Saturday, December 27, 2008

Butter, Margarine and Heart Disease










Thursday, December 25, 2008

The Fundamentals





Merry Christmas, happy Hanukkah, and happy holidays to everyone!

Sunday, December 14, 2008

U.S. Weight, Lifestyle and Diet Trends, 1970- 2007

The 250 extra calories are coming from carbohydrate (NHANES).

We're eating more vegetables and fruit (USDA).

Bye bye whole milk. Hello skim milk (USDA).



  • An increase in cereal grain consumption, particularly wheat.
  • An increase in sweetener consumption

Saturday, December 6, 2008

Peripheral vs. Ectopic Fat



People with excess visceral fat are also

reflect liver function to varying degrees.

Here are some ideas.

Wednesday, December 3, 2008

Polyunsaturated Fat Intake: What About Humans?












Sunday, November 30, 2008

Polyunsaturated Fat Intake: Effects on the Heart and Brain

I'm revisiting the topic of the omega-6/omega-3 balance and total polyunsaturated fat (PUFA) intake because of some interesting studies I've gotten a hold of lately (thanks Robert). Two of the studies are in pigs, which I feel are a decent model organism for studying the effect of diet on health as it relates to humans. Pigs are omnivorous (although more slanted toward plant foods), have a similar digestive system to humans (although sturdier), are of similar size and fat composition to humans, and have been eating grains for about the same amount of time as humans.

In the last post on the omega-6/omega-3 balance, I came to the conclusion that a roughly balanced but relatively low intake of omega-6 and omega-3 fats is consistent with the diets of healthy non-industrial cultures. There were a few cultures that had a fairly high long-chain omega-3 intake from seafood (10% of calories), but none ate much omega-6.

first study explores the effect of omega-6 and omega-3 fats on heart function. Dr. Sheila Innis and her group fed young male pigs three different diets:
  1. An unbalanced, low PUFA diet. Pig chow with 1.2% linoleic acid (LA; the main omega-6 plant fat) and 0.06% alpha linolenic acid (ALA; the main omega-3 plant fat).
  2. A balanced, low PUFA diet. Pig chow with 1.4% LA and 1.2% ALA.
  3. An unbalanced, but better-than-average, "modern diet". Pig chow with 11.6% LA and 1.2% ALA.
After 30 days, they took a look at the pigs' hearts. Pigs from the first and third (unbalanced) groups contained more "pro-inflammatory" fats (arachidonic acid; AA) and less "anti-inflammatory" fats (EPA and DHA) than the second group. The first and third groups also experienced an excessive activation of "pro-inflammatory" proteins, such as COX-2, the enzyme inhibited by aspirin, ibuprofen and other NSAIDs.

The most striking finding of all was the difference in lipid peroxidation between groups. Lipid peroxidation is a measure of oxidative damage to cellular fats. In the balanced diet hearts, peroxidation was half the level found in the first group, and one-third the level found in the third group!
This shows that omega-3 fats exert a powerful anti-oxidant effect that can be more than counteracted by excessive omega-6. Nitrosative stress, another type of damage, tracked with n-6 intake regardless of n-3, with the third group almost tripling the first two. I think this result is highly relevant to the long-term development of cardiac problems, and perhaps cardiovascular disease in general.

another study with the same lead author Sanjoy Ghosh, rats fed a diet enriched in omega-6 from sunflower oil showed an increase in nitrosative damage, damage to mitochondrial DNA, and a decrease in maximum cardiac work capacity (i.e., their hearts were weaker). This is consistent with the previous study and shows that the mammalian heart does not like too much omega-6! The amount of sunflower oil these rats were eating (20% food by weight) is not far off from the amount of industrial oil the average American eats.

