tag:blogger.com,1999:blog-42436479117767684472024-03-13T12:51:37.346-07:00Healthy CDC DiabetesAnonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.comBlogger25125tag:blogger.com,1999:blog-4243647911776768447.post-71406038553192363942013-06-10T00:14:00.000-07:002013-06-10T00:14:00.858-07:00Millions on Verge of Diabetes Don't Know ItTHURSDAY, March 21 (HealthDay News) -- Only 11 percent of the
estimated 79 million Americans who are at risk for diabetes know they
are at risk, federal health officials reported Thursday.<br />
The condition, known as prediabetes, describes
higher-than-normal blood sugar levels that put people in danger of
developing diabetes, according to the U.S. Centers for Disease Control
and Prevention.<br />
"We have a huge issue with the small number of
people who know they have it. It's up a bit from when we measured it
last, but it's still abysmally low," said report author Ann Albright,
director of the CDC's Division of Diabetes Translation.<br />
"We need
people to understand their risk and take action if they are at risk for
diabetes," Albright said. "We know how to prevent type 2 diabetes, or at
least delay it, so there are things people can do, but the first step
is knowing what your risk is -- to know if you have prediabetes."<br />
Things
that put people at risk for prediabetes include being overweight or
obese, being physically inactive and not eating a healthy diet, Albright
said. These people should see their doctor and have their blood sugar
levels checked, she said. <br />
There is also a genetic component,
Albright said, which is why having a family history of diabetes is
another risk factor. "Your genetics loads the gun, then your lifestyle
pulls the trigger," she said.<br />
According to the report, published in the March 22 issue of the <i>Morbidity and Mortality Weekly Report</i>,
the lack of awareness of prediabetes was the same across the board,
regardless of income, education, health insurance or access to health
care.<br />
One expert found the numbers troubling.<br />
"People don't
know about prediabetes, they don't exercise, they don't eat appropriate
foods and we are going to have many more diabetics in the near future
than we have now," said Dr. Spyros Mezitis, an endocrinologist at Lenox
Hill Hospital in New York City.<br />
The danger of prediabetes is that
it can progress to full-blown diabetes, with all the complications that
condition entails, including heart, kidney, circulation and vision
problems.<br />
Albright noted that 30 percent or more of those with prediabetes will develop diabetes over the course of a decade. <br />
The
number of Americans with diabetes is already staggering. According to
the American Diabetes Association, 25.8 million children and adults in
the United States -- 8.3 percent of the population -- have diabetes.<br />
"The
good news is we know there are things you can do to prevent or delay
the development of type 2 diabetes," Albright said. "You can prevent or
delay diabetes if you lose 5 percent to 7 percent of your body weight
and get 150 minutes of physical activity a week."<br />
Another expert said it starts with what you eat.<br />
Eating
a healthy diet that limits sugars and carbohydrates is important, said
Dr. Joel Zonszein, director of the Clinical Diabetes Center at
Montefiore Medical Center in New York City.<br />
Exercise and diet can
reduce the risk of diabetes by about 58 percent, he said, and "giving
the drug metformin can reduce the risk by 31 percent. Lifestyle changes,
together with metformin, which the American Diabetes Association
recommends for prediabetes, will be very effective.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-10151414808151695812013-06-09T00:13:00.001-07:002013-06-09T00:13:18.438-07:00Diabetes cases continue to climb in Georgia<div class="cmSource">
The Atlanta Journal-Constitution
</div>
<div class="cmArticle cmOembedContainer">
The number
of Georgians with diabetes continues to rise, jumping 145 percent from
1995 to 2010, according to a new Centers for Disease Control and
Prevention study.<br />
In Georgia, 9.8 percent of residents said they
had diabetes in 2010, compared with 4.0 percent in 1995, said Linda
Geiss, lead author of the study, released Thursday.<br />
Only Oklahoma and Kentucky saw a bigger jump in the number of cases during that 15-year period, according to the study.<br />
Geiss
said Southern states overall have the highest rates of diabetes in the
nation because of residents’ sedentary lifestyles and poor eating
habits.<br />
Diabetes is a chronic disease resulting from the body’s
inability to process sugar. It is the nation’s seventh-leading cause of
death, according to the CDC. It’s also a leading cause of kidney
failure, nontraumatic lower-limb amputations, new cases of blindness,
heart disease and stroke, according to the CDC.<br />
The new study is based on telephone surveys of at least 1,000 adults in each state in 1995 and 2010.<br />
Mississippi
had the highest obesity rate and the highest diabetes rate, the CDC
reported. Nearly 12 percent of Mississippians say they have diabetes,
compared with the national average of 7 percent.<br />
“Unfortunately,
people are still eating too much and exercising too little,” said
Michael Gault, executive director of the American Diabetes Association
for the Atlanta region. His organization offers numerous programs to
raise awareness of the disease and to help people who have contracted
diabetes.<br />
The association’s Tour de Cure bike ride attracted Scott
Dube, who has Type 2 diabetes, which may be prevented through lifestyle
changes and accounts for 90 percent to 95 percent of U.S. cases.<br />
Dube,
51, of Kennesaw was diagnosed in 1986 during a routine physical. He has
ridden in the diabetes association’s annual bike rides for many years.<br />
Having
diabetes has caused him to make better life choices, Dube said. “It’s a
struggle. But it’s not a thing that should just keep you down and out.”<br />
Dube made the necessary lifestyle changes, including cycling and other exercise and changes to his diet.<br />
“It starts with your mind-set,” he said. “You have to be positive and aggressive to fight it.”<br />
For
more information on diabetes, go to www.yourdiabetesinfo.org, which is
part of a partnership of the CDC and the National Institutes of Health
that provides resources to improve the treatment and outcomes of people
with the disease, promotes early diagnosis, and works to prevent or
delay the onset of Type 2 diabetes.</div>
Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-70220608791968370792011-01-27T19:00:00.000-08:002013-06-05T01:06:29.150-07:00The Diabetes EpidemicThe CDC just released its latest estimate of diabetes prevalence in the US (<a href="http://www.cdc.gov/media/releases/2011/p0126_diabetes.html">1</a>):<br /><blockquote>Diabetes affects 8.3 percent of Americans of all ages, and 11.3 percent of adults aged 20 and older, according to the National Diabetes Fact Sheet for 2011. About 27 percent of those with diabetes—7 million Americans—do not know they have the disease. Prediabetes affects 35 percent of adults aged 20 and older.</blockquote>Wow-- this is a massive problem. The prevalence of diabetes has been increasing over time, due to more people developing the disorder, improvements in diabetes care leading to longer survival time, and changes in the way diabetes is diagnosed. Here's a graph I put together based on CDC data, showing the trend of diabetes prevalence (percent) from 1980 to 2008 in different age categories (<a href="http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.htm">2</a>):<br /><br /><div style="text-align: left;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqrd-G8GJ0szEOJjgUtAk4-rjBHPZyrVqLRpZN0K2wcgWb95GