Found two more studies measuring diet pattern and mood disorders!
The first one is Dietary pattern and depressive symptoms in middle age from the British Journal of Psychiatry in 2009 (free full text, go take a look!). This paper is part of the large Whitehall II epidemiological study, where some 10,000 people were screened at baseline (phase 1) for all sorts of demographic characteristics, stress levels, health, lifestyle factors, blood pressure, and some labwork. Every 2&1/2 years or so, the study subjects received a postal questionnaire to fill out (phases 2,4,6,8), and every 5 years a questionnaire and a clinical examination were done (phases 3,5,7). In this paper, the data was taken from 3486 White European participants with data on dietary patterns and all covariates at phase 5 and depression at phase 7. The 175 Black and 331 Asian participants were excluded due to "differences in eating patterns." (!!!)
Dietary "pattern" was determined by a Food Frequency Questionnaire based on the one used in the Nurses Health Study (but changed up to include British sorts of foods - like bangers and mash, or crisps, or yorkshire pudding). Here's a good write-up addressing the (actually rather rigorous, but still hopeless) validity of the FFQ used in the Nurses Health Study. 127 food items were rated according to how often they were consumed - "never or less than once per month" up to "six or more times per day" - the 127 items were divided into 37 groups, and dietary patterns were identified using "principal component analysis" of the 37 groups, and statisticians gleefully addressed the data with graphs and scree plots and tweaks and nudges until a score pops out about each person's diet, falling into "whole foods" or the "processed foods" patterns.
"Whole foods" were diets consisting of vegetables, fruits and fish.
"Processed foods" were diets consisting of "high consumption of sweetened desserts, chocolates, fried food, processed meat, pies, refined grains, high fat dairy products, and condiments."
Depression measures were determined by a 20 question "Center for Epidemiologic Studies Depression Scale." People with a score higher than 15 were considered depressed.
Then the statisticians got a whack at the data again, adjusting for covariates such as age, gender, marital status, employment grade, education, smoking, physical activity, health status (based on clinical findings such as a high hemoglobin A1C (a measure of average blood glucose), blood pressure, being on antidepressants, etc.), a second "GHQ" depression subscale, and a cognitive score based on 65 question test.
Ready for the results yet? What do you think will turn out?
Patients with the highest intake of whole foods were less likely to be depressed (and this association wasn't affected much, actually, by adjusting for all the covariates, which is interesting - suggesting that the association with diet could be as important or more important than all those other covariates.). Patients with a high intake of processed food were much more likely to be depressed.
There is another interesting thing about this study. See, from just the above data, you don't know whether depressed people are too blue to do anything but sit around gorging on meat pies, sugar, and refined grains, or if the diet actually leads to the depression. The depression measures were repeated at phase 5 and phase 7, and when the 427 participants who were depressed at stage 5 were excluded, the data showed that the same people who had crappy diets but were not depressed (yet) at phase 5 were more likely to be depressed at phase 7. In addition, the researchers went back to the phase 3 data, and found no evidence that the dietary patterns in phase 5 were worse for the participants who were depressed at phase 3. These are clues that crappy diet precedes depressive symptoms, not the other way around.
All in all, a rather cool study, considering the limitations of epidemiology.
The second study is hot off the presses - Diet quality in bipolar disorder in a population-based sample of women from the Journal of Affective Disorders (I think this is the November issue - these are the corrected proofs available online before print). The subjects used were women from the Australian Geelong Osteoporosis Study (I blogged about them back in June). 1046 women randomly recruited from compulsory voting roles volunteered for this particular piece of the study. Each of the women were given the gold standard interview for diagnosis of psychiatric disorders - the SCID (non-patient edition). Patients with depression or anxiety were excluded, allowing for patients with bipolar disorder to be compared to those with no current (or lifetime) psychopathology.
Once again, a food frequency questionnaire was used, and the diets were broken up into "traditional" (vegetables, fruit, beef, lamb, fish, whole grains), "western" (meat pies, processed meats, pizza, chips, hamburgers, white bread, sugar, flavored milk drinks, and beer), and "modern" (fruits, salads, fish, yogurt, nuts, beans, tofu, and red wine). Blah blah blah logistic regression analyses and exposure variables were studiously applied and accounted for (can you tell I'm not an epidemiologist?).
Here's an interesting tidbit that I don't remember from the previous paper I blogged about in June - the researchers note that it was the absolute amount of western style foods that seemed to be related to the risk of depression rather than the amount as a proportion of overall energy consumption. Therefore, the researchers examined the data in this grouping as both absolute amounts, percentage of energy, and covariate confounding. Whew.
Bipolar disorder is less common than depressive or anxiety disorders, so only 23 women in the whole study qualified for the diagnosis (there were 332 with depression or anxiety and therefore excluded from this analysis, and 691 without depressive or anxiety disorders). Participants with bipolar disorder were younger and had higher average daily energy intake, though there was no difference in education, BMI, alcohol intake, education, socioeconomic status, smoking, and physical activity compared to those with no psychopathology. (Interesting - bipolar disorder and substance abuse are highly correlated so it is something to keep in mind that these 23 bipolar ladies didn't seem to smoke or drink more than the 691 "normals.")
Now the diet results! Individuals with a "modern" pattern were more likely to have a diagnosis of bipolar disorder, as were individuals with a "western" pattern, before and after adjustments for energy intake. A "traditional" dietary pattern was protective. These data held even when accounting for age.
As in the previous study (which I addressed in the comments in my previous blog post), the diets were also given a total "DQS" or dietary quality score, associated with how close the diets came to the national recommendations for good diets (similar to the USDA recommendations). DQS score of diets had no correlation with bipolar disorder, protective or not protective.
Overall, the authors noted (as I do now!) that the association with depressive, anxiety, and bipolar disorders are similar - a "traditional" diet being protective, and modern and western diets being similarly dismal. My theory is that an individual's response to diet would be based on genetic risk, so the inflammation level related to similar dietary choices would come out as different psychopathology depending on your genes.
The authors of the second study make note of the results of the first study I mentioned above - they think diet is causative, not a choice as a result of specific psychiatric illness. They note systemic inflammation, oxidative stress, and neurotrophin levels as potential explanations of the demonstrated associations between dietary quality and bipolar disorder. I agree. Wholeheartedly.
Eat real food, folks. It won't hurt. And maybe it will help.
Showing posts with label nutrition. Show all posts
Showing posts with label nutrition. Show all posts
Thursday, October 7, 2010
Monday, June 21, 2010
Cravings and Processed Food Woo Woo
David Kessler wrote an interesting book last year called The End of Overeating, in which he examined the nature of the food industry in America today and how it might contribute to overeating and obesity. Kessler's book takes up where Fast Food Nation left off - Fast Food Nation will make you never want to eat at a fast food restaurant again, (and also, since reading it I've used as much sterile technique as I can in handling industrial beef and chicken in my own kitchen.) The End of Overeating examines many of the menu items and advertising for our favorite chain restaurants (Chilis, TGI Fridays, those sorts of places), noting that most of the food is purposefully made "hyperpalatable" with generous heapings of fat, salt, and sugar. He contends that this combination short-circuits our appetite regulatory system, so we eat more and more, and begin gaining weight, when weight gain has been such an unusual problem historically for the human species.
I agree that the types of food (particularly wheat, sugar, vegetable oils, and other highly refined carbohydrates) seem to drive us into addictive behaviors when it comes to eating (and as I mentioned in the Wheat and Schizophrenia post, there is some biological evidence that gluten and beta casein A1 activate opiate receptors). All the pretty, pretty advertising with those short ribs dripping in sugar and doesn't help get the message across that those short ribs (or really, the sugary sauce) should be a special treat, rather than a daily indulgence. But at the heart of the idea that the industry is manipulating our food and our eating is still that idea that we are weak, that we are gluttons, and if only we could get ourselves in hand, we wouldn't be fat. That the food industry is playing to our weakness and leading us along the path to disease and obesity.
We aren't weak. And guess what, if you are obese, it is not because you are a glutton. It really is your glands (if one can use 'glands' in a broad sense to encompass the hormonal environment and appetite regulatory systems). Really. And the only way that obesity is genetic is that some people will be more vulnerable to the hormonal impact of all the trashy food we eat that is not actually, truly, fit for human consumption. Stick to whole, real food and ditch the wheat, vegetable oil, and sugar (and if you are obese, cut down your carbohydrates in general), and you don't have to worry about bowing to food industry's every whim.
"Naturally" skinny folks - even you (unless you are extremely lucky) will slowly, inevitably put on visceral fat over the years on a Western diet. Half the people who die of heart attacks aren't obese. At least those of us who tend to put on a bit of fat have an early warning sign and, perhaps, a bit more motivation to get cracking on cleaning up our foods.