A third paper by Dr. Sheila Innis' group studied the effect of the omega-6 : omega-3 balance on the brain fat composition of pigs, and the development of neurons
in vitro (in a culture dish). There were four diets, the first three similar to those in the first study:
  1. Deficient. 1.2% LA and 0.05% ALA.
  2. Contemporary. 10.7% LA and 1.1% ALA.
  3. Evolutionary. 1.2% LA and 1.1% ALA.
  4. Supplemented. The contemporary diet plus 0.3% AA and 0.3% DHA.
The first thing they looked at was the ability of the animals to convert ALA to DHA and concentrate it in the brain. DHA is critical for brain and eye development and maintenance. The evolutionary diet was most effective at putting DHA in the brain, with the supplemented diet a close second and the other three lagging behind. The evolutionary diet was the only one capable of elevating EPA, another important fatty acid derived from ALA. If typical fish oil rather than isolated DHA and AA had been given as the supplement, that may not have been the case. Overall, the fatty acid composition of the brain was quite different in the evolutionary group than the other three groups, which will certainly translate into a variety of effects on brain function.

The researchers then cultured neurons and showed that they require DHA to develop properly in culture, and that long-chain omega-6 fats are a poor substitute. Overall, the paper shows that the modern diet causes a major fatty acid imbalance in the brain, which is expected to lead to developmental problems and probably others as well. This can be partially corrected by supplementing with fish oil.

Together, these studies are a small glimpse of the countless effects we are having on every organ system, by eating fats that are unfamiliar to our pre-industrial bodies. In the next post, I'll put this information into the context of the modern human diet.

Wednesday, November 26, 2008

Health is Multi-Factorial

Thanks to commenter Brock for pointing me to this very interesting paper, "Effects of fish oil on hypertension, plasma lipids, and tumor necrosis factor-alpha in rats with sucrose-induced metabolic syndrome". As we know, sugar gives rats metabolic syndrome when it's added to regular rat chow, probably the same thing it does to humans when added to a processed food diet.

One thing has always puzzled me about sugar. It doesn't appear to cause major metabolic problems when added to an otherwise healthy diet, yet it wreaks havoc in other contexts. One example of the former situation is the
Kuna, who are part hunter-gatherer, part agricultural. They eat a lot of refined sugar, but in the context of chocolate, coconut, fish, plantains, root vegetables and limited grains and beans, they are relatively healthy. Perhaps not quite on the same level as hunter-gatherer groups, but healthier than the average modernized person from the point of view of the diseases of civilization.

This paper really sheds light on the matter. The researchers gave a large group of rats access to drinking water containing 30% sucrose, in addition to their normal rat chow, for 21 weeks. The rats drank 4/5 of their calories in the form of sugar water. There's no doubt that this is an extreme treatment. They subsequently developed metabolic syndrome, including abdominal obesity, elevated blood pressure, elevated fasting insulin, elevated triglycerides, elevated total cholesterol and LDL, lowered HDL, greatly increased serum uric acid, greatly elevated liver enzymes suggestive of
liver damage, and increased tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is a hormone secreted by visceral (abdominal) fat tissue that may play a role in promoting insulin resistance.

After this initial 12-week treatment, they divided the metabolic syndrome rats into two groups:
  • One that continued the sugar treatment, along with a diet enriched in corn and canola oil (increased omega-6).
  • A second that continued the sugar treatment, along with a diet enriched in fish oil (increased omega-3).
The two diets contained the same total amount of polyunsaturated fat (PUFA), but had very different omega-6 : omega-3 ratios. The first had a ratio of 9.3 (still better than the average American), while the second had a ratio of 0.02, with most of the omega-3 in the second group coming from EPA and DHA (long-chain, animal omega-3s). The second diet also contained four times as much saturated fat as the first, mostly in the form of palmitic acid.

Compared to the vegetable oil group, the fish oil group had lower fasting insulin, lower blood pressure, lower triglycerides, lower cholesterol, and lower LDL. As a matter of fact,
the fish oil group looked as good or better on all these parameters than a non-sugar fed control group receiving the extra vegetable oil alone (although the control group isn't perfect because it inevitably ate more vegetable oil-containing chow to make up for the calories it wasn't consuming in sugar). The only things reducing vegetable oil and increasing fish oil didn't fix were the weight and the elevated TNF-alpha, although they didn't report the level of liver enzymes in these groups. The TNF-alpha finding is not surprising, since it's secreted by visceral fat, which did not decrease in the fish oil group.

I think this is a powerful result. It may have been done in rats, but the evidence is there for a similar mechanism in humans. The Kuna have a very favorable omega-6 : omega-3 ratio, with most of their fat coming from highly saturated coconut and cocoa. This may protect them from their high sugar intake. The Kitavans also have a very favorable omega-6 : omega-3 ratio, with most of their fat coming from coconuts and fish. They don't eat refined sugar, but they do eat a tremendous amount of starch and a generous amount of fruit.

The paper also suggests that the metabolic syndrome is largely reversible.

I believe that both excessive sugar and
excessive omega-6 from modern vegetable oils are a problem individually. But if you want to have a much bigger problem, try combining them!

Monday, November 24, 2008

Real Food X: Roasted Marrow Bones

Bone marrow is a food that has been prized throughout history-- from hunter-gatherer tribes to haute cuisine chefs. It's not hard to understand why, once you've tasted it. It's delicate, meaty and fatty. It's also rich in fat-soluble vitamins, including vitamins K1 and K2, although this will depend on what the animal has eaten.

Roasted marrow bones make a simple appetizer. Beef bones are the best because of their size. Select wide bones that are cut about three inches long. They should be from the femur or the humerus, called the "shank bones". These are sometimes available in the frozen meats section of a grocery store, otherwise a butcher can procure them. If you have access to a farmer's market that sells meats, vendors will typically have bones cut for you if you request it.

  1. Preheat oven to 450 F (230 C).
  2. Place bones, cut side up, in a baking dish or oven-proof skillet.
  3. Bake for about 15 minutes, until the marrow begins to separate from the bone, but not much longer because it will turn to mush.
  4. Scoop out and eat the marrow by itself, on sourdough rye toast or however you please.
  5. Make soup stock from the leftover bones.

Saturday, November 22, 2008

Vitamin K2 in Marrow

I'm always on the lookout for foods rich in vitamin K2 MK-4, because it's so important and so rare in the modern food system. I heard some internet rumors that marrow might be rich in fat-soluble vitamins. Google let me down, so I decided to look through the rat studies on K2 MK-4 in which they looked at its tissue distribution.

I found one that looked at the K2 MK-4 content in different tissues of rats fed vitamin K1. Marrow was rich in K2, along with testes. It contains 10-20 times more MK-4 than liver by weight, and more than any of the other organs they tested (serum, liver, spleen, kidney, heart, testes, marrow, brain) except testes. They didn't include values for salivary gland and pancreas, the two richest sources.

If we assume beef marrow has the same amount of MK-4 as rat marrow per weight (I have no idea if this is really the case, but it's probably in the ballpark), two ounces of beef marrow would contain about 10 micrograms MK-4. Not a huge source, but significant nevertheless.

Bone marrow was a prized food in many hunter-gatherer societies. Let's see what Dr. Weston Price has to say about it (from Nutrition and Physical Degeneration):
For the Indians living inside the Rocky Mountain Range in the far North of Canada, the successful nutrition for nine months of the year was largely limited to wild game, chiefly moose and caribou. During the summer months the Indians were able to use growing plants. During the winter some use was made of bark and buds of trees. I found the Indians putting great emphasis upon the eating of the organs of the animals, including the wall of parts of the digestive tract. Much of the muscle meat of the animals was fed to the dogs. It is important that skeletons are rarely found where large game animals have been slaughtered by the Indians of the North. The skeletal remains are found as piles of finely broken bone chips or splinters that have been cracked up to obtain as much as possible of the marrow and nutritive qualities of the bones. These Indians obtain their fat-soluble vitamins and also most of their minerals from the organs of the animals. An important part of the nutrition of the children consisted in various preparations of bone marrow, both as a substitute for milk and as a special dietary ration.
Here's a bit more about these same groups, also from Nutrition and Physical Degeneration:
The condition of the teeth, and the shape of the dental arches and the facial form, were superb. Indeed, in several groups examined not a single tooth was found that had ever been attacked by tooth decay. In an examination of eighty-seven individuals having 2,464 teeth only four teeth were found that had ever been attacked by dental caries. This is equivalent to 0.16 per cent. As we came back to civilization and studied, successively, different groups with increasing amounts of contact with modern civilization, we found dental caries increased progressively, reaching 25.5 per cent of all of the teeth examined at Telegraph Creek, the point of contact with the white man's foods. As we came down the Stikine River to the Alaskan frontier towns, the dental caries problem increased to 40 per cent of all of the teeth.
Evidently, the traditionally-living groups were doing something right.

Thursday, November 13, 2008

Google Flu Trends




Wednesday, November 12, 2008

Can Vitamin K2 Reverse Arterial Calcification?


  • One continued on the warfarin and K1 diet






Monday, November 10, 2008

Real Food IX: Idlis

Traditional cultures throughout the world went to great lengths to maximize the nutritional value of the ingredients they had. Fermentation is a technique that was widely used for preparing grains and legumes. Humans are not well adapted to grains or legumes, in large part due to their assortment of anti-nutrients (substances that prevent the absorption of nutrients) and other toxins. Fermentation is a very effective way to eliminate anti-nutrients, making grains and legumes more nutritious and easily digested.

Idlis are steamed, naturally leavened cakes made from a fermented mixture of ground rice and beans. They're mild, savory and fluffy, and pair well with nearly any dish. I think they fill in well for bread. Due to the combination of rice and beans, they contain a fair amount of high-quality complete protein. They are also very economical. Idlis have their roots in Southern Indian cuisine more than 1,000 years ago. They may have originated as a fermented bean dish, with rice added to the recipe later in history.

The recipe takes 2-3 days to complete, but actually doesn't require much work. First, the beans and rice are soaked separately, then they are ground and mixed, then they are allowed to ferment for 24-48 hours and steamed. This type of days-long soaking and fermentation process is common in many grain-based cultures worldwide.

The recipe traditionally calls for short-grain white rice and urad dal (split black gram). I've been using short-grain brown rice with good results. You will only be able to find urad dal in an Indian grocer, specialty store or online. If you can't find urad dal, try experimenting with other types of mild dry beans.

Ingredients and materials
  • One cup urad dal or other dried bean
  • Two cups short-grain brown or white rice
  • One teaspoon fenugreek (optional)
  • Two teaspoons non-iodized salt
  • Filtered or otherwise dechlorinated water
  • Muffin tray
  • Large pot for steaming (optional)
  1. Soak urad dal and rice separately for 6 hours (longer if you're using a different type of bean). Add fenugreek to the rice before soaking (optional). It's used traditionally to speed fermentation.
  2. Pour water off the urad dal and rice/fenugreek mixture. Don't rinse.
  3. Grind the urad dal in a food process or or blender with a minimum amount of water until it's a smooth paste. The water must not be chlorinated or it will kill our bacteria! Brita-type water filters remove chlorine, as does boiling or leaving water uncovered overnight.
  4. Grind the rice/fenugreek mixture coarsely with a minimum amount of dechlorinated water.
  5. Mix the ground urad dal, ground rice and salt. The salt must be non-iodized, or the batter will not ferment! Pickling salt, kosher salt and unrefined sea salt work well. Add dechlorinated water until it's a thick paste, stirrable but not liquid.
  6. Ferment for 24-48 hours. You know it's ready when the dough has risen significantly, and the odor has gone from harsh and beany to mild and savory. Fermentation time will depend on the ambient temperature.
  7. Fill muffin trays about half-way with batter and steam until a knife inserted into them comes out clean, 15-20 minutes. You can also bake them at 350 F. It's not traditional, but I like them baked almost as much. If you really want to be traditional, you can buy an idli steamer.
Here are photos of my last batch. Soaking the urad dal and rice:

Batter, pre-fermentation:

Batter, post-fermentation (48 hours). It more than doubled in volume. The color didn't actually change, that's just my camera.

Ready to steam or bake.

After baking. One escaped! Into my belly.

Thanks to Soumya dey and Wikipedia for the top photo

Friday, November 7, 2008

Cardiovascular Disease and Vitamin K2

Vitamin K2 is intimately involved in calcium metabolism. Matrix Gla-protein (MGP) is a vitamin K-dependent protein that is secreted in cartilage, lung, heart, kidney and arteries. MGP prefers the MK-4 form of vitamin K2, the type that occurs almost exclusively in animal foods. Mice lacking MGP develop extensive arterial and soft tissue calcification (accumulation of calcium, as in bone). Same for humans with naturally occurring mutations in MGP (Keutel syndrome). It also happens in rats treated with warfarin, which inhibits vitamin K recycling. Let's hear what Dr. Cees Vermeer and his group have to say about MGP:
Among the proteins involved in vascular calcium metabolism, the vitamin K-dependent matrix Gla-protein (MGP) plays a dominant role. Although on a molecular level its mechanism of action is not completely understood, it is generally accepted that MGP is a potent inhibitor of arterial calcification. Its pivotal importance for vascular health is demonstrated by the fact that there seems to be no effective alternative mechanism for calcification inhibition in the vasculature. An optimal vitamin K intake is therefore important to maintain the risk and rate of calcification as low as possible.
So why do we care about vessel calcification? It associates strongly with the risk of heart attack and total mortality, better than traditional markers like the Framingham risk index*. That's because it's actually a measure of the disease process, rather than a marker with an unclear connection to it.

In my post on vitamin K2, I mentioned the Rotterdam study, which found that vitamin K2 intake is strongly associated with a lower risk of cardiovascular and total mortality. Vitamin K1, which is the type found in plants, was not associated with reduced mortality. I just came across another study in women selected from the PROSPECT cohort that showed something similar. Women with the highest K2 intake had the lowest level of coronary calcification. There was no association with K1. This suggests, yet again, that humans aren't very good at making the conversion from K1 to K2 MK-4. This is probably because during evolution, we always had a ready source of K2, so efficient conversion became unnecessary. Vitamin K2 MK-4 is found almost exclusively in animal foods.

Notably absent from the main text body is a discussion of where the K2 is coming from. It's tucked away in one sentence of the methods section: "cheese contributed 54%, milk products 22% and meat 15% of menaquinone intake." Oops! These are the foods that are supposed to cause heart disease! And do you remember where the K2 is? In the fat-- double oops! Yet another important nutrient that's found in animal fat.

Keep in mind that these Dutch women have an intake of K2 that is probably lower than what we would have eaten as hunter-gatherers. Most people in modern societies are verifiably K2 deficient. A focus on the organs (brain, pancreas) and fats of wild animals, shellfish, fish eggs and insects would have assured hunter-gatherers a high intake of vitamin K2 MK-4. This is precisely what Weston Price found in Nutrition and Physical Degeneration. He refers to vitamin K2 MK-4 as "activator X" in the book. In modern times, our most readily available source of vitamin K2 MK-4 is actually not a paleolithic food at all, it's butter from pasture-raised cows. It's how we can get away with not eating brain, pancreas and bugs.

*I plugged my numbers into this Framingham risk index calculator and it gave me the message "Please go back and enter an HDL value in the range of 20-100."!! I can imagine if you follow NCEP dietary guidelines your HDL would never break 100 mg/dL!

Monday, November 3, 2008

Winterize Your Diet

As winter approaches, there are steps you can take to preserve your health and well-being. Here's a list of things I find useful:

-Eat in season. Root vegetables like beets, turnips, rutabagas and potatoes are in season and make a satisfying dish. Try baked beets with raw garlic, sage and butter. Winter squash are tasty, nutritious and colorful. They make excellent soups and mashes, and can be baked or steamed. My favorite varieties are butternut, kabochas, delicata and gold nugget. They pair well with sage or nutmeg. In some places, hardy greens such as kale and collards are available in winter. Many fruits such as apples, pears and citrus are in season during the winter (or stored from fall).

