Low-carb diets work.

That is pretty much a scientific fact at this point.

At least 23 high quality studies in humans have shown this to be true.

In many cases, a low-carb diet causes 2-3 times more weight loss as the standard low-fat diet that were still being told to follow (1, 2).

Low-carb diets also appear to have an outstanding safety profile. No serious side effects have been reported.

In fact, the studies show that these diets cause major improvements in many important risk factors (3).

Triglycerides go way down and HDL goes way up. Blood pressure and blood sugar levels also tend to decrease significantly (4, 5, 6, 7).

A high percentage of the fat lost on a low carb diet comes from the belly area and the liver. This is the dangerous visceral fat that builds up in and around the organs, driving inflammation and disease (8, 9, 10).

These diets are particularly effective for people with metabolic syndrome and/or type 2 diabetes. The evidence is overwhelming.

However, there is a lot of controversy about why these diets work.

People like to debate the mechanism, the stuff that is actually going on in our organs and cells that makes the weight go off.

Unfortunately, this is not fully known, and chances are that it is multifactorial as in, there are many different reasons why these diets are so effective (11).

In this article, I take look at some of the most convincing explanations for the effectiveness of low carb diets.

Insulin is a very important hormone in the body.

It is the main hormone that regulates blood sugar levels and energy storage.

One of the functions of insulin is to tell fat cells to produce and store fat, and to hold on to the fat that they already carry.

It also tells other cells in the body to pick up glucose (blood sugar) from the bloodstream, and burn that instead of fat.

So, insulin stimulates lipogenesis (production of fat) and inhibits lipolysis (the burning of fat).

It is actually well established that low-carb diets lead to drastic and almost immediate reductions in insulin levels (12, 13).

Here is a graph from one study on low-carb diets (14).

Photo source: Diet Doctor.

According to many experts on low-carb diets, including Gary Taubes and the late Dr. Atkins, lower insulin levels are the main reason for the effectiveness of low-carb diets.

They have claimed that, when carbs are restricted and insulin levels go down, the fat isnt locked away in the fat cells anymore and becomes accessible for the body to use as energy, leading to reduced need for eating.

However, Id like to point out that many respected obesity researchers do not believe this to be true, and do not think the carbohydrate-insulin hypothesis of obesity is supported by the evidence.

Bottom Line: Blood levels of the hormone insulin go way down when carb intake is reduced. High insulin levels contribute to fat storage, and low insulin levels facilitate fat burning.

In the first 1-2 weeks of low carb eating, people tend to lose weight very quickly.

The main reason for this is reduction in water weight.

The mechanism behind it is two-fold:

This does not happen to nearly the same extent on a higher carb diet, even if calories are reduced significantly.

Even though some people use this as an argument against low-carb diets, reduced water weight should be considered an advantage.

I mean, who wants to carry around excess bloat and water weight all the time?

Anyway, despite claims to the contrary, this is far from being the main weight loss advantage of low-carb diets.

The studies clearly show that low-carb diets lead to more fat being lost as well, especially the dangerous belly fat found in the abdominal cavity (8, 16).

So, part of the weight loss advantage of low-carb diets is explained by reductions in water weight, but there is still a major fat loss advantage as well.

Bottom Line: When people go low-carb, they lose significant amounts of excess water from their bodies. This explains the rapid weight loss seen in the first week or two.

In most studies where low carb and low fat diets are compared, the low carb groups end up eating much more protein.

This is because people replace many low-protein foods (grains, sugars) with higher protein foods like meat, fish and eggs.

Numerous studies show that protein can reduce appetite, boost metabolism, and help increase muscle mass, which is metabolically active and burns calories around the clock (17, 18, 19, 20).

Many nutrition experts believe that the high protein content of low-carb diets is the main reason for their effectiveness.

Bottom Line: Low carb diets tend to be much higher in protein than low fat diets. Protein can reduce appetite, boost metabolism and help people hold on to muscle mass despite restricting calories.

Although this is controversial, many experts do believe that low carb diets have a metabolic advantage.

In other words, that low carb diets increase your energy expenditure, and that people lose more weight than can be explained by reduced calorie intake alone.

There are actually some studies to support this.

A study conducted in 2012 found that a very low carb diet increased energy expenditure compared to a low fat diet, during a period of weight maintenance (21).

The increase was around 250 calories, which is equivalent to an hour of moderate-intensity exercise per day!

However, another study has suggested that it may be the high protein (but not low carb) part of the diet that causes the increase in calories burned (22).

That being said, there are other mechanisms that may cause an additional metabolic advantage.

On a very low carb, ketogenic diet, when carb intake is kept extremely low, a lot of protein is being transformed into glucose in the beginning, a process called gluconeogenesis (23).

This is an inefficient process, and can lead to hundreds of calories being wasted. However, this is mostly temporary as ketones should start replacing some of that glucose as brain fuel within a few days (24).

Bottom Line: Low-carb diets appear to have a metabolic advantage, but most of it is caused by the increased protein intake. In the beginning of a very low carb, ketogenic diet, some calories are wasted when glucose is produced.

Low carb diets automatically exclude some of the worlds most fattening junk foods.

This includes sugar, sugary drinks, fruit juices, pizzas, white bread, french fries, pastries and most unhealthy snacks.

There is also an obvious reduction in variety when you eliminate most high-carb foods, especially given that wheat, corn and sugar are in almost all processed foods.

It is well known that increased food variety can drive increased calorie intake (25).

Many of these foods are also highly rewarding, and the reward value of foods can impact how many calories we end up eating (26).

So, reduced food variety and reduced intake of highly rewarding junk foods should both contribute to a reduced calorie intake.

Bottom Line: Low carb diets exclude many foods that are highly rewarding and extremely fattening. These diets also have less food variety, which may lead to reduced calorie intake.

Probably the single biggest explanation for the weight loss effects of low carb diets, is their powerful effects on appetite.

It is well established that when people go low carb, their appetite goes down and they start eating fewer calories automatically (27).

In fact, studies that compare low carb and low fat diets usually restrict calories in the low-fat groups, while the low-carb groups are allowed to eat until fullness (28).

Despite that, the low carb groups still usually lose more weight.

There are many possible explanations for this appetite reducing effect, some of which we have already covered.

The increased protein intake is a major factor, but there is also evidence that ketosis can have a powerful effect (29).

Many people who go on a ketogenic diet feel that they only need to eat 1 or 2 meals per day. They simply dont get hungry more often.

There is also some evidence that low carb diets can have beneficial effects on appetite regulating hormones like leptin and ghrelin (30).

Bottom Line: Low carb diets lead to an automatic reduction in calorie intake, so that people eat fewer calories without having to think about it.

Even though low carb diets are very effective in the short-term, the long-term results are not that great.

Most studies that last for 1-2 years show that the difference between the low-carb and low-fat groups mostly disappears.

There are many possible explanations for this, but the most plausible one is that people tend to abandon the diet over time, and start gaining the weight back.

This is not specific to low carb diets, and is a well known problem in most long-term weight loss studies. Most diets are incredibly hard to stick to.

Some people refuse to accept that low carb diets can work, and that people can eat as much as they want, because that must violate the calories in, calories out model.

However, when you understand the mechanisms behind low carb diets, you can see that the CICO model is not being violated, and the laws of thermodynamics still hold.

The truth is, low carb diets work on both sides of the calorie equation.

They boost your metabolism (increasing calories out) and lower your appetite (reducing calories in), leading to automatic calorie restriction.

Calories still count, its just that low carb diets automate the process and help prevent the biggest side effect of conscious calorie restriction, which is hunger.

See more here:
Why do Low Carb Diets Work? The Mechanism Explained

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Edmund Fountain / Food & Environment Reporting Network

Theresa Dardar is leading an effort among several Louisiana tribes to restore their food sovereigntythe sustainable production of healthy, culturally appropriate foodas the land around them disintegrates.

When Theresa Dardar was growing up in Houma, her mother used to take her to visit relatives in the Pointe-au-Chien Indian Tribe community. They would drive 20 miles toward the Gulf of Mexico, park at the local grocery store, and ask someone to ferry them across the bayou. From there, theyd walk across land thick with oak, hackberry, and palmetto until they reached her grandfathers house.

Dardars grandfather raised chickens and pigs. Next door, her uncle raised cattle. Even at 62, Dardar carries a vivid memory of her grandfather dipping a cup into the blood of a freshly slaughtered pig and drinking it. He would send some of the pork home with Dardars mother, who would make it into boudin sausages. She would also bring home some of the redfish he caught in the waters near his home.

This story is a collaboration between the Food & Environment Reporting Network, which focuses on investigative and explanatory reporting about food, agriculture and environmental health; Gravy, which explores stories of the changing American South through the foods we eat; and The Lens, which covers public-policy issues facing New Orleans and the Gulf Coast.

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Back then, tribal members fed themselves wellwith seafood, of course, but also with the livestock they raised, the fruits and vegetables they planted, and the marsh hens they extricated from their fur traps. They hunted for turtle and alligator, too, and gathered medicinal plants from the land.

Thats because there was land. Viewed from above in the early 20th century, Pointe-au-Chien was surrounded by a dense thicket of green, broken up by splashes of blue. Those proportions flipped over Dardars lifetime. The land vanished until the community became a narrow neck of high ground surrounded almost entirely by open water. The area immediately around Terrebonne Bay, which includes Pointe-au-Chien, went from 10 percent water in 1916 to 90 percent in 2016, according to geographer Rebekah Jones, a Ph.D. candidate at Florida State University. The U.S. Geological Survey said the larger Terrebonne Basin lost almost 30 percent of its land from 1932 to 2010.

Today, the property surrounding Dardars grandfathers home bears little resemblance to the place she visited as a child. Theres no more trees, she said. Theres a little strip of land where he and my uncle lived. The piece of land is so small now that I dont think anyone would be able to live there.

This is the dilemma Dardar spends much of her time agonizing over. She has lived in Pointe-au-Chien for more than 40 years, in a house overlooking a bayou lined with shrimp boats. (Pointe-au-Chien means Dog Point; the larger rural community is often called Pointe-aux-Chenes, or Oak Point.) She has served as a deckhand on her husband Donalds shrimping boat and has skinned the nutria he once trapped in the winters. Shes watched that shrimping business dwindle, and the trapping business disappear altogether. And shes seen neighbors give up on their gardens and animals.

Dardar isnt sitting back, though. She and her tribe are trying out new ways to grow vegetables and medicinal plants even as the land around them vanishes. She heads an intertribal effort to restore food sovereigntythe sustainable production of healthy and culturally appropriate foodto a half-dozen of Louisianas Native American communities. That effort might inform all of us about how to feed ourselves during these times of environmental stress.

Edmund Fountain / Food & Environment Reporting Network

Island Road connects Pointe-au-Chien with Isle de Jean Charles, which has lost 98 percent of its island home since 1955. At high tide, the road is sometimes covered with water, making it impassable for school buses.

The land loss faced by the 680-member Pointe-au-Chien tribe is one of the central facts of life south of New Orleans. Each year, about 16 square miles vanish from the Louisiana coast. The levees along the Mississippi River have starved the area of the sediment needed to replenish a sinking delta. The dredging of 10,000 miles of canals by the oil and gas industry has sucked saltwater inland, killing the vegetation that holds the mud together. And climate change is accelerating global sea-level rise, which promises to overtake subsidence as a key factor in land loss during the next century.

Edmund Fountain / Food & Environment Reporting Network

A boater passes a floodgate under construction in Bayou Pointe-aux-Chenes.