But there is that little niggling fact that there are addictive qualities to processed modern foods. And when you are newly breaking the habit, or if you are feeling emotionally overwhelmed, it can be easy to slip back into the happy world of drippy sugar sauce and shiny, shiny glazed doughnuts.
The End Of Overeating's most interesting message, I think, is in the idea of "food rehab." He recommends the most effective behavioral method around (and an ancient method designed to keep us from eating poisonous things!) for conquering cravings - disgust. What has helped for me is a reading/educational program (hardly sexy - it's not a 5 day diet or a juice fast - it's a reading/educational program!). Fast Food Nation, Michael Pollan's books, Food Inc., The End of Overeating, Good Calories, Bad Calories, and The Unhealthy Truth will get you hopping mad, and sickened. When you get the idea drilled into your head that processed sugar/vegetable oil bombs are actually poison, and that little bit of bile rises to the back of the throat when you think about eating them, the cravings ain't so bad. Read about The Lady's Brunch Burger, preferably after you have eaten a large, satisfying meal. If you are the kind who gets fired up about corporate conspiracy and the government's seeming lack of protection of our interests (for example, our health), then these books are the books for you.
And if you are the kind of person who must have what you "cannot" have, remember, the paleo way of eating is not about being a martyr. It's about eating food we're evolved to eat most of the time to hopefully reduce the risks of western disease. It doesn't mean you can never have a shiny, shiny glazed doughnut again. It will throw your hormones out of whack for a bit, and if you are trying to lose fat, it will slow the process down. But in the whole scheme of the million calories we consume over the year, that Sunday morning doughnut is not such a big deal. Don't be surprised, however, if it doesn't appeal to you after a while. And that's okay too.
(And now a little side rant about what the nutritional guidelines have done to our food - all those sad skinless chicken breasts and "lite" vegetable oil dressings... they made real food the enemy, when it has nurtured and sustained us for thousands of generations. Science is a powerful tool, but if you don't have common sense, it will lead you very far astray.)
Off to have a square of chocolate now. Remember, chocolate is a vegetable (70% cacao and higher, that is).
I agree that the types of food (particularly wheat, sugar, vegetable oils, and other highly refined carbohydrates) seem to drive us into addictive behaviors when it comes to eating (and as I mentioned in the Wheat and Schizophrenia post, there is some biological evidence that gluten and beta casein A1 activate opiate receptors). All the pretty, pretty advertising with those short ribs dripping in sugar and doesn't help get the message across that those short ribs (or really, the sugary sauce) should be a special treat, rather than a daily indulgence. But at the heart of the idea that the industry is manipulating our food and our eating is still that idea that we are weak, that we are gluttons, and if only we could get ourselves in hand, we wouldn't be fat. That the food industry is playing to our weakness and leading us along the path to disease and obesity.
We aren't weak. And guess what, if you are obese, it is not because you are a glutton. It really is your glands (if one can use 'glands' in a broad sense to encompass the hormonal environment and appetite regulatory systems). Really. And the only way that obesity is genetic is that some people will be more vulnerable to the hormonal impact of all the trashy food we eat that is not actually, truly, fit for human consumption. Stick to whole, real food and ditch the wheat, vegetable oil, and sugar (and if you are obese, cut down your carbohydrates in general), and you don't have to worry about bowing to food industry's every whim.
"Naturally" skinny folks - even you (unless you are extremely lucky) will slowly, inevitably put on visceral fat over the years on a Western diet. Half the people who die of heart attacks aren't obese. At least those of us who tend to put on a bit of fat have an early warning sign and, perhaps, a bit more motivation to get cracking on cleaning up our foods.
But there is that little niggling fact that there are addictive qualities to processed modern foods. And when you are newly breaking the habit, or if you are feeling emotionally overwhelmed, it can be easy to slip back into the happy world of drippy sugar sauce and shiny, shiny glazed doughnuts.
The End Of Overeating's most interesting message, I think, is in the idea of "food rehab." He recommends the most effective behavioral method around (and an ancient method designed to keep us from eating poisonous things!) for conquering cravings - disgust. What has helped for me is a reading/educational program (hardly sexy - it's not a 5 day diet or a juice fast - it's a reading/educational program!). Fast Food Nation, Michael Pollan's books, Food Inc., The End of Overeating, Good Calories, Bad Calories, and The Unhealthy Truth will get you hopping mad, and sickened. When you get the idea drilled into your head that processed sugar/vegetable oil bombs are actually poison, and that little bit of bile rises to the back of the throat when you think about eating them, the cravings ain't so bad. Read about The Lady's Brunch Burger, preferably after you have eaten a large, satisfying meal. If you are the kind who gets fired up about corporate conspiracy and the government's seeming lack of protection of our interests (for example, our health), then these books are the books for you.
And if you are the kind of person who must have what you "cannot" have, remember, the paleo way of eating is not about being a martyr. It's about eating food we're evolved to eat most of the time to hopefully reduce the risks of western disease. It doesn't mean you can never have a shiny, shiny glazed doughnut again. It will throw your hormones out of whack for a bit, and if you are trying to lose fat, it will slow the process down. But in the whole scheme of the million calories we consume over the year, that Sunday morning doughnut is not such a big deal. Don't be surprised, however, if it doesn't appeal to you after a while. And that's okay too.
(And now a little side rant about what the nutritional guidelines have done to our food - all those sad skinless chicken breasts and "lite" vegetable oil dressings... they made real food the enemy, when it has nurtured and sustained us for thousands of generations. Science is a powerful tool, but if you don't have common sense, it will lead you very far astray.)
Off to have a square of chocolate now. Remember, chocolate is a vegetable (70% cacao and higher, that is).
Sunday, June 20, 2010
Vegetable Oils and our Brave New World
A quick review of the basic premise, this new lens through which I examine nutrition, general health, and mental health: humans beings will have the best chance of good physical and mental health by staying true to the diet and activities that we are evolved for. Let's get back to diet for the moment and focus on some of the differences between what we eat today, and what physically healthy peoples and cultures ate. Much of the following information is taken from Food and Western Disease (never leave home without it).
We know from several hundred years of good observation and anthropology that healthy peoples ate a wide variety of different foods, with vastly differing percentages of macronutrients (primarily differences in carbohydrates and fats - protein is usually around 15-30% of calories). The types and quality of the food they ate, however, universally differed from our current diet in the following ways:
1) no wheat, and if grain-based the grains are carefully prepared to minimize antinutrients
2) minimal amounts of omega 6 fatty acids balanced with omega 3 fatty acids (or vast amounts of omega 3)
3) reliance on whole foods with no industrial processing (therefore no highly refined carbohydrates or sugar other than perhaps seasonal raw honey and wild fruits)
In my opinion, one doesn't need to understand the science or biochemistry of these differences to go forward with a paleolithic-style diet based on the time-tested diets of healthy cultures. However, I'm interested in what it is about these differences that might cause Western disease.
I'm going to focus on #2 at the moment, and introduce a fading star of the "heart-healthy diet," vegetable oils. (Or not so fading star - this recent article trumpets vegetable oil as the second coming, though, as always, Stephan at Whole Health Source has a reasoned review.)
Corn oil, safflower oil, sunflower oil, peanut oil and/or soybean oil are ingredients in pretty much all processed food. Just check the list on the back. They are in breakfast cereal, bread and other baked goods, and also in fried items, salad dressings, mayonnaise, sauces, and are used (along with canola oil) in the fryers at most restaurants. They are cheap and relatively tasteless, which makes them perfect for certain industrial and restaurant food applications. They are also universally high in omega 6 fatty acids, and therefore we eat a ton of them in the Western diet, especially since throwing out butter, lard, and beef tallow 30-40 years ago.
How could this possibly matter? Omega 6 fatty acids are a type of PUFA (polyunsaturated fatty acid), which are required by the body to make certain hormones and signaling molecules. Omega 6 PUFAs are "essential" fatty acids - we can't make these signaling molecules without them, and we need them to live. PUFAs are made into HUFAs (highly unsaturated fatty acids - which isn't all that vital to this discussion but I like to say 'HUFA'), and omega 6 PUFAs (in particular linoleic acid) are made into the HUFA arachidonic acid. Arachidonic acid (AA) is the precursor for all sorts of *inflammatory* signaling molecules, including (as an example) COX-1 and COX-2 (which are blocked by ibuprofen and other NSAIDS that decrease pain and inflammation). (Here is a very understandable review of eicosanoids.)
Too much inflammation mediated by a high dietary percentage of the omega 6 fatty acid linoleic acid (the predominant fatty acid in corn oil) can be reasonably associated with coronary vascular disease, insulin resistance, cancer, hypothyroidism and other autoimmune diseases, thrombotic stroke, headaches, asthma, arthritis,(1) melanoma, depression, and psychosis.