-Prepare soup stocks. There's nothing like a long-simmered bone broth to drive away the winter chill. They are also rich in minerals and gelatin, which aids digestion and soothes the digestive tract.

-Make sauerkraut or other fermented vegetables. Fermentation was once used as a means to preserve flavor and nutrition for the winter. Fermented vegetables are a powerful digestive aid. After the first frost, cabbage is at its sweetest. Sweet cabbage makes the best kraut.

-Keep your vitamin D level high. This may protect against the typical winter ills, including flu and seasonal depression. Unless you live in a warm climate and spend time outside in the winter regularly, it's wise to seek out vitamin D. High-vitamin cod liver oil, pasture-raised animal fats, shellfish and fatty fish are good sources. Some people may wish to supplement with vitamin D3.

Saturday, November 1, 2008

Book Review: Dangerous Grains

Dangerous Grains is about the health hazards of gluten grains. It's co-written by James Braly, an M.D. who specializes in food allergies, and Ron Hoggan, a celiac patient who has written widely on the subject.

Celiac disease is a degeneration of the intestinal lining caused by exposure to gluten. Gluten sensitivity is a broader term that encompasses any of the numerous symptoms that can occur throughout the body when susceptible people eat gluten. The term gluten sensitivity includes celiac disease. Gluten is a protein found in wheat, its close relatives (kamut, spelt, triticale), barley and rye. Wheat is the most concentrated source.

Dangerous Grains is a good overview of the mountain of data on celiac disease and gluten sensitivity that few people outside the field are familiar with. For example, did you know:

  • An estimated one percent of the U.S. population suffers from celiac disease.
  • Approximately 12 percent of the US population may suffer from gluten sensitivity, according to blood antibody tests.
  • Gluten can damage nearly any part of the body, including the brain, the digestive tract, the skin and the pancreas. Sometimes gastrointestinal symptoms are absent.
  • Both celiac and other forms of gluten sensitivity increase the risk of a large number of diseases, such as type 1 diabetes and cancer, often dramatically.
  • The majority of people with gluten sensitivity are not diagnosed.
  • Most doctors don't realize how common gluten sensitivity is, so they rarely test for it.
  • Celiac disease and other symptoms of gluten sensitivity are easily reversed by avoiding gluten.
That's an enormous disease burden coming from a single type of food. I suspect the true incidence may actually be higher, although it's difficult to be sure.

Dangerous Grains
also discusses the opioid-like peptides released from gluten during digestion. Opioids are powerful drugs, such as heroin and morphine, that were originally derived from the poppy seed pod. They are strong suppressors of the immune system and quite addictive. There are no data that conclusively prove the opioid-like peptides in gluten cause immune suppression or addiction to wheat, but there are some interesting coincidences and anecdotes. Celiac patients are at an increased risk of cancer, particularly digestive tract cancer, which suggests that the immune system is compromised. Heroin addicts are also at increased risk of cancer. Furthermore, celiac patients often suffer from abnormal food cravings. 

I know several people who have benefited greatly from removing gluten from their diets. Anyone who has digestive problems, from gas to acid reflux, or any other mysterious health problem, owes it to themselves to try a gluten-free diet for a month. Gluten consumption has increased quite a bit in the U.S. in the last 30 years, mostly due to an increase in the consumption of processed wheat snacks. I believe it's partly to blame for our declining health. Wheat has more gluten than any other grain. Avoiding wheat and all its derivatives is a keystone of my health philosophy.

Another notable change that Sally Fallon and others have pointed out is that today's bread isn't made the same way our grandparents made it. Quick-rise yeast allows bread to be fermented for as little as 3 hours, whereas it was formerly fermented for 8 hours or more. This allowed the gluten to be partially broken down by the microorganisms in the dough.
Some gluten-sensitive people report that they can eat well-fermented sourdough wheat bread without symptoms. I think these ideas are plausible, but they remain anecdotes to me at this point. Until research shows that gluten-sensitive people can do well eating sourdough wheat bread in the long term, I'll be avoiding it. I have no reason to believe I'm gluten sensitive myself, but through my reading I've been convinced that wheat, at least how we eat it today, is probably not healthy for anyone.