Whats more, as the barrier islands to the south have disappeared, Pointe-au-Chien has become more open to storm damage. In 1985, Hurricane Juan flooded the Dardars mobile home; the couple, along with Donalds grandmother, took shelter in a small boat. The couple built an elevated house after thatits now common to see houses built up on stiltsand a small levee went up in their backyard. But they remain vulnerable: 2008s Hurricane Gustav blew off part of the Dardars porch, tore a hole in their roof, and destroyed other houses. Less than two weeks later, the community was flooded by storm surge from Hurricane Ike.

The U.S. Army Corps of Engineers is trying to protect communities like Pointe-au-Chien with a controversial $13 billion project called Morganza to the Gulf98 miles of earthen levees punctuated by floodgates. A levee is going up immediately behind the tribal headquarters, at the edge of open water that used to be cattle pasture. Dardar believes the levee will buy us a few years, but only if the community doesnt suffer a direct hit by a fearsome storm. Its in Gods hands; lets put it that way, she said. Some scientists agree the project will have limited benefit, particularly considering the price tag.

Sitting on the back porch of her tribes headquarters, Dardar looked over a small, scrubby yard with a row of small trees at the back. Beyond that, a dump truck revved and beeped as it poured dirt for the levee. Dardar recalled wondering why the project was called Morganza to the Gulf, because the levee doesnt go to the Gulf. Then she realized: The Gulf of Mexico will come to us.

Not only do land loss and flooding make it harder to raise livestock, planting fruits and vegetables also gets tricky. When I grew up, everybody had a garden, said tribal council member Christine Verdin, who is 57. My grandma had probably five different species of figs. She had orange trees, satsumas, navels. She had lemon trees. She had her own peaches. And because of the water coming in, it just ruined all her plants and all her trees.

Edmund Fountain / Food & Environment Reporting Network

Christine Verdin stands in front of her wrecked childhood home next to the Pointe-au-Chien Indian Tribes community center. The home was damaged by Hurricane Rita in 2005.

Theresa Dardars 83-year-old mother-in-law, Nazia Dardar, maintains a large garden in a backyard filled with fruit trees, Muscovy ducks, and roosters. She sells her surplus produce to neighbors. But shes one of the few holdouts who arent discouraged by repeated flooding.

Imports of cheap shrimp have driven prices so low at the dock that commercial shrimpers like Donald Dardar can hardly justify the cost of fuel and ice.That leaves the tribes traditional mainstay, seafood. But even that is becoming a luxury. Imports of cheap shrimp have driven prices so low at the dock that commercial shrimpers like Donald Dardar can hardly justify the cost of fuel and ice. Local crabbers report significant drops in their yields since the 2010 BP oil spill. (It is one of several possible causes.) And the federal government warns that accelerating wetlands loss in Louisiana endangers the nurseries for many species of fish and shellfish.

With residents replacing seafood with store-bought chicken, pork, and beef, the tribal culture is suffering, too. We dont see each other as much, Dardar said. Before the spill, Donalds brother used to do a crab boil at least three, four times a week on the side of the bayou. No invitation was needed: The community would pass by, and they would stop and wed visit. Theyd eat. That tradition ended after the crab haul became sporadic. It all fell apart, she said.

Edmund Fountain / Food & Environment Reporting Network

Nazia Dardar handles bags of beans and okra seeds from her freezer in Pointe-au-Chien.

Its not just Pointe-au-Chien. Across southeastern Louisiana, tribes are grappling with what land loss means for their dinner plates, their traditions, and their health.

We are stewards of the environment: protect first, use second, said Shirell Parfait-Dardar, traditional chief of the Grand Caillou/Dulac Band of the Biloxi-Chitimacha-Choctaw tribe. (Dardar is a common name across tribes.) The 450-member tribe, which has fanned north from its original home at the edge of the Gulf, used to raise dairy cattle and poultry, she said. But flooding has ruled out ethical husbandry.

We will not suffer any animal, said Parfait-Dardar, who lives in Chauvin, southeast of Houma. A south wind comes through here, and thats ityouve got yards covered. We can get out of the way of the waters. Animals dont have that benefit. Theyre stuck where you put them. And we will not subject them to that.

As the tribe has moved away from self-reliance, family diets have shifted toward processed food. The boxed dinners, they are very convenient, Parfait-Dardar said. You can get a ton of them, 10 for $10. And for a family as big as mineI have four children [and] my husband doesnt make all that much moneyweve got to stretch that dollar to feed our kids. The health consequences, though, have been predictable. We have a very high rate of high cholesterol, she said of the tribe. Diabetes is rampant. And its all got to do with our diet.

Before the spill, Donalds brother used to do a crab boil at least three, four times a week on the side of the bayou. The community would pass by, and they would stop and wed visit. Theyd eat.Theresa DardarThese are issues that Native Americans deal with nationally. If you take the food desert map and overlay it with where tribal lands are, there is pretty much a direct correlation, said Lea Zeise, a New Orleans-based staffer for the Intertribal Agriculture Council. Its no coincidence, experts say, that Native Americans are twice as likely as whites to be diagnosed with diabetes and are at high risk for heart disease and stroke. The disruption of traditional agriculture and hunting has resulted in increased consumption of fattypical of the contemporary western diet, writes physician Dorothy Gohdes in the National Institute of Diabetes and Digestive and Kidney Diseases reference book Diabetes in America.

Some Louisiana tribes have decided they cant tackle the problems alone. Six have joined together to discuss innovative ways to reclaim their food sovereignty. Calling themselves the First Peoples Conservation Council, they meet every three months, along with representatives from nonprofits and the U.S. Department of Agricultures Natural Resources Conservation Service. Theresa Dardar serves as president.

Five of the tribes are coastal. None of them is recognized by the U.S. government, though most are recognized by the state of Louisiana, which has less restrictive standards. Besides Pointe-au-Chien and Grand Caillou/Dulac, they include the 600-member Isle de Jean Charles Band of the Biloxi-Chitimacha-Choctaw, which has lost 98 percent of its island home since 1955 and last year received a $48 million federal grant to relocate inland. (Isle de Jean Charles is three miles from Pointe-au-Chien but considerably more exposed. Most of the members, including the chief, have already left the island.)

Rounding out the councils coastal members are the Bayou Lafourche Band of the Biloxi-Chitimacha, whose 600 members have been forced inland by devastating hurricanes, and the Grand Bayou Village Atakapa-Ishak/Chawasha tribe, whose 14 homes in Plaquemines Parish are accessible only by boat. Grand Bayous tribe has 400 members, but most live away from the village, in part because of the challenges of living with land loss.

These meetings are hours-long brainstorming sessions that draw from the collective wisdom of the tribes and the technical expertise of the government and nonprofit groups. Some of the discussions center around programs the Agriculture Department funds, like plastic-covered hoop houses to protect vegetable gardens. (The U-shaped metal structures extend growing seasons, minimize soil erosion, and protect against pests and wind.) They talk about lobbying for federal recognition of soft-shell crab as a farm commodity, which could make producers eligible for crop insurance, disaster loans, and federal subsidies. And they discuss 21st-century ways to share traditional knowledge, like an Excel spreadsheet to record changes in growing seasons.

Edmund Fountain / Food & Environment Reporting Network

Nazia Dardar (left) and her daughter-in-law Theresa Dardar walk through their garden in Pointe-au-Chien.

On a December morning at the Agriculture Departments office in the St. Charles Parish town of Luling, representatives from four tribes got together for the final First Peoples Conservation Council meeting of 2016. There were greetings in French, a prayer in English, and a business agenda that extended well beyond lunchtime.

Zeise of the Intertribal Agriculture Council reported on a federal grant her organization had received to develop marketing cooperatives, which the tribes could use to sell products like dried shrimp. Wed have to start small, said Rosina Philippe, an elder from Grand Bayou Village. We know the process of drying shrimp. But as far as the business side of it, thats something that wed have to learn.

Edmund Fountain / Food & Environment Reporting Network

Just beyond Theresa Dardars backyard in Pointe-au-Chien is a levee, built after Hurricane Juan. On the other side, you can see where water has replaced land.

But is there interest in learning that kind of stuff? Zeise asked.

Yes, Philippe said. We talk about it all the time. We just dont know how to put the next foot forward.

Philippe also talked about a project her tribe, which is not protected by levees, is working on: gardens in boxes that can be lifted with pulleys. Grand Bayou Village has tried traditional raised-bed gardens, but they have proven impractical. Tides have been higher, she explained to me afterward. In storm events, we get more water, so they get inundated with saltwater. That kills the plants. Hence the idea of gardens that can be raised and lowered mechanically. They could grow typical vegetables like tomatoes, along with traditional medicines and indigenous plants like wild celery and parsley. Philippe also described plans to create a floating garden by mounting a container on top of a 4-foot-by-8-foot section of plastic dock.

Like their ancestors did, the tribes are thinking about their childrens childrenseven generations down the line. The councils conversations are starting to bear fruit now, albeit on a modest scale. Down in Chauvin, Shirell Parfait-Dardarinspired by discussions of raised-bed gardenshas built one of her own using recycled materials, including old trampoline parts that serve as a trellis for green beans. In Pointe-au-Chien, Theresa Dardars husband Donald has started growing vegetables under a federally subsidized hoop house behind the couples home. The couple was spurred to act after Theresa talked with a Department of Agriculture staffer who attends council meetings.

Edmund Fountain / Food & Environment Reporting Network

Chief Shirell Parfait-Dardar, of the Grand Caillou/Dulac Band of Biloxi-Chitimacha-Choctaw Indians, stands behind the trellis for her green beans, made of old trampoline parts.

Pointe-au-Chiens big project, still in its early phases, is to build a greenhouse for medicinal plants and possibly vegetables. Christine Verdin, the tribal council member, hopes the effort will teach children about gardening and will produce crops that people can transfer to their own yards. If we can get things started here in this greenhouse, she said, Im hoping it will multiply.

More than any individual project, whats instructive about the First Peoples Conservation Council is the pooling of wisdom. Federal staffers provide technical guidance, but dont steer the conversation. This, Zeise said, is refreshing. Its a solutions-based relationshipand not just the solutions that the [Agriculture Department] already has in mind, but the solutions that actually match the cultural and subsistence needs of the community, she said.

One of those staffers, conservationist Randolph Joseph, said thats the principle: People with a wide range of experiences, working in collaboration, stand the best chance of coming up with innovative responses to threats like land loss and saltwater intrusion.

If we can get things started here in this greenhouse, Im hoping it will multiply.Christine VerdinIts going to take their creativity to solve that problem, he said. Once they get it down, then maybe we can help them to perfect it, to expand on it, to make it more efficientand maybe [we can] adopt some of the practices that theyre using, that we may not have knowledge of. We dont have all the answers to their issues. But I think working together, we can find some practices that will work.

Joseph hopes the conservation council can become a model for tribal and non-tribal communities. Louisianas coastal tribes are some of North Americas first responders: Theyre dealing with disaster ahead of most of us. But these environmental problems wont remain isolated: In the Terrebonne Basin alone, the coastline could eventually creep north to the suburbs of Houma, according to state and federal coastal experts.

Indeed, other communities will have to contend with how to feed themselves in the face of climate change and coastal erosion. Were on the front lines and its going to spread, Parfait-Dardar said. By trying solutions and sharing what works, she added, we can help make a difference. We have to consider what were leaving behind for the next seven generations.

This story was reported and written by Barry Yeoman, a freelance journalist based in Durham, North Carolina. Eve Abrams and Thomas Walsh recorded the audio. Edmund Fountain, a photographer based in New Orleans, made the pictures.