But why do I keep harping on "balance" and those omega 3 PUFAs? Well, turns out the omega 3s (wild fish oil is the best source, but it is also available in grass-fed animal fat, other kinds of seafood, flax, and in more balanced levels with omega 6 in walnuts and macadamia nuts) compete in the body with the omega 6s in every which way. Omega 3s are precursors for anti-inflammatory signal molecules (which, obviously, counteract the inflammatory signal molecules). We can only store so much of either, so if we eat omega 3, we displace some of the omega 6 from our systems. Supplementing with omega 3 fatty acids has been shown to be beneficial in a number of major diseases (2). Again, we need both to survive, but if we max out on the omega 6 without any omega 3, we end up with a highly inflammatory soup of chemicals stored and floating around in our bodies predisposing us to that list again - cancer, diabetes, obesity, depression, heart disease, and autoimmune diseases.
Here are some numbers from Food and Western Disease about ratios of of omega 6 to omega 3 fatty acids in different populations (from page 46):
Omega 6/ Omega 3 ratio
Coastal fishing populations: <1
Hunter-gatherers: 2-3
Greece in the 1900s: 2
Japan today: 4
Northern Europe today: 15
USA today: 17
And here's the real kicker about the modern diet - first we load ourselves up with vegetable oils to create a large reservoir of pro-inflammatory molecules, and then add a soup of what are thought to be highly allergenic and pro-inflammatory proteins (gluten, gliadin, beta casein A1, proteins from peanuts and similar proteins from genetically modified soy, etc. etc.). Our modern diseases can almost always be linked back to inflammation of some kind. In my mind, this combination explains why my schedule is full every day.
How can you eat less omega 6 and more omega 3? One way is to eat more paleo. Get rid of the processed food. Use olive oil and vinegar instead of supermarket salad dressing. Balance out nuts (relatively high in omega 6 too) with some fish oil from wild caught fish. Poultry fat is relatively higher in omega 6, so eat grass fed beef and wild caught fish in a nice balance with your chicken and turkey.
And here's where I really part ways with the Grand Poohbahs of nutritional recommendations - you can eat more saturated fat. (Really. It won't kill you.) Instead of baking with industrial seed oils, use butter or coconut oil. They are neutral players in the omega 3 omega 6 fat war, and plenty of healthy cultures eat a reasonable or even high amount of saturated fat (the Masai, the Kitavans, the Tokelau) and they don't drop dead of heart attacks at age 50. Or 75. Pastured butter, bone marrow, and other yummy, more traditional treats are high in saturated fats are also the best sources of some vitamins we need but just don't get in our modern diet. But more on that later.
See, here's what has happened with the nutritional recommendations over the years. First we were told not to eat saturated fat and foods high in cholesterol. It was figured out almost immediately that foods high in cholesterol (such as eggs) don't cause heart disease or even elevated cholesterol in humans, but that was deemed confusing, so the message changed to don't eat saturated fat. At first everyone was moved over to the PUFAs - vegetable oils, including all that deadly trans fat margarine, but then it was discovered that PUFAs cause cancer and trans fats are horrible, so the message switched to 'eat low fat!' We're fairly restricted in the amount of protein we can eat anyway, so a low fat diet is therefore very high in carbohydrates (our particularly vicious mix of sugar and wheat). Then everyone following this advice got REALLY fat and diabetes incidence exploded. So THEN there was more backpedaling, and the message has changed to "healthy fats" (the omega 3s and olive oil), and "whole grains" (which when eaten without careful preparation as we eat them now *may* contribute to the problem) of a Mediterranean diet. (Though a true Mediterranean diet has plenty of saturated fat too. Cheese. Butter. France. Synonymous.) And consider that most of the disease states I'm looking at require two hits from the diet to make them happen - for example, wheat lectins to open the gut, and casein protein in the blood to predispose beta cells to autoimmune destruction in type one diabetes.
But one can see that all these nutritional recommendations backflip over themselves to catch up with science, and everyone is confused, sick, fat, and unhappy. But one doesn't need to stress over food, or make food the enemy. All one has to do is to go to a basic, default paleo style diet and then add in more modern foods (such as dairy) based on observations from other cultures (like the Masai) who ate them and don't have the diseases of modern civilization. All the work has already been done for us! We just have to pay attention.
We know from several hundred years of good observation and anthropology that healthy peoples ate a wide variety of different foods, with vastly differing percentages of macronutrients (primarily differences in carbohydrates and fats - protein is usually around 15-30% of calories). The types and quality of the food they ate, however, universally differed from our current diet in the following ways:
1) no wheat, and if grain-based the grains are carefully prepared to minimize antinutrients
2) minimal amounts of omega 6 fatty acids balanced with omega 3 fatty acids (or vast amounts of omega 3)
3) reliance on whole foods with no industrial processing (therefore no highly refined carbohydrates or sugar other than perhaps seasonal raw honey and wild fruits)
In my opinion, one doesn't need to understand the science or biochemistry of these differences to go forward with a paleolithic-style diet based on the time-tested diets of healthy cultures. However, I'm interested in what it is about these differences that might cause Western disease.
I'm going to focus on #2 at the moment, and introduce a fading star of the "heart-healthy diet," vegetable oils. (Or not so fading star - this recent article trumpets vegetable oil as the second coming, though, as always, Stephan at Whole Health Source has a reasoned review.)
Corn oil, safflower oil, sunflower oil, peanut oil and/or soybean oil are ingredients in pretty much all processed food. Just check the list on the back. They are in breakfast cereal, bread and other baked goods, and also in fried items, salad dressings, mayonnaise, sauces, and are used (along with canola oil) in the fryers at most restaurants. They are cheap and relatively tasteless, which makes them perfect for certain industrial and restaurant food applications. They are also universally high in omega 6 fatty acids, and therefore we eat a ton of them in the Western diet, especially since throwing out butter, lard, and beef tallow 30-40 years ago.
How could this possibly matter? Omega 6 fatty acids are a type of PUFA (polyunsaturated fatty acid), which are required by the body to make certain hormones and signaling molecules. Omega 6 PUFAs are "essential" fatty acids - we can't make these signaling molecules without them, and we need them to live. PUFAs are made into HUFAs (highly unsaturated fatty acids - which isn't all that vital to this discussion but I like to say 'HUFA'), and omega 6 PUFAs (in particular linoleic acid) are made into the HUFA arachidonic acid. Arachidonic acid (AA) is the precursor for all sorts of *inflammatory* signaling molecules, including (as an example) COX-1 and COX-2 (which are blocked by ibuprofen and other NSAIDS that decrease pain and inflammation). (Here is a very understandable review of eicosanoids.)
Too much inflammation mediated by a high dietary percentage of the omega 6 fatty acid linoleic acid (the predominant fatty acid in corn oil) can be reasonably associated with coronary vascular disease, insulin resistance, cancer, hypothyroidism and other autoimmune diseases, thrombotic stroke, headaches, asthma, arthritis,(1) melanoma, depression, and psychosis.
But why do I keep harping on "balance" and those omega 3 PUFAs? Well, turns out the omega 3s (wild fish oil is the best source, but it is also available in grass-fed animal fat, other kinds of seafood, flax, and in more balanced levels with omega 6 in walnuts and macadamia nuts) compete in the body with the omega 6s in every which way. Omega 3s are precursors for anti-inflammatory signal molecules (which, obviously, counteract the inflammatory signal molecules). We can only store so much of either, so if we eat omega 3, we displace some of the omega 6 from our systems. Supplementing with omega 3 fatty acids has been shown to be beneficial in a number of major diseases (2). Again, we need both to survive, but if we max out on the omega 6 without any omega 3, we end up with a highly inflammatory soup of chemicals stored and floating around in our bodies predisposing us to that list again - cancer, diabetes, obesity, depression, heart disease, and autoimmune diseases.
Here are some numbers from Food and Western Disease about ratios of of omega 6 to omega 3 fatty acids in different populations (from page 46):
Omega 6/ Omega 3 ratio
Coastal fishing populations: <1
Hunter-gatherers: 2-3
Greece in the 1900s: 2
Japan today: 4
Northern Europe today: 15
USA today: 17
And here's the real kicker about the modern diet - first we load ourselves up with vegetable oils to create a large reservoir of pro-inflammatory molecules, and then add a soup of what are thought to be highly allergenic and pro-inflammatory proteins (gluten, gliadin, beta casein A1, proteins from peanuts and similar proteins from genetically modified soy, etc. etc.). Our modern diseases can almost always be linked back to inflammation of some kind. In my mind, this combination explains why my schedule is full every day.
How can you eat less omega 6 and more omega 3? One way is to eat more paleo. Get rid of the processed food. Use olive oil and vinegar instead of supermarket salad dressing. Balance out nuts (relatively high in omega 6 too) with some fish oil from wild caught fish. Poultry fat is relatively higher in omega 6, so eat grass fed beef and wild caught fish in a nice balance with your chicken and turkey.
And here's where I really part ways with the Grand Poohbahs of nutritional recommendations - you can eat more saturated fat. (Really. It won't kill you.) Instead of baking with industrial seed oils, use butter or coconut oil. They are neutral players in the omega 3 omega 6 fat war, and plenty of healthy cultures eat a reasonable or even high amount of saturated fat (the Masai, the Kitavans, the Tokelau) and they don't drop dead of heart attacks at age 50. Or 75. Pastured butter, bone marrow, and other yummy, more traditional treats are high in saturated fats are also the best sources of some vitamins we need but just don't get in our modern diet. But more on that later.
See, here's what has happened with the nutritional recommendations over the years. First we were told not to eat saturated fat and foods high in cholesterol. It was figured out almost immediately that foods high in cholesterol (such as eggs) don't cause heart disease or even elevated cholesterol in humans, but that was deemed confusing, so the message changed to don't eat saturated fat. At first everyone was moved over to the PUFAs - vegetable oils, including all that deadly trans fat margarine, but then it was discovered that PUFAs cause cancer and trans fats are horrible, so the message switched to 'eat low fat!' We're fairly restricted in the amount of protein we can eat anyway, so a low fat diet is therefore very high in carbohydrates (our particularly vicious mix of sugar and wheat). Then everyone following this advice got REALLY fat and diabetes incidence exploded. So THEN there was more backpedaling, and the message has changed to "healthy fats" (the omega 3s and olive oil), and "whole grains" (which when eaten without careful preparation as we eat them now *may* contribute to the problem) of a Mediterranean diet. (Though a true Mediterranean diet has plenty of saturated fat too. Cheese. Butter. France. Synonymous.) And consider that most of the disease states I'm looking at require two hits from the diet to make them happen - for example, wheat lectins to open the gut, and casein protein in the blood to predispose beta cells to autoimmune destruction in type one diabetes.
But one can see that all these nutritional recommendations backflip over themselves to catch up with science, and everyone is confused, sick, fat, and unhappy. But one doesn't need to stress over food, or make food the enemy. All one has to do is to go to a basic, default paleo style diet and then add in more modern foods (such as dairy) based on observations from other cultures (like the Masai) who ate them and don't have the diseases of modern civilization. All the work has already been done for us! We just have to pay attention.
Thursday, June 17, 2010
Eat What You Want**, Lose Fat, and Keep it Off Forever
** except for a few foods which currently constitute 60% of the standard American diet
(disclaimer again - I'm not your doctor - you may have a particular medical condition so that this information does not apply to you. Talk to your doctor if you have questions, but make sure he/she knows what the Friedewalde equation is!)
All you have to do is follow a few dietary rules to be more hunter gatherer in your eating:
1) Eat veggies. May substitute fruits sometimes, but most of the time it should be veggies. Prepare the veggies any way you like, and most people can use coconut oil and butter (from pastured sources is preferred).
2) Eat protein several times a day, too. It is preferable for it to be wild caught fish, organic poultry (or pork, for most people), shellfish and shrimp, omega 3 or organic eggs or grass fed beef, bison, buffalo, goats, venison, etc.
3) Snacks can be nuts, veggies, fruit, veggies with almond butter - that sort of thing.
4) Avoid (for the most part) soy, peanuts, grains, corn, and any processed food or added sugar.
5) Avoid all processed vegetable oils (watch those salad dressings, and "real" mayonnaise at the store is soybean oil! Use olive oil and lemon juice or vinegar!)
6) Keep your dairy high fat, fermented if possible, and try not to have it for every single meal.
7) Avoid alcohol (for the most part)
*Now a few simple lifestyle rules:
1) Get plenty of sleep
2) Move around (I'll have another post on exercise with more details)
3) Don't get too stressed (Build anti-stress/enjoyable time into your daily life)
*A few specifics on medical conditions/medications which may affect these rules:
1) Antihypertensive medication: Most people who start to eat this way decrease their salt consumption dramatically (no processed food), and the weight loss can lead to lower blood pressures fairly quickly. Keep your pressure monitored and consult your doctor.
2) Diabetes - especially type II, on any sulfonylurea medications (glipizide (glucotrol) and glyburide (micronase) are the most common, but there are several more): Dropping your carbohydrates like this can lead to low blood sugars if you are on these medicines, which cause your pancreas to secrete more insulin. So again, consult with your doctor!
3) Any condition for which you have to be on coumadin (warfarin) - A diet high in veggies can increase vitamin K, which will make your coumadin less effective. A diet high in omega 3s relative to omega 6 fatty acids will make you more likely to bleed (omega 6 fatty acids are pro-thrombic and omega-3s tend to displace them in the diet and in tissues). So again, go slowly (see below), keep the INR in check, and CONSULT WITH YOUR DOCTOR.
4) Advanced Ischemic Heart Disease and Severe Type II Diabetes - *some* evidence suggests saturated fats may actually be bad for you. Focus on the olive oil and fish oil, and keep in mind that most animal fats (the fat on your steak and in your chicken skin) are actually very high in oleic acid (same fat as olive oil) and other "cholesterol neutral" fats. Plain old saturated fat would include: coconut and palm oil, high fat dairy, butter, beef tallow, lard. This advice may change as the science on this subject is expanding far more rapidly than the "official" advice. But even Staffan Lindeberg, my paleonutrition guru, advises against loads of saturated fat with these conditions. I'll have a whole post on this once I do more research and wrap my head around the theory of lipotoxicity. However, I must admit I am exasperated with the cognitive dissonance between the official recommendations and what might actually work to help improve insulin resistance and reduce atherosclerosis. As near as I can tell, the official way to eat recommended to diabetics is moderate or low carb, lots of fiber, and low in animals and animal fat. This means you are pretty much limited to salad, skinless chicken breasts, olive oil, and wood chips (fiber), with some token whole grains, potato, or fruit thrown in. But the truth of the matter is, we can either be low carb OR low fat. Protein can't really change that much. Wood chips are not a viable substitution for fat. Sigh. I'm a psychiatrist, and this kills me. I'm not sure how the heads of nutritionists, cardiologists, and endocrinologists just don't explode.
*How to Start Slowly:
Not ready to take the full plunge? Still have lots of pasta in the pantry?
1) Start by ditching the processed food, meaning anything with 10 zillion ingredients and anything with high fructose corn syrup in it. Get rid of fruit juice, soda, and other added sugars. Take your coffee black or with cream, switch to a touch of honey (preferably raw) instead of sugar. Reduce the amount of honey over time. Use real maple syrup on your pancakes. You'll use less because it costs more.
2) After you're comfortable with that, then reduce the grains/sugars to one meal a day. The other meals should follow the simple dietary rules. Your best bet is to have the high-carb meal happen within a two hour window after you exercise. Your worst bet is to have your high-carb meal every morning for breakfast. If you want a sugary treat, eat it within 30 minutes after exercise.
3) Then clean up your grains. Wheat is probably the worst offender, wild rice and quinoa are the least, though you can pack on quite a carb load with an anemic-looking amount of rice. Get rid of any non-organic sources (the others will be genetically modified which *may* have autoimmune implications - until they are more thoroughly tested, why risk it?). Corn may be more or less okay, but in processed food usually comes with a lot of corn oil, which is horrible. Sorry.
*I'm following all your rules and I'm still not losing weight!!
1) What is your insulin status? You may be sensitive to too many carbohydrates (if you have excess abdominal fat, love handles, high blood pressure, have trouble losing weight, and you've been eating the standard American diet, you're probably a bit insulin resistant). First, ditch any remaining grains. Then decrease the amounts of more sugary fruits like apples, oranges, bananas, pineapples - you're better off with lower carb fruits like plums, peaches, figs, those kinds of things, and then only once a day or every few days.
2) Are you intolerant to lactose or casein? Get rid of the dairy (except eggs) and see what happens.
3) Are you following the lifestyle rules too? Diet is probably only 80% of fat loss.
4) Are you vitamin D deficient?
5) Are you eating too much protein? If you are packing in five pounds of porterhouse a day, you could be making glucose via gluconeogenesis, resulting in fat gain.
*I'm following all your stupid rules, and I feel like crap!!
1) A sudden drop in carbohydrates can cause some people to feel sick and tired and grouchy. This can happen even without ketosis (which won't generally happen with the amount of carbohydrates you would eat from having lots of veggies and fruit). This usually passes within a couple of days, (after which you will tend to feel energetic, clear-headed, and fabulous) but go to the "How to Start Slowly" section if you like.