I'm not aware of any truly healthy traditional culture that eats wheat as a staple. As a matter of fact, white wheat flour has left a trail of destruction around the globe wherever it has gone. Polished rice does not have such a destructive effect, so it's not simply the fact that it's a refined carbohydrate. Hundreds, if not thousands of cultures throughout the world have lost their robust good health upon abandoning their traditional foods in favor of white flour and sugar. The medical and anthropological literature are peppered with these stories.

Overall, the book is well written and accessible to a broad audience. I recommend it to anyone who has health problems or who is healthy and wants to stay that way!

Monday, October 20, 2008

DART: Many Lessons Learned

The Diet and Reinfarction Trial (DART), published in 1989, is one of the most interesting clinical trials I've had the pleasure to read about recently. It included 2,033 British men who had already suffered from an acute myocardial infarction (MI; heart attack), and tested three different strategies to prevent further MIs. Subjects were divided into six groups:
  • One group was instructed to reduce total fat to 30% of calories (from about 35%) and replace saturated fat (SFA) with polyunsaturated fat (PUFA).
  • The second group was told to double grain fiber intake.
  • The third group was instructed to eat more fatty fish or take fish oil if they didn't like fish.
  • The remaining three were control groups that were not advised to change diet; one for each of the first three.
Researchers followed the six groups for two years, recording deaths and MIs. The fat group reduced their total fat intake from 35.0 to 32.3% of calories, while doubling the ratio of PUFA to SFA (to 0.78). After two years, there was no change in all-cause or cardiac mortality. This is totally consistent with the numerous other controlled trials that have been done on the subject. Here's the mortality curve:

Here's what the authors have to say about it:
Five randomised trials have been published in which a diet low in fat or with a high P/S [polyunsaturated/saturated fat] ratio was given to subjects who had recovered from MI. All these trials contained less than 500 subjects and none showed any reduction in deaths; indeed, one showed an increase in total mortality in the subjects who took the diet.
So... why do we keep banging our heads against the wall if clinical trials have already shown repeatedly that total fat and saturated fat consumption are irrelevant to heart disease and overall risk of dying? Are we going to keep doing these trials until we get a statistical fluke that confirms our favorite theory? This DART paper was published in 1989, and we have not stopped banging our heads against the wall since. The fact is, there has never been a properly controlled clinical trial that has shown an all-cause mortality benefit for reducing total or saturated fat in the diet (without changing other variables at the same time). More than a dozen have been conducted to date.

On to fish. The fish group tripled their omega-3 intake, going from 0.6 grams per week of EPA to 2.4 g (EPA was their proxy for fish intake). This group saw a significant reduction in MI and all-cause deaths, 9.3% vs 12.8% total deaths over two years (a 27% relative risk reduction). Here's the survival chart:

Balancing omega-6 intake with omega-3 has consistently improved cardiac risk in clinical trials. I've discussed that here.

The thing that makes the DART trial really unique is it's the only controlled trial I'm aware of that examined the effect of grain fiber on mortality (without simultaneously changing other factors). The fiber group doubled their grain fiber intake, going from 9 to 17 grams by eating more whole grains. This group saw a non-significant trend toward increased mortality and MI compared to its control group. Deaths went up from 9.9% to 12.1%, a relative risk increase of 18%. I suspect this result was right on the cusp of statistical significance, judging by the numbers and the look of the survival curve:

You can see that the effect is consistent and increases over time. At this rate, it probably would have been statistically significant at 2.5 years.

I think the problem with whole grains is that the bran and germ contain a disproportionate amount of toxins, such as the mineral-binding phytic acid.  The bran and germ also contain a disproportionate amount of nutrients. To have your cake and eat it too, soak, sprout or ferment grains. This reduces the toxin load but preserves or enhances nutritional value. Wheat may be a problem whether it's treated this way or not.

Subjects in the studies above were eating grain fiber that was not treated properly, and so they were increasing their intake of some pretty nasty toxins while decreasing their nutrient absorption. Healthy non-industrial cultures would never have made this mistake. Grains must be treated with respect, and whole grains in particular.

Sunday, October 12, 2008

We're Starting to Get It

I just read an interesting post on the Food is Love blog.
According to the USDA (admittedly not always the most reliable source of accurate information, but we’ll go with it for the moment), the number of farmers markets in the US has risen significantly in the last ten years, from 2,746 in 1998 to 4,685 in 2008. If we get another 580 markets, an increase possible in the next year or two if trends continue, we’ll have tripled the number of recorded markets since 1994.
Plenty of farmers markets don’t get tallied in official lists, of course. Valereee, over at Cincinnati Locavore, points out that the USDA database only lists a quarter of the markets in her hometown. I see a few missing on the Seattle list as well.
People are slowly starting to get it. We're realizing that the processed food industry does not look out for our best interests. We're realizing that the frailty of modern children as well as our own health problems are due to the outsourcing of agriculture and food preparation. We're realizing that local farms and markets build strong communities.

We're realizing that a return to traditional, wholesome food is the only path to whole health and well-being.

Further reading:
My Real Food manifesto.

Wednesday, October 8, 2008

One Last Thought

In Dr. Lindeberg's paleolithic diet trial, subjects began with ischemic heart disease, and glucose intolerance or type II diabetes. By the end of the 12-week study, on average their glucose control was approaching normal and every subject had normal fasting glucose. Glucose control and fasting glucose in subjects following the "Mediterranean diet" did not change significantly. He didn't report changes in cardiovascular risk factors.

Why was the paleolithic diet so effective at restoring glucose control, while the Mediterranean diet was not? I believe the reason is that the Mediterranean diet did not eliminate the foods that were causing the problem to begin with: processed grains, particularly wheat. The paleolithic diet was lower in carbohydrate than the Mediterranean diet (40% vs 52%), although not exceptionally so. The absolute difference was larger since the paleolithic dieters were eating fewer calories overall (134 g vs 231 g). When they analyzed the data, they found that "the effect of the paleolithic diet on glucose tolerance was independent of carbohydrate intake". In other words, paleolithic dieters saw an improvement in glucose tolerance even if they ate as much carbohydrate as the average for the Mediterranean group.

This study population is not representative of the general public. These are people who suffered from an extreme version of the "disease of civilization". But they are examples of a process that I believe applies to nearly all of us to some extent. This paper adds to the evidence that the modern diet is behind these diseases.

A quick note about grains. Some of you may have noticed a contradiction in how I bash grains and at the same time praise Nutrition and Physical Degeneration. I'm actually not against grains. I think they can be part of a healthy diet, but they have to be prepared correctly and used in moderation. Healthy non-industrial cultures almost invariably soaked, sprouted or sourdough-fermented their grains. These processes make grains much more nutritious and less irritating to the digestive tract, because they allow the seeds to naturally break down their own toxins such as phytic acid, trypsin inhibitors and lectins.

Gluten grains are a special case. 12% of the US public is though to be gluten sensitive, as judged by anti-gliadin antibodies in the bloodstream. Nearly a third have anti-gliadin antibodies in their feces [update- these two markers may or may not indicate gluten sensitivity. SJG 2011]. Roughly 1% have outright celiac disease, in which the gut lining degenerates in response to gluten. All forms of gluten sensitivity increase the risk of a staggering array of health problems. There's preliminary evidence that gluten may activate the innate immune system in many people even in the absence of antibodies. From an anthropological perspective, wherever wheat flour goes, so does the disease of civilization. Rice doesn't have the same effect. It's possible that properly prepared wheat, such as sourdough, might not cause the same problems, but I'm not taking my chances. I certainly don't recommend quick-rise bread, and that includes whole wheat. Whole wheat seemed to be enough to preserve glucose intolerance in Lindeberg's study...