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Reclaiming native ground: Can Louisiana's tribes restore their traditional diets as waters rise? - The Lens

Skiers and snowboarders enjoy the fresh snow at Thunder Ridge Ski Area in Patterson. Feb. 9, 2017. Frank Becerra Jr./Lohud

Kendra Holze, and her daughter Skye, ride the chairlift as they enjoy the fresh fallen snow at Thunder Ridge Ski Area in Patterson Feb. 9, 2017.(Photo: Frank Becerra Jr./The Journal News)Buy Photo

The snow was coming down sideways at the summit of Thunder Ridge late Thursdayafternoon as skiers and snowboarders came out in droves to play in the fresh powder that continued to pile up all day in Patterson.

It was a snow day for Lower Hudson Valley schools, so what better to do in a snowstorm than have your Mom or Dad drive up Route 22 to the regions lone surviving ski hill in northeast Putnam County for a day on the slopes.

By 3 p.m., teens and young adults were lining up to take advantage of twilight skiing, which lets you ski and ride for $30 from then until 9 p.m. under the lights.

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About a foot of light powder was there for the taking a rarity in a winter when Thunder Ridge has depended in large part on a steady diet of man-made snow from its upgraded snowmaking system.

Among the skiers were Kendra Holze, and her daughter, Skye, 4, of Patterson. Holze grew up skiing Thunder Ridge, and recalls thatFriday night skiing was a highlight of her high school years. Now shes teaching her daughter, who was all bundled up in pink as she made her turns down Lovers Lane, the meandering trail that winds off the top of the mountain.

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This is our 15th time skiing so far this year, said Holze. Sometimes well just pop up for an hour or so. Shes really learning.

Dr. David Johnston, of Ridgefield, Connecticut, declared a snow day in his medical practice, and brought his sons, Matthew, 13, and Gavin, 11, to New York for the powder day. Having skied earlier this year in the Berkshires and Vermont, Matthew shrugged when asked if hed had a good day on the hill. He wished the double chair had opened so he could ski Wildcat or Timber Wolf off the top.

But his younger brother was having a ball in the fresh snow. And their father said Thunder Ridge was a good choice because it was so close on a snowy day.

Skiers and snowboarders enjoy the fresh fallen snow at Thunder Ridge Ski Area in Patterson Feb. 9, 2017.(Photo: Frank Becerra Jr./The Journal News)

But his younger brother was having a ball in the fresh snow. And their father said Thunder Ridge was a good choice because it was so close on a snowy day.

Its good enough for me, he said. Its better than hanging out at home, the price is right, and its nice not having it icy here.

With a vertical elevation of just 600 feet, Thunder Ridge runs dont take long. But theres fun to be had, especially its main run, called The Face, where the ski area regularly holds high school and regional ski races. On Wednesday, the trail was awash in powder, which was forming moguls along the side where it hadnt been groomed. By late afternoon, there were powder stashes down through the woods on Evergreen and the broad meadow where it merges with Santa Fe.

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Running the operation is Dean Ryder, president of Putnam County National Bank in Carmel, who grew up skiing here when it was called Birch Hill, and bought the ski area from a bank a few years ago after it had foreclosed on a previous owner. He was up in the cafeteria, on the phone, in his snow boots, blue blazer, tie and freshly pressed shirt, and a Thunder Ridge cap on his head.

He was crowing about his daughter, Casey, who was a ski team star at Carmel High and now coaches racers out at the Telluride ski resort in southwest Colorado.

Skiers and snowboarders enjoy the fresh fallen snow at Thunder Ridge Ski Area in Patterson Feb. 9, 2017.(Photo: Frank Becerra Jr./The Journal News)

He was also consulting with James Mazzocchi, who runs the ski areas snowmaking and grooming operation, about how to keep the trails in tiptop shape through the weekend.

Yet to open this year is the expert trail, Fools Delight, just to the right of the main lift. It has the areas steepest pitch, but needs a considerable amount of snow to safely open.

Its almost ready, said Mazzocchi. Just need a little more in the lip, before the drop-off.

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Although I did not know her name, or anything about her other than her medical history, my heart went out to the 97-year-old woman who, with her family, had a very big decision to make.

I learned about her situation recently at a weekly conference at Temple University Hospital that I often attend. This type of meeting, bringing together interventional cardiologists, cardiac surgeons, nurses, allied health professionals, and cardiologists specializing in cardiac imaging, is held regularly in many hospitals across the country. In the case of this patient, we needed to figure out whether a new and enormously popular cardiac valve procedure that can be done without open heart surgery would likely help her live longer and better or potentially make things worse, at enormous expense both emotionally and financially.

Still active despite her age, this woman had critical aortic stenosis, a cardiac valve problem that without treatment would almost certainly lead to death within a year. The only way to help her would be transcatheter aortic valve replacement (TAVR, for short), which allows people at higher risk, such as the elderly, to have aortic valve surgery. After discussing all of the issues in her case, we agreed in the meeting that she could be a candidate for the procedure, if she and her family understood the risks and wanted to proceed.

TAVR can be lifesaving. A normal aortic valve has a circumference about the size of a quarter as it opens with each beat of the heart to allow blood to go from the left ventricle to the aorta. As we age, the valve can become so calcified that it shrinks to the size of a pencil or less. There are no "natural" fixes lifestyle changes and a careful diet will not help. Surgery is the only option, and traditional open-heart surgery is tough on the elderly. Yet, if the aortic valve closes off so much that there is chest pain, fluid on the lungs, or a loss of consciousness, this valve problem will likely prove fatal in less than a year.

In the TAVR procedure, a new heart valve is delivered through an artery accessed in the patient's leg. With no need for open heart surgery, patients are home from the hospital in just a few days. It has given thousands of people a longer life, and a better quality of life. The procedure is so popular that it may replace standard valve surgery in a few years.