*Wait a minute - where are the portion sizes and calorie counts?
1) Hunter gatherers did not have FitDay. And many modern hunter gatherer societies have plenty of food about - no malnutrition, and yet still they are effortlessly slim. Our appetites regulate themselves, as long as we don't have foods about which likely throw off our hormonal appetite regulation (added sugar and wheat are the most likely culprits). Don't go hungry. If you are hungry, eat. If you aren't hungry, you don't have to eat. If you're like me, you might not trust your natural appetite after watching your food closely for a long time. Then go for a pile of veggies and a palm-sized amount of protein. The rest will take care of itself.
*I want a cookie!!!!!
Eat a cookie.
No, seriously, eat a cookie. The way of eating detailed above puts us into a fat-burning metabolic mode. As long as you spend the majority of your time eating according to the rules, you should be in fat-burning mode most of the time, and a cookie ain't gonna hurt much. You will be out of fat-burning mode for a few hours. Big deal. If you are insulin resistant, it will be harder to get into fat-burning mode, and harder to get out of fat-storing mode. So a cookie is going to do your diet more harm than someone who is insulin sensitive.
* The American Heart Association Or Other Official Grand Poohbas say that vegetable oils are fine and are preferred to animal fats! Why is that?
They are trying to get you to decrease the amount of saturated fat you eat by replacing it with vegetable oil. Corn oil will lower your total cholesterol lickety split, but here's a gem of an old study dug up on Hyperlipid showing it may also kill you and cause diabetes (1). I personally think it is unfortunate advice, as the seed oils such as corn oil are high in omega-6 and will cause your omega-3s and omega-6s to be out of balance, and this is most likely very bad for both your health and your brain. I'll do another post on the specifics of the PUFA fat balance.
* Won't I be missing vital vitamins and minerals if I am not eating grains?
No. You won't be. Tells you how important grains are to good health. If you drop grains, you don't need a single vitamin or mineral supplement to make up for it. Not the same story if you drop all animal foods! Speaking of...
* I'm a vegetarian
Why? Is it strictly for improved health? Then you might want to look into it some more and consider other approaches. Adult vegetarians are generally healthier than the average American on the standard American diet, but you will be missing some major vitamins and minerals (especially if you are a vegan), and you will find it very difficult to keep your omega 6 and omega 3 in balance. Is it for environmental, sustainability, or spiritual reasons? All those are very valid and important reasons to some people, though I would argue that if you consume conventional grains, that the environment suffers a great deal (2). Consider adding dairy, and especially consider adding fish. Flax oil is an okay omega-3 additive, though it is high in phytoestrogens, and many people have poor conversion from flax oil (ALA) to the shorter-chain omega 3 acids we need to use in our bodies (found in fish oil). Watch your corn oil and omega 6 intake like a hawk. Soak/use traditional methods to prepare your grains and beans. Nuts can be pretty high in omega 6, so steer towards macadamia nuts which are somewhat higher in omega 3s.
(disclaimer again - I'm not your doctor - you may have a particular medical condition so that this information does not apply to you. Talk to your doctor if you have questions, but make sure he/she knows what the Friedewalde equation is!)
All you have to do is follow a few dietary rules to be more hunter gatherer in your eating:
1) Eat veggies. May substitute fruits sometimes, but most of the time it should be veggies. Prepare the veggies any way you like, and most people can use coconut oil and butter (from pastured sources is preferred).
2) Eat protein several times a day, too. It is preferable for it to be wild caught fish, organic poultry (or pork, for most people), shellfish and shrimp, omega 3 or organic eggs or grass fed beef, bison, buffalo, goats, venison, etc.
3) Snacks can be nuts, veggies, fruit, veggies with almond butter - that sort of thing.
4) Avoid (for the most part) soy, peanuts, grains, corn, and any processed food or added sugar.
5) Avoid all processed vegetable oils (watch those salad dressings, and "real" mayonnaise at the store is soybean oil! Use olive oil and lemon juice or vinegar!)
6) Keep your dairy high fat, fermented if possible, and try not to have it for every single meal.
7) Avoid alcohol (for the most part)
*Now a few simple lifestyle rules:
1) Get plenty of sleep
2) Move around (I'll have another post on exercise with more details)
3) Don't get too stressed (Build anti-stress/enjoyable time into your daily life)
*A few specifics on medical conditions/medications which may affect these rules:
1) Antihypertensive medication: Most people who start to eat this way decrease their salt consumption dramatically (no processed food), and the weight loss can lead to lower blood pressures fairly quickly. Keep your pressure monitored and consult your doctor.
2) Diabetes - especially type II, on any sulfonylurea medications (glipizide (glucotrol) and glyburide (micronase) are the most common, but there are several more): Dropping your carbohydrates like this can lead to low blood sugars if you are on these medicines, which cause your pancreas to secrete more insulin. So again, consult with your doctor!
3) Any condition for which you have to be on coumadin (warfarin) - A diet high in veggies can increase vitamin K, which will make your coumadin less effective. A diet high in omega 3s relative to omega 6 fatty acids will make you more likely to bleed (omega 6 fatty acids are pro-thrombic and omega-3s tend to displace them in the diet and in tissues). So again, go slowly (see below), keep the INR in check, and CONSULT WITH YOUR DOCTOR.
4) Advanced Ischemic Heart Disease and Severe Type II Diabetes - *some* evidence suggests saturated fats may actually be bad for you. Focus on the olive oil and fish oil, and keep in mind that most animal fats (the fat on your steak and in your chicken skin) are actually very high in oleic acid (same fat as olive oil) and other "cholesterol neutral" fats. Plain old saturated fat would include: coconut and palm oil, high fat dairy, butter, beef tallow, lard. This advice may change as the science on this subject is expanding far more rapidly than the "official" advice. But even Staffan Lindeberg, my paleonutrition guru, advises against loads of saturated fat with these conditions. I'll have a whole post on this once I do more research and wrap my head around the theory of lipotoxicity. However, I must admit I am exasperated with the cognitive dissonance between the official recommendations and what might actually work to help improve insulin resistance and reduce atherosclerosis. As near as I can tell, the official way to eat recommended to diabetics is moderate or low carb, lots of fiber, and low in animals and animal fat. This means you are pretty much limited to salad, skinless chicken breasts, olive oil, and wood chips (fiber), with some token whole grains, potato, or fruit thrown in. But the truth of the matter is, we can either be low carb OR low fat. Protein can't really change that much. Wood chips are not a viable substitution for fat. Sigh. I'm a psychiatrist, and this kills me. I'm not sure how the heads of nutritionists, cardiologists, and endocrinologists just don't explode.
*How to Start Slowly:
Not ready to take the full plunge? Still have lots of pasta in the pantry?
1) Start by ditching the processed food, meaning anything with 10 zillion ingredients and anything with high fructose corn syrup in it. Get rid of fruit juice, soda, and other added sugars. Take your coffee black or with cream, switch to a touch of honey (preferably raw) instead of sugar. Reduce the amount of honey over time. Use real maple syrup on your pancakes. You'll use less because it costs more.
2) After you're comfortable with that, then reduce the grains/sugars to one meal a day. The other meals should follow the simple dietary rules. Your best bet is to have the high-carb meal happen within a two hour window after you exercise. Your worst bet is to have your high-carb meal every morning for breakfast. If you want a sugary treat, eat it within 30 minutes after exercise.
3) Then clean up your grains. Wheat is probably the worst offender, wild rice and quinoa are the least, though you can pack on quite a carb load with an anemic-looking amount of rice. Get rid of any non-organic sources (the others will be genetically modified which *may* have autoimmune implications - until they are more thoroughly tested, why risk it?). Corn may be more or less okay, but in processed food usually comes with a lot of corn oil, which is horrible. Sorry.
*I'm following all your rules and I'm still not losing weight!!
1) What is your insulin status? You may be sensitive to too many carbohydrates (if you have excess abdominal fat, love handles, high blood pressure, have trouble losing weight, and you've been eating the standard American diet, you're probably a bit insulin resistant). First, ditch any remaining grains. Then decrease the amounts of more sugary fruits like apples, oranges, bananas, pineapples - you're better off with lower carb fruits like plums, peaches, figs, those kinds of things, and then only once a day or every few days.
2) Are you intolerant to lactose or casein? Get rid of the dairy (except eggs) and see what happens.
3) Are you following the lifestyle rules too? Diet is probably only 80% of fat loss.
4) Are you vitamin D deficient?
5) Are you eating too much protein? If you are packing in five pounds of porterhouse a day, you could be making glucose via gluconeogenesis, resulting in fat gain.
