I have to say that this type of counting is a work in progress. I doubt that there are hard and fast cut offs or rules because each physiology is slightly different. I seem to be able to drop weight at higher carb counts, but if these carbs are coming from more starchy foods like potatoes (rare for me) or higher sugar foods like grapes, Ill stop losing. My preliminary answers to you would be: potatoes definitely count and that goes for sweet potatoes. All potatoes are significant sources of starchy carbs. If you have any type of squash, just count the carbs as per any other food. I discourage legumes in my practice because we focus more on older food sources and legumes are a relatively new one (about 10,000 years old, similar to grain). I am not sure if there would be a difference in effect if you consumed the 100 carbs from foods like legumes and potatoes rather than from fruits or low fat dairy. Perhaps you can tell me! Dr. B.

It doesnt for me because single studies get a lot of attention in the press, but dont prove anything on their own. At best, we can say there is an association between the blood markers that are produced and cardiovascular disease. We cant say they are causative. We also dont know whether primal eaters make this marker. Who is to say why the gut flora are different in meat eaters? Meat eaters in our society are also the ones who are eating a lot of processed food. In addition, we cant say whether these markers would be produced when people eat meats that are raised without grain. There are many questions out there for sure, but for me, this would not change my diet. I dont eat much red meat because I cant get meat that I feel comfortable with (in terms of how it is fed). This wont change my chicken and fish or egg and dairy pattern. Thats just me however.

Hi Chuck, Of course, this all remains very complicated. Your question is the right one. What makes some people process this food as TMAO and others not? Why did the vegans develop a different type of gut flora? And, of course, the even bigger question as to whether TMAO is causative of disease or just associated with it. Research into these areas is incredibly layered and complicated. I also agree with you that it's sad that we are always reaching for a drug. What we should have learned over the last 50 years is that drugs are not solutions, they are simply patches for single problems. In the world of diet and illness we have the opportunity to become more well by cleaning up our nutritional act, but that is usually not the way we prefer to think. A drug solution is most unfortunate, in my view, when we are using it to justify a behavior that is unhealthy but which we are loathe to give up.

Hi Kat, Yes. I believe that one of the major problems we have in controlling weight is our desire to want fixes that allow us to continue eating the things we are addicted to. Intuitive eating approaches would have you believe that you can eat anything, as long as you follow your bodys instructions. I can tell you that even as a very skinny twenty year old with pretty normal eating responses I was not immune to the addictive power of modern stuff. I ate a ton but just was lucky enough to have a physiology that could dispose of it. It is a combination of the foods themselves and our own physiology that messes up the signaling. Most of us know very well that our body will send reasonable signals after a dinner of salmon and salad, but go completely bonkers after bread, pasta or cookies. But we still hope.....I think that most successful maintainers are the people who have faced head on the truth. There is no compromising with modern addictive foods. They have to go. Dr. B.

I venture to say you would change your opinion on this if you spent time, as I do, treating people with obesity. Since their related conditions resolve with weight loss it is very hard to make the case that obesity is not directly involved in harming them. I also take exception to your statement that there are plenty of lean diabetics. That is true in the type I diabetic population, but type I diabetes is a completely different disease that the type two diabetes that is ravaging the world at the moment. The vast majority of type two diabetics are overweight or obese. (80% according to the National Institute of Diabetic and Kidney Disease http://diabetes.niddk.nih.gov/dm/pubs/overview/index.aspx. It appears to be a disease of fat and insulin dysregulation. I would suggest that by giving obesity a pass you are making an argument that is hugely difficult to sustain. I dont know if you are aware of the fact, for example, that visceral adipose tissue gives off a host of measurable inflammatory chemicals and attracts infiltration by white cells which further cause inflammation. These changes lead inflammatory changes in the blood vessels which make them more susceptible to plaque accumulation. Or that the high insulin levels that come along with obesity and insulin resistance also provoke the release of IGF, insulin growth factor, a stimulant to cancer growth. There are innumerable, well documented, direct negative results of obesity....not in every overweight or obese person, but in enough of them to cause significant, serious health consequences. It appears that you would prefer not to believe this. That is your right of course and your judgement. But before you make up your mind, please make sure you have familiarized yourself with the science as we currently know it. If you then think its all alot of baloney, thats certainly your call to make.

Hi Valerie, While there are a few people out there who still beiieve that obesity is not a health issue (see the writing of Paul Campos, an attorney for example) these people are not physicians or scientists. Obesity is directly related to diabetes, hypertension, insulin resistance, cancer, heart disease, stroke, high lipids and a slew of other medical issues. In other words, just about everything that causes modern illness and death from preventable causes is an offshoot of obesity. The current estimated death rate from obesity in the US is close to, or exceeds that from smoking...estimated at about 300,000 deaths per year. http://www.nytimes.com/2004/03/10/us/death-rate-from-obesity-gains-fast-on-smoking.html. I refer you to the following CNN piece, based on a global study in the Lancet, one of the most prestigious medical journals in the world. http://www.cnn.com/2012/12/13/health/global-burden-report . Being worried about the way we eat and our size is not meant to trivialize hunger. Hunger still exists and must be dealt with in many parts of the world. But death, disability and the bankrupting of our health system from preventable disease are real consequences of the obesity epidemic. Not inventions. Dr. B.

Thanks Jan! I think you will find that it actually works quite beautifully. But be tough, not moderate. Thats the key.

Hi Sheri, Over many, many years I have found that the reason diets dont work is that they dont have a way to get low enough in calories and they are not followed consistently. Take a look at my post on Why Your Weight Loss Diet Isnt Working . Hope that this helps. I definitely believe that using meal replacements like medifast or other protein shakes allows many people to get calories low enough. Its very hard to get accurate calorie lowering when eating food that is of variable source and amount. One optimistic thing that I can tell you is that many people come to our clinic saying that it is impossible to lose weight for them, yet they always do when they are on the right plan. Barbara

Absolutely. Its great to have the evidence produced by a reputable journalist. I like to say this to the teens I sometimes treat. You think you are being all counter-culture by eating chips and junk, but in fact, you are playing right into the hands of the fat cats in your parents generation. What a joke on you! B