Butstudies have shown that 25 percent of people who have TAVR die within the first year, and 4 percent will have a major stroke. While 40 percent more may experience some kind of mild cognitive impairment after the procedure, nine in 10 of those patients improve significantly after one year. After the procedure, some patients require a permanent pacemaker, as the electrical mechanics of the heart can be disturbed. All this must be weighed against the even greater risks of standard aortic valve heart surgery which isn't an option for people like our 97-year-old patient.

Additionally, and not talked about as much: TAVR is not easy to learn, requiring a significant number of procedures before a physician is proficient. But if you've seen ads for hospitals promoting the procedure, it's clear that this is a big business for many medical centers.

These thoughts were all going through my mind as the Temple group discussed another case, that of an 85-year-old man who was also a candidate for this procedure. Physically, he seemed a good match for it. But he had poor short-term memory, and the concern was raised that he could have mild Alzheimers disease. How could we know whether he was truly capable of giving his consent for the procedure?

The ethical implications of who should be a candidate for one of these new procedures are staggering. If nothing is done, death is virtually certain. But, if things go wrong, the patient can end up in a coma, leaving family members with extremely tough choices. And let us not forget, the costs of these procedures can be astronomical the TAVR device alone costs an estimated $32,000, compared with $4,000 to $7,000 for other heart valves.

The question arises: Can doctors do a better job of predicting who might benefit most and least from TAVR? If so, doctors, nurses, and experts in ethics could speak clearly and simply to the patient and family members to help them make a decision about proceeding.

There is help on the way. Toolsare rapidly being developed to predict outcomes after TAVR. Patients who are older than 85, frail, disabled, or require constant use of oxygen generally don't do very well after TAVR, these evidence-based tools indicate. Of course, patients are all individuals, so tools cannot do the entire assessment. Still, they are potentially helpful and should be standard practice. Difficult choices could be eased by including palliative care experts on the TAVR team, who could help make patients who opt against having the procedure more comfortable, and also assist family members who are facing the mortality of their loved ones.

The 85-year-old man was further evaluated, and his doctors thought him capable of making a decision to proceed. Both he and the 97-year old woman we discussed in the valve conference made the choice to have TAVR. They did very well with their procedures, and are safely home with their families. In both cases, the fact that they were otherwise fairly healthy, and wanted to get back to their active lives, helped the patients, families and TAVR team decide to proceed.

Other patients will understandably come to a different conclusion. Dying in ones own bed at an advanced age, with close family in attendance as well as support from palliative care, does not sound so bad compared with what modern medicine can sometimes offer. This is especially true if what is billed as a simple operation goes awry. We cannot afford to forget that surgery, even less-invasive surgery, may not be for everyone.

David Becker, M.D., is a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. He has been in practice for 25 years.

Originally posted here:
For cardiologist, life-saving valve procedure is not always the right choice - Philly.com

February 8, 2017 by Nick Caplan, The Conversation Separated at launch. Scott and Mark Kelly. Credit: NASA

NASA astronaut Scott Kelly recently spent one year in space, while his identical twin brother Mark (a former NASA astronaut himself) stayed on Earth. The mission was part of an important health experiment, looking at how being in space affects our bodies. While the data are still being studied carefully, NASA recently released some intriguing preliminary findings.

Kelly launched aboard the Russian Soyuz Rocket on March 27 2015, along with Russian cosmonauts Genaldy Padalka and Mikhail Kornienko (joining Kelly on the one year mission). Before, during and after the 340 days he spent aboard the International Space Station, a large volume of biological samples was collected from both Scott and Mark. By looking at molecular changes between the identical twins that were separated at launch, NASA hope to shed light on how certain proteins and bacteria in the body are influenced by nature or nurture by taking advantage of the extreme environmental differences between living on Earth or in space.

Space agencies around the world have a shared goal of taking people to Mars. Missions to Mars will involve crews spending about three years away from Earth's gravity, taking about six months travelling to Mars in microgravity, followed by more than a year on the Martian surface, living and working in about a third gravity we experience on Earth. This is before the planets realign and it's time for the six-month return journey back home. In order to safely complete this journey, effective countermeasures to the potential influences of the extreme environment of space on the human body must be developed.

Previous missions to the International Space Station have identified many of the effects of microgravity on human physiology. Muscles, especially those that help support the body's posture against gravity, waste away, bones become less dense, increased pressure in the skull leads to visual impairments and the amount of blood in the body reduces. As if that wasn't enough, the heart also gets smaller as it can pump blood to the brain more easily and cosmic radiation can lead to increased cancer risk.

To counteract all this, astronauts on the International Space Station complete a rigorous exercise programme (about two hours daily), accompanied by a strictly planned diet.

Molecular adaptations to spaceflight

The NASA Twins Study uses the relatively new field of omics the study of a large number of systems in the human body at a molecular level. Initial findings involved telomeres often described as the "ticking clock of the cell". Telomeres are DNA sequences at the end of chromosomes protecting them from degrading. As we age, the telomeres get shorter and shorter.

The study found that telomeres in white blood cells get longer in space. This was potentially thought to be due to the increased exercise regime and strict diet that Scott followed, but perhaps Einstein's time dilation effect could be playing a part in astronauts' telomeres seemingly ageing slower. Despite this, markers of inflammation in the blood increased in space and after landing back on Earth, which could have been caused by the physical stress placed on Scott's body during re-entry and landing.

Some changes to DNA were also seen in Scott's gene expression. This finding could help identify specific genes that are sensitive to environmental stress so that we can help protect them. During the second half of Scott's mission, bone formation also reduced, which is more commonly seen in osteoporosis.

Astronauts will need to reach Mars and be able to perform physical and cognitive tasks to survive for months on end in the partial gravity environment of the Martian surface. They will have to construct the habitat in which they will live, perform system maintenance and carry out scientific research. By understanding how microgravity influences astronauts' DNA, drugs and other countermeasures can be developed to prevent these changes and ensure that astronauts stay healthy.