*I'm following all your stupid rules, and I feel like crap!!
1) A sudden drop in carbohydrates can cause some people to feel sick and tired and grouchy. This can happen even without ketosis (which won't generally happen with the amount of carbohydrates you would eat from having lots of veggies and fruit). This usually passes within a couple of days, (after which you will tend to feel energetic, clear-headed, and fabulous) but go to the "How to Start Slowly" section if you like.
*Wait a minute - where are the portion sizes and calorie counts?
1) Hunter gatherers did not have FitDay. And many modern hunter gatherer societies have plenty of food about - no malnutrition, and yet still they are effortlessly slim. Our appetites regulate themselves, as long as we don't have foods about which likely throw off our hormonal appetite regulation (added sugar and wheat are the most likely culprits). Don't go hungry. If you are hungry, eat. If you aren't hungry, you don't have to eat. If you're like me, you might not trust your natural appetite after watching your food closely for a long time. Then go for a pile of veggies and a palm-sized amount of protein. The rest will take care of itself.
*I want a cookie!!!!!
Eat a cookie.
No, seriously, eat a cookie. The way of eating detailed above puts us into a fat-burning metabolic mode. As long as you spend the majority of your time eating according to the rules, you should be in fat-burning mode most of the time, and a cookie ain't gonna hurt much. You will be out of fat-burning mode for a few hours. Big deal. If you are insulin resistant, it will be harder to get into fat-burning mode, and harder to get out of fat-storing mode. So a cookie is going to do your diet more harm than someone who is insulin sensitive.
* The American Heart Association Or Other Official Grand Poohbas say that vegetable oils are fine and are preferred to animal fats! Why is that?
They are trying to get you to decrease the amount of saturated fat you eat by replacing it with vegetable oil. Corn oil will lower your total cholesterol lickety split, but here's a gem of an old study dug up on Hyperlipid showing it may also kill you and cause diabetes (1). I personally think it is unfortunate advice, as the seed oils such as corn oil are high in omega-6 and will cause your omega-3s and omega-6s to be out of balance, and this is most likely very bad for both your health and your brain. I'll do another post on the specifics of the PUFA fat balance.
* Won't I be missing vital vitamins and minerals if I am not eating grains?
No. You won't be. Tells you how important grains are to good health. If you drop grains, you don't need a single vitamin or mineral supplement to make up for it. Not the same story if you drop all animal foods! Speaking of...
* I'm a vegetarian
Why? Is it strictly for improved health? Then you might want to look into it some more and consider other approaches. Adult vegetarians are generally healthier than the average American on the standard American diet, but you will be missing some major vitamins and minerals (especially if you are a vegan), and you will find it very difficult to keep your omega 6 and omega 3 in balance. Is it for environmental, sustainability, or spiritual reasons? All those are very valid and important reasons to some people, though I would argue that if you consume conventional grains, that the environment suffers a great deal (2). Consider adding dairy, and especially consider adding fish. Flax oil is an okay omega-3 additive, though it is high in phytoestrogens, and many people have poor conversion from flax oil (ALA) to the shorter-chain omega 3 acids we need to use in our bodies (found in fish oil). Watch your corn oil and omega 6 intake like a hawk. Soak/use traditional methods to prepare your grains and beans. Nuts can be pretty high in omega 6, so steer towards macadamia nuts which are somewhat higher in omega 3s.
Tuesday, June 15, 2010
Beans and Grains: A Brief Introduction
In previous entries, I made mention of a paleolithic-style diet being optimal for human consumption. By "optimal" I meant you can rely on your appetite to direct you to stay lean (if you are already lean), or be a tad more careful about what you eat and lose the extra fat (in a later post I will explain exactly how to lose the fat!), and, it seems pretty scientifically clear from epidemiological and observational studies (and from a few small studies on people with actual disease) that if you spend your whole life eating this way, also get plenty of sleep, a moderate amount of exercise, and appropriate social interaction, your chances of getting Western diseases such as ischemic heart disease, type II diabetes, many autoimmune diseases, stroke, acne, depression, hypertension, obesity, osteoporosis, and tooth decay are very small. Ooo ooo cool! Sign me up!
There's just one *little* caveat which I will elucidate more fully today - the strict paleo folks avoid grains (including corn, wheat, rye, buckwheat, oats, quinoa, spelt, rice - except maybe wild rice). Or beans and legumes - including chickpeas, peanuts, and especially soy. Or sometimes cow's or goat's milk (though I will go into more detail about milk in a separate post). Also, some will avoid potatoes, tomatoes, eggplants, and other nightshades. Hmm. Kind of a drag, really. (Though once you've gone over to the dark side of paleo, those large pants and type II diabetes seem like way more of a drag than giving up your daily dinner roll).
How could beans and grains be bad for you? Well, let me count the ways:
Lectins: Lectins sit on the outside of plants, attached to sugar molecules. Their roll in nature is thought to be to protect the plant from plant-eating animals. While lots of plants have lectins, the highest concentrations are in seeds, soybeans, beans, potatoes, and peanuts. Normal cooking doesn't destroy the lectins, though pressure cooking will (except for wheat agglutinin - that nasty bugger is impossible to kill), and your stomach and digestive tract don't seem to break them down completely either. (Well, who cares?) Turns out these lectins can penetrate your gut and fly around willy nilly within your body, and there is a mounting body of scientific evidence that lectins play a role in atherosclerosis, insulin resistance, cancer, and autoimmune disease (1). Wheat agglutinin has been shown to bind leptin receptors, which could explain leptin resistance (the first step on the road to obesity). Unfortunately, the theoretical biochemical mechanisms of these things in each separate disease state are becoming clear, and it ain't pretty. Oh. (Now there's no way to get away from lectins - tons of plants have them! But if you vary your plant consumption you'll be exposed to less of the same ones all the time. And seeds and beans, the plant's precious resource for future plant generations, have the most concentrated versions.) To add to the problem, post-modern genetically modified wheat and soy have enhanced lectin activity. Lectins are pesticides, after all, and these superwheats and supersoybeans are more resistant to pests and/or Roundup pesticide. This means the wheat we eat today is very different than the wheat we grew up with 30 years ago, and GMO soybean is questioned as a cause in the rise of peanut allergies in children.
Protease inhibitors: Live in beans and seeds and cereals. They keep the gut from breaking down protein entirely. That means if you eat protein + cereal, your absorption of the protein can be diminished.
Phytoestrogens and isoflavones: These are plant-made hormones that can disrupt the endocrine system. They also might be powerful antioxidants, but that isn't entirely clear. Soy is chock-full of them.
Glycoalkaloids: on the skins of potatoes - can be poisonous in large quantities - probably fine in small quantities.
Plant sterols: thought to decrease the absorption of cholesterol, these guys have been added to margarine recently. Seeing as how margarine is not exactly a health food, adding plant sterols to it seems to me like sprinkling lipitor on your pizza. A certain cardiologist blogger makes a convincing argument to steer clear of sterols.
Phytic Acids: Found on all grains, and while you can get rid of these with warm soaking and fermenting, the phytic acids in oats won't reduce that way, as oats have no natural phytases. These bind dietary minerals, such as calcium, magnesium, zinc, iron, you name it. So if you consume the unreduced phytic acids with every meal, a lot of the minerals in your food will go down the toilet. Literally.
The kicker is, humans have been consuming grains for 10,000 years. Over time we developed a million ways to reduce the toxic effects of these grains via various traditional harvesting and cooking techniques. Without these techniques (hand milling, soaking, sprouting, long fermentation times rather than quick-rise yeast) and getting a lot of our calories from wheat (whose giladins and glutens are among the toughest to get rid of), cereals and beans become sources of nutrient depleting, empty calories, and vectors of biochemical mayhem within the body. Take a grain and smash it flat to mix all the phytic acids and lectins together, then puff it and oxidize the seed oils, add sugar and sell it as chocolate puff cereal - we aren't exactly evolved to eat that.
It's not that a little bit will be all that bad (unless, perhaps, you have autoimmune disease, which I will go into later). It's that massive exposure in every meal day in day out... well...
(Information from this post was taken almost entirely from Staffan Lindeberg's Food and Western Disease. In addition, some of the thoughts about genetically modified wheat and soy come from The Unhealthy Truth.)
There's just one *little* caveat which I will elucidate more fully today - the strict paleo folks avoid grains (including corn, wheat, rye, buckwheat, oats, quinoa, spelt, rice - except maybe wild rice). Or beans and legumes - including chickpeas, peanuts, and especially soy. Or sometimes cow's or goat's milk (though I will go into more detail about milk in a separate post). Also, some will avoid potatoes, tomatoes, eggplants, and other nightshades. Hmm. Kind of a drag, really. (Though once you've gone over to the dark side of paleo, those large pants and type II diabetes seem like way more of a drag than giving up your daily dinner roll).
