that I wanted to focus my blog on how technology can also help us to combat bullying and help those at risk for suicide. Risk for suicide can increase among those who feel isolated and disconnected from resources. They can also suffer when surrounded by social norms that do not support help seeking for the resources that they need.

So I wanted to present these resources that have gone viral in just the past few days. I can't help but think about all the isolated kids/teens they may reach:

1. MTV launched an Iphone application to combat bullying called "Over the Line". Users can post a bullying scenario that they've experienced and other users can vote if it was "over the line". This has the potential to help promote positive norms/limits regarding how we treat each other. The peer support online may also encourage users to ask for help.

2. MTV was also involved in the launch of "Love is Louder". This "movement" has begun primarily in response to anti-gay bullying and suicides among LGBT youth. Viewers (and celebrities) can upload videos of support for these youth. It has been described as a way to channel the sadness and anger we all feel following these events. Again- this has the potential to build peer support among individuals that may be at risk. It also introduces celebrities or role models to support positive social norms.

3. Columnist Dan Savage has organized the "It Gets Better" campaign. The goal is to reach out to lesbian, gay, transgender and bisexual youth who may be the victims of bullying and remind/assure them that things will get better. This campaign has also attracted many celebrity supporters telling their stories (e.g., Tim Gunn from Project Runway was featured on many of my friends' Facebook pages today).

4. Four days ago, Ellen DeGeneres posted "An Important Message" on YouTube regarding the recent suicides of LGBT youth. As of tonight, there had been 235,627 views of that video. She pledged her support and encouraged all of us to have zero tolerance regarding bullying and the loss of these kids/teens.

So that's the complicated story. Technology brings new prevention challenges to bullying. But it can also build peer networks and deliver resources to those in isolation. It can bring the voice of celebrities or other role models into the discussion, which can be a strong influence on kids/teens. I urge us not to write off all technology in light of recent events.

For example, if anyone reading this blog needs help- please call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255). Their technology even allows for Veterans to chat with an online counselor. Amazing!