Of course, it is not all about exploring the solar system. Many of the global space agencies aim to study how space affects the human body in order to improve healthcare interventions for patients on Earth. As the use of omics develops, it could lead to personalised healthcare.

By using these techniques to comprehensively analyse blood samples taken in hospitals, or even in doctors surgeries, it might one day be the case that doctors can predict whether a patient might develop a certain disease, and prescribe preventative drugs to reduce the likelihood of the patient becoming ill in the first place. Findings from NASA's Twin Study could, therefore, help us living longer and healthier lives on Earth.

Explore further: Change in astronaut's gut bacteria attributed to spaceflight

This article was originally published on The Conversation. Read the original article.

Northwestern University researchers studying the gut bacteria of Scott and Mark Kelly, NASA astronauts and identical twin brothers, as part of a unique human study have found that changes to certain gut "bugs" occur in space.

Preliminary research results for the NASA Twins Study debuted at NASA's Human Research Program's annual Investigators' Workshop in Galveston, Texas the week of January 23. NASA astronaut Scott Kelly returned home last March ...

The human body is incredibly complex. Every part of usfrom our bones to our blood cellsis subject to a host of chemical reactions and molecular interactions that, without our conscious effort, keep us alive.

NASA astronaut Scott Kelly shared a series of sunrise photographs with his social media followers on Tuesday, March 1, 2016, as he prepared to depart the International Space Station and return to Earth aboard a Soyuz TMA-18M ...

NASA astronaut Scott Kelly will Thursday set a new record for the longest single stretch of time spent in space by an American, with 216 consecutive days at the International Space Station.

Would you like to spend a year gazing down from the International Space Station? Before you pack your bag, you should think about what actually might happen to you in microgravity, away from the protection of the atmosphere ...

A team of scientists at NASA's Glenn Research Center in Cleveland recently completed a technology demonstration that could enable new scientific missions to the surface of Venus. The team demonstrated the first prolonged ...

Many scientists believe the Earth was dry when it first formed, and that the building blocks for life on our planetcarbon, nitrogen and waterappeared only later as a result of collisions with other objects in our solar ...

For astronomers trying to understand which distant planets might have habitable conditions, the role of atmospheric haze has been hazy. To help sort it out, a team of researchers has been looking to Earth specifically ...

About 4.6 billion years ago, an enormous cloud of hydrogen gas and dust collapsed under its own weight, eventually flattening into a disk called the solar nebula. Most of this interstellar material contracted at the disk's ...

On Feb. 9, 2017, NASA's Magnetospheric Multiscale mission, known as MMS, began a three-month long journey into a new orbit. MMS flies in a highly elliptical orbit around Earth and the new orbit will take MMS twice as far ...

For years, their existence has been debated: elusive electrical discharges in the upper atmosphere that sport names such as red sprites, blue jets, pixies and elves. Reported by pilots, they are difficult to study as they ...

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NASA sent a twin to space to study nature versus nurture and we're starting to get results - Phys.Org

Buncombe County, like much of the nation, has a diabetes problem. The diseasewas ranked as the 10th-leading cause of death in the countyin the 2015 Community HealthAssessment, an annual gathering of data from residents to determine local wellness in relation to state and national averages. While there are numerous reasons why this has become an epidemic, the assessment found that23.5 percent of Buncombe adults are obese, and that just over 30 percent of students in K-5 public schools are overweight or obese, factors that increase the incidence of diabetes.

The good news: Asheville-area health professionals say there are affordable and accessible ways to address this growing risk for generations young and old. A wealth of information, diet trends and practiceshas emergedto address weight loss and the prevention of diabetes.

Christin Banman, a registered dietitian with Mountain Kidney and Hypertension Associates, is accustomed to dealing with the factors that lead to diabetes, Type 2 in particular. You immediately have to get into the home life situation with these issues, she says.Who does the cooking? Whos in the house? The majority of her patients have fought weight gain, high blood pressure and long-standing medical issuestheir entire lives. Their multiple problems create the onset of Type 2 diabetes, she says, which in turn causes kidney malfunction due to higher levels of blood sugar.

Banmans advice for someone who has contracted the disease and is seeking reversal of the diagnosis is similar to that shed offeranyonewho is prediabetic. She recommends affordable and simple dietary solutions that include buying frozen vegetables for cost and longevity, avoiding most beverages in favor of purchasing foods, buying grains in bulk, and shopping at Aldi and other affordable markets in their area.

Watchingyour weightis key to help preventing Type 2 diabetes, Banman says. I really feel like if someone can jump start or hit the restart button with the sugar busters or Atkins diet just to get an initial amount of weight off, Im a supporter of that. I think the long-term benefits of just getting a little bit of weight off exceed the consequences of that diet.

I think what were dealing with is whats referred to as a toxic food environment, where we have heavily marketed, very inexpensive, unhealthy foods on every corner in hospitals, airports and even in our school systems, she continues. This food environment surrounds us. So its hard for me to argue with someone who says, The croissant sandwiches were two-for-one on the way in. With someone that has limited food money, that speaks. So thats part of the food environment were dealing with.

Diabetes and lifestyle

Type 2 diabetes affects 29.1 million people in the U.S., according to the Centers for Disease Control and Prevention.The most common causes for the onset of this illness are obesity, smoking, physical inactivity, age, family history, high blood pressure and a high alcohol intake,according to WebMD.

Diabetes causes blood glucose levels to rise above normal. When people eat, their bodies turn food into glucose, or sugars, for their body to use as energy. The pancreascreates the hormoneinsulin, which allows those sugars to get into the cells of the body. But with Type 2 diabetes, thebody is no longer able to use its own insulin as well as it should, causing sugar to build up in theblood.