How could beans and grains be bad for you? Well, let me count the ways:
Lectins: Lectins sit on the outside of plants, attached to sugar molecules. Their roll in nature is thought to be to protect the plant from plant-eating animals. While lots of plants have lectins, the highest concentrations are in seeds, soybeans, beans, potatoes, and peanuts. Normal cooking doesn't destroy the lectins, though pressure cooking will (except for wheat agglutinin - that nasty bugger is impossible to kill), and your stomach and digestive tract don't seem to break them down completely either. (Well, who cares?) Turns out these lectins can penetrate your gut and fly around willy nilly within your body, and there is a mounting body of scientific evidence that lectins play a role in atherosclerosis, insulin resistance, cancer, and autoimmune disease (1). Wheat agglutinin has been shown to bind leptin receptors, which could explain leptin resistance (the first step on the road to obesity). Unfortunately, the theoretical biochemical mechanisms of these things in each separate disease state are becoming clear, and it ain't pretty. Oh. (Now there's no way to get away from lectins - tons of plants have them! But if you vary your plant consumption you'll be exposed to less of the same ones all the time. And seeds and beans, the plant's precious resource for future plant generations, have the most concentrated versions.) To add to the problem, post-modern genetically modified wheat and soy have enhanced lectin activity. Lectins are pesticides, after all, and these superwheats and supersoybeans are more resistant to pests and/or Roundup pesticide. This means the wheat we eat today is very different than the wheat we grew up with 30 years ago, and GMO soybean is questioned as a cause in the rise of peanut allergies in children.
Protease inhibitors: Live in beans and seeds and cereals. They keep the gut from breaking down protein entirely. That means if you eat protein + cereal, your absorption of the protein can be diminished.
Phytoestrogens and isoflavones: These are plant-made hormones that can disrupt the endocrine system. They also might be powerful antioxidants, but that isn't entirely clear. Soy is chock-full of them.
Glycoalkaloids: on the skins of potatoes - can be poisonous in large quantities - probably fine in small quantities.
Plant sterols: thought to decrease the absorption of cholesterol, these guys have been added to margarine recently. Seeing as how margarine is not exactly a health food, adding plant sterols to it seems to me like sprinkling lipitor on your pizza. A certain cardiologist blogger makes a convincing argument to steer clear of sterols.
Phytic Acids: Found on all grains, and while you can get rid of these with warm soaking and fermenting, the phytic acids in oats won't reduce that way, as oats have no natural phytases. These bind dietary minerals, such as calcium, magnesium, zinc, iron, you name it. So if you consume the unreduced phytic acids with every meal, a lot of the minerals in your food will go down the toilet. Literally.
The kicker is, humans have been consuming grains for 10,000 years. Over time we developed a million ways to reduce the toxic effects of these grains via various traditional harvesting and cooking techniques. Without these techniques (hand milling, soaking, sprouting, long fermentation times rather than quick-rise yeast) and getting a lot of our calories from wheat (whose giladins and glutens are among the toughest to get rid of), cereals and beans become sources of nutrient depleting, empty calories, and vectors of biochemical mayhem within the body. Take a grain and smash it flat to mix all the phytic acids and lectins together, then puff it and oxidize the seed oils, add sugar and sell it as chocolate puff cereal - we aren't exactly evolved to eat that.
It's not that a little bit will be all that bad (unless, perhaps, you have autoimmune disease, which I will go into later). It's that massive exposure in every meal day in day out... well...
(Information from this post was taken almost entirely from Staffan Lindeberg's Food and Western Disease. In addition, some of the thoughts about genetically modified wheat and soy come from The Unhealthy Truth.)
Sunday, June 13, 2010
The Carbohydrate Post: An Ode To America's Pot Belly
Let's start with a little biochemistry. Hope you are sipping your antioxidant green tea right now. Ahem. Carbohydrates come in two flavors, officially, simple, and complex. Nutrition junkies and medical folks tend to group them thusly: fruits and veggies, starchy carbs, and added sugars. Fruits and veggies are, for the most part, obvious. Starchy carbs include bread, crackers, cake, pastry, flour, tortillas, oatmeal, cereals, rice, corn, and potatoes (regular and sweet), and some other starchy root vegetables. Added sugars are table sugar, corn syrup, honey, maple syrup, molasses - you get the picture. Other types of foods, such as beans and milk products, are also pretty high in carbohydrates.
Carbohydrates are important in our sordid little tale of obesity due to their captaincy position in directing insulin to do its deeds. All carbohydrates that we eat, whether whole grains or white bread or Pepsi, go through our tummies and digestive organs, where some are released immediately (glucose), and others are kept around for further processing (into glucose, eventually). Once they are released, your blood sugar levels rise, signaling the pancreas to release insulin. Insulin is a growth hormone and leads the way in causing a whole host of reactions in our body - its main role is to help us store glucose, fat, and any extra protein we eat as fat. So if we eat a lot of carbohydrates and we don't burn them immediately by being Tour de France bike racers, we store it. Some glucose is stored in the muscles for short term reserves, but the rest is processed by the body and goes into the fat stores.
Here's where the fallacy of high carbohydrate, low fat diets really hit home, especially for anyone with type II diabetes, prediabetes, or insulin resistance (possibly anyone with abdominal obesity) Any kind of high carbohydrate diet will keep insulin levels high unless you really cut back on the calories, or you exercise like a maniac (1). Insulin is vital, but having too much floating around is implicated in type II diabetes, obesity, atherosclerosis, depression, dementia, and all those other diseases of Western civilization we spend all our free cash on as we get older. And guess what, the body has a nasty habit of cutting your metabolic rate when you cut calories, by lowering your base body temperature, making you lethargic so you move less, and pulling in a whole host of hormonal and neural changes designed to make you EAT. Your body doesn't care if you have several months' worth of extra fat - if you go super low calorie and rely on glucose for your primary fuel, you will feel as if you are starving. Same thing happens, unfortunately, when you exercise a lot. You can't help it. Every evolutionary driven instinct will have you eat more, and then you eventually gain weight.
A high carbohydrate, high fat diet is even worse. Carbs are the captain, after all. Sugar and starch tell your body to store all the carbs AND the fat you eat as fat!
However, carbohydrates aren't the whole problem. Let's look at the Kitavans in Papua New Guinea (2). they are a modern hunter-gatherer people who subsist mostly on a diet of starchy root vegetables and coconuts. High carb and tons of saturated fat. Also, 76% of the men and 80% of the women smoke, as tobacco has been farmed on the island for 100 years. They don't get more exercise than a typical westerner who has a physical job, or a moderately active exerciser who has a less active job. And guess what - no western disease! No angina, heart attacks, strokes (even though they have high cholesterol, due to the coconut diet), no diabetes, no cancer (except some squamous and oral cancers due to the tobacco and habits of chewing betel nuts - but no lung cancer!). The average BMI on the island for women is around 18.5 ("model thin"), and for men around 20. Their cholesterol and blood pressure do not rise with age as westerners do. These observations were made by doctors, not anthropologists. They tend to die of infections, accidents, homicide, or quietly of old age after fatigue for a few days. There is no malnutrition - leftover food abounds and is fed to the numerous dogs (3).
Also, let's look at the Raramuri of the Copper Canyons of Mexico, who eat mostly a corn meal mush, an antioxidant drink made of chia seeds, lime juice, and sugar, and corn beer. The kids also play a game before school that involves running 8 miles, and whole groups in the various villages routinely participate in footraces of 50-200 miles. Guess what - their hearts are in fine shape (according to McDougall, but then, I haven't exactly seen a CT scan of their coronary arteries or anything), and blood pressure is nice and low (4).
The Raramuri health can be explained by all the exercise (and running for them I'm guessing is low intensity - long distance high intensity exercise has been associated with developing atherosclerosis and inflammation (5) ), but what about the Kitavans? It must be something about the kind of starchy carbs they eat - no grains, no potatoes, no rice, no corn.
Most hunter-gatherer populations (in modern times or historically) do not eat as the Raramuri or the Kitavans do - they tend to eat mostly fruits, veggies, meat (lean grassfed meat, but also organ meats and bone marrow loaded with saturated fat!), fish, shellfish, nuts, seeds and some of those starchy root vegetables...
Carbohydrates are important in our sordid little tale of obesity due to their captaincy position in directing insulin to do its deeds. All carbohydrates that we eat, whether whole grains or white bread or Pepsi, go through our tummies and digestive organs, where some are released immediately (glucose), and others are kept around for further processing (into glucose, eventually). Once they are released, your blood sugar levels rise, signaling the pancreas to release insulin. Insulin is a growth hormone and leads the way in causing a whole host of reactions in our body - its main role is to help us store glucose, fat, and any extra protein we eat as fat. So if we eat a lot of carbohydrates and we don't burn them immediately by being Tour de France bike racers, we store it. Some glucose is stored in the muscles for short term reserves, but the rest is processed by the body and goes into the fat stores.
Here's where the fallacy of high carbohydrate, low fat diets really hit home, especially for anyone with type II diabetes, prediabetes, or insulin resistance (possibly anyone with abdominal obesity) Any kind of high carbohydrate diet will keep insulin levels high unless you really cut back on the calories, or you exercise like a maniac (1). Insulin is vital, but having too much floating around is implicated in type II diabetes, obesity, atherosclerosis, depression, dementia, and all those other diseases of Western civilization we spend all our free cash on as we get older. And guess what, the body has a nasty habit of cutting your metabolic rate when you cut calories, by lowering your base body temperature, making you lethargic so you move less, and pulling in a whole host of hormonal and neural changes designed to make you EAT. Your body doesn't care if you have several months' worth of extra fat - if you go super low calorie and rely on glucose for your primary fuel, you will feel as if you are starving. Same thing happens, unfortunately, when you exercise a lot. You can't help it. Every evolutionary driven instinct will have you eat more, and then you eventually gain weight.
A high carbohydrate, high fat diet is even worse. Carbs are the captain, after all. Sugar and starch tell your body to store all the carbs AND the fat you eat as fat!
However, carbohydrates aren't the whole problem. Let's look at the Kitavans in Papua New Guinea (2). they are a modern hunter-gatherer people who subsist mostly on a diet of starchy root vegetables and coconuts. High carb and tons of saturated fat. Also, 76% of the men and 80% of the women smoke, as tobacco has been farmed on the island for 100 years. They don't get more exercise than a typical westerner who has a physical job, or a moderately active exerciser who has a less active job. And guess what - no western disease! No angina, heart attacks, strokes (even though they have high cholesterol, due to the coconut diet), no diabetes, no cancer (except some squamous and oral cancers due to the tobacco and habits of chewing betel nuts - but no lung cancer!). The average BMI on the island for women is around 18.5 ("model thin"), and for men around 20. Their cholesterol and blood pressure do not rise with age as westerners do. These observations were made by doctors, not anthropologists. They tend to die of infections, accidents, homicide, or quietly of old age after fatigue for a few days. There is no malnutrition - leftover food abounds and is fed to the numerous dogs (3).
Also, let's look at the Raramuri of the Copper Canyons of Mexico, who eat mostly a corn meal mush, an antioxidant drink made of chia seeds, lime juice, and sugar, and corn beer. The kids also play a game before school that involves running 8 miles, and whole groups in the various villages routinely participate in footraces of 50-200 miles. Guess what - their hearts are in fine shape (according to McDougall, but then, I haven't exactly seen a CT scan of their coronary arteries or anything), and blood pressure is nice and low (4).
The Raramuri health can be explained by all the exercise (and running for them I'm guessing is low intensity - long distance high intensity exercise has been associated with developing atherosclerosis and inflammation (5) ), but what about the Kitavans? It must be something about the kind of starchy carbs they eat - no grains, no potatoes, no rice, no corn.
Most hunter-gatherer populations (in modern times or historically) do not eat as the Raramuri or the Kitavans do - they tend to eat mostly fruits, veggies, meat (lean grassfed meat, but also organ meats and bone marrow loaded with saturated fat!), fish, shellfish, nuts, seeds and some of those starchy root vegetables...
The Basic Premise
I come from the perspective that the healthiest diet and circumstances for human beings, body and mind, will be the ones we are evolved for. In practical terms, that means the diet and habits of our Paleolithic ancestors. More recently I've focused my personal research on the nutritional aspects of this theory, and that is where I will begin with my blog posts. Paleolithic psychology is an academic science in it's own right. My particular interest is in where molecular biology, nutrition, and optimal brain function meet.
Let's begin with diet. Ancient humans ate wild game (including marrow and organ meats), shellfish, fish, tubers, green leafy vegetables, eggs, fruits, and nuts. Notably absent are the vegetable oils and highly processed foods created in the last 50 or so years. Grains (corn, wheat, barley, rye, oats, buckwheat, quinoa, millet, etc.), legumes (red and black and pinto beans, legumes, garbanzo beans, peanuts), nightshades (white potatoes, tomatoes, peppers, and eggplant) and milk products are also relatively new foods to the human palate.
Anthropological evidence and epidemiological studies of modern and past hunter gatherers, as well as agrarian societies of the last 10,000 years, show us that the physical health of hunter gatherers far surpasses the health of grain-based societies (1). They lived longer (until the last 100 years and the invention of antibiotics and vaccines), and were free of diseases such as osteoporosis, metastatic cancer, and tooth decay, and modern hunter gatherers who eat traditional diets do not have diabetes, hypertension, obesity, atherosclerosis, acne, osteoporosis, dementia, or any of the most common cancers that we suffer from in the West.
Traditional agrarian societies were also relatively healthy (2), but they did not consume white flour, vegetable oils, refined sugar, or pasteurized milk products. In addition, they used a number of soaking and fermenting techniques to make grains and legumes healthier. And while some grains may be acceptable after preparation, I believe there may be no hope for wheat.
It is only in our modern world that we have access to entirely invented foods, chemical sugars, processed oils, quick rise breads, and genetically modified soy and wheat. While I will come up with a lot of biochemical smoke to pinpoint the fires in these nouveau foods that I believe are unhealthy, I do that out of intellectual interest rather than necessity. I already know that humans who did not eat those foods were healthier than we are. We'll see if we can find some good evidence that they were happier, too.
The vast majority of our calories should come from foods that are known to be healthy - grassfed beef, pastured chickens and other poultry and their eggs, pastured game meats and pigs, locally grown or organically grown produce, wild fish from unpolluted waters, coconuts and other tree nuts, and olive oil. Fermented and full fat (especially raw, if you are not immunocompromised - very young children and babies, pregnant women, etc.) dairy is also acceptable. Anything that has ingredients you cannot readily pronounce without a background in biochemistry should be, for the most part, avoided, as best you can. If you are a cook and have the time and industry to prepare grains and legumes as they should be prepared, then have at it. Don't worry, more details about the specifics will follow!
Let's begin with diet. Ancient humans ate wild game (including marrow and organ meats), shellfish, fish, tubers, green leafy vegetables, eggs, fruits, and nuts. Notably absent are the vegetable oils and highly processed foods created in the last 50 or so years. Grains (corn, wheat, barley, rye, oats, buckwheat, quinoa, millet, etc.), legumes (red and black and pinto beans, legumes, garbanzo beans, peanuts), nightshades (white potatoes, tomatoes, peppers, and eggplant) and milk products are also relatively new foods to the human palate.
Anthropological evidence and epidemiological studies of modern and past hunter gatherers, as well as agrarian societies of the last 10,000 years, show us that the physical health of hunter gatherers far surpasses the health of grain-based societies (1). They lived longer (until the last 100 years and the invention of antibiotics and vaccines), and were free of diseases such as osteoporosis, metastatic cancer, and tooth decay, and modern hunter gatherers who eat traditional diets do not have diabetes, hypertension, obesity, atherosclerosis, acne, osteoporosis, dementia, or any of the most common cancers that we suffer from in the West.
Traditional agrarian societies were also relatively healthy (2), but they did not consume white flour, vegetable oils, refined sugar, or pasteurized milk products. In addition, they used a number of soaking and fermenting techniques to make grains and legumes healthier. And while some grains may be acceptable after preparation, I believe there may be no hope for wheat.
It is only in our modern world that we have access to entirely invented foods, chemical sugars, processed oils, quick rise breads, and genetically modified soy and wheat. While I will come up with a lot of biochemical smoke to pinpoint the fires in these nouveau foods that I believe are unhealthy, I do that out of intellectual interest rather than necessity. I already know that humans who did not eat those foods were healthier than we are. We'll see if we can find some good evidence that they were happier, too.
The vast majority of our calories should come from foods that are known to be healthy - grassfed beef, pastured chickens and other poultry and their eggs, pastured game meats and pigs, locally grown or organically grown produce, wild fish from unpolluted waters, coconuts and other tree nuts, and olive oil. Fermented and full fat (especially raw, if you are not immunocompromised - very young children and babies, pregnant women, etc.) dairy is also acceptable. Anything that has ingredients you cannot readily pronounce without a background in biochemistry should be, for the most part, avoided, as best you can. If you are a cook and have the time and industry to prepare grains and legumes as they should be prepared, then have at it. Don't worry, more details about the specifics will follow!
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