In 2014, the North Carolina State Report nameddiabetes as the seventh-leading cause of death in the state, the fourth-leading cause for African-Americans and the third-leading causefor American Indians. In WNC, the rate of white people living with the disease is highest, at 11.6 percent, while the rate of African Americans in the eastern part of the state is 15.3 percent.

Harvard UniversitysPATHS (Providing Access to Healthy Solutions) report for North Carolina in 2014outlined how legislation could mitigatethe disease, including a mandate for insurers to cover diabetes-related services as well as the creation of a unified public health system to providewhole-person care. The PATHS report is funded through Together on Diabetes,a philanthropic program of the Bristol-Myers Squibb Foundation,and was launched in 2010 to improve the health outcomes of people living with Type 2 diabetes bystrengthening patient self-management education, community-based supportive services and broad-based community mobilization.

Short of legislative measures, how can the millions of Americans seeking to control their weight and improve their health avoid Type 2 diabetes?

Dr. Daniel Stickler of the Apeiron Center for Human Potential in Asheville relates the illness tolifestyle. Type 2 diabetes is not truly a disease, he says.Type 2 diabetes is a lifestyle aspect. You can progress to the point where you actually poison your beta cells in the pancreas after years of being Type 2 diabetic, but it really is a lifestyle. Weve seen plenty of reversals on people that were diabetic or prediabetic that changed their lifestyle and completely reversed the disease without medication.

Stickler saysthat a whole-person approach is needed. Apeiron uses that approach, looking closely at a persons genetics and at about 75 different genomic variations that help predict appetite, hunger and nutrient selection from fats to carbs and proteins.Apeiron tailors diets specifically around a persons genomics, goals and experiences to create a program that is individualized, rather than using a diet from a book.

The problem that you run into is that when you diagnose someone with a disease, they become the disease, Stickler says. The title becomes them, and until they can get to the point where they understand they are not Type 2 diabetes, youre not going to make any progress with them. Were treating it with these medications that arent treating the core cause, which is lifestyle. Its OK to bridge that to get things under control, but the whole focus needs to be on treating the core cause, which is a lifestyle component that has created an insulin resistance in the body. And it is easily reversible.

We have epigenetic coaches that work with clients and read their genetic data, looking at 500 genetic variations and working with sleep, stress, nutrition, exercise and human movement environment, thoughts, etc. So were venturing into all realms in how we address health.

Ways to approach diet, exercise

Banman notes thatMedicare initially covers only three hours a year of dietary intervention and just two hours annually thereafter. This is where support becomes very limited, she says, adding that a majority of her patients arediagnosed in their mid-60s, which makes it difficult for them to get up and get moving. In addition, stress from finances, work and family are debilitating factors, pushing diet and exercise to the bottom of their priorities. Im struck with the layers in their lives that are making things so complicated, and Im very sympathetic to it and help however I can, she says.

Stickler and Banman both recommend the Mediterranean diet, which is in concert with the diabetic diet, according to Banman, and which research has consistently shown to bean effective way to also reduce the risk of heart disease, lower low-density lipoproteins (or bad cholesterol) and lower risks associated with cancer, Parkinsons and Alzheimers diseases.

The American Diabetes Association outlinesa Mediterranean meal plan on itswebsite. Key components of the diet, according to the Mayo Clinic, are limiting red meat;eating fish at least twice a weekand otherwise primarily plant-based food, whole grains and nuts; replacing butter with olive oil; and using herbs and spices instead of salt.

In Buncombe County, residents can address stress, exercise and dietthrough the Diabetes Wellness and Prevention Program offered by the YWCA, a program designed specifically for adults with or at risk for Type 2 diabetes. Preventive health coordinatorLeah Berger-Singer saysthatparticipants are given a gym membership, bimonthly personal training, aweekly support group (which discusses health-related topics such as living healthy on a budget) and tips onstress management. Were aiming to provide access to people that may not otherwise have access to a gym, cooking classes, swim lessons and other options, she says.We also provide monthly dinner lectures or lunch and learns, hands-on cooking demos, field trips and other extracurricular activities.

Chiropractor and yoga instructor J. Anya Harris of Crystalign Chiropractic in Asheville saysthat stress-reduction techniques coupled with group exercise can be keys to combating many diseases, including diabetes.Getting out of your routine and your house and away from your cellphone is really important, she advises. Her approach with patients is to address both spinal health and overall physical health, as well as stress and energy levels. Chiropractic care helps to create arange of motion and mobility, freeing up the body to get patientsto the point where they feel good enough to exercise again or continue exercising, she explains. It also opens up the neural pathways that keep the organs, muscles and spine balanced, she adds. With the energy work, Im shifting relationships and trauma to give them the spark to get them moving. Its all about setting up the mind, body and soul to help them feel at ease in their own skin and really define their why. If you dont know your why, then none of it matters, because you wont stay consistent. The why will give them reframing in their consciousness that will keep them moving toward their goal.

For more information:

Mountain Kidney & Hypertension, 10 McDowell St., Asheville, offers a variety of services, including diet and meal planning for diabetics and services for those suffering from hypertension and kidney disease. 258-8545

The Apeiron Center for Human Potential, 190 Broadway, focuses on preventive wellness, including genomic assessments, epigenetic coaching and human potential assessments and coaching. (888) 547-1444

Crystalign Chiropractic,36 Clayton St., off Charlotte Streetin Asheville, offers head-to-toe chiropractic adjustments, trigger-point muscle therapy, energy work, nutrition analysis and wellness coaching. 335-2208

The YWCAs Diabetes Wellness and Prevention Program operates atthe YWCA in downtown Asheville, offering a comprehensive diabetes program to prevent or reverse the illness.Preventive health coordinator Leah Berger-Singer can be reached at 254-7206, ext.212, or Leah.bs@ywcaofasheville.org.

Originally posted here:
Exercise and a healthy diet help prevent Type 2 diabetes - Mountain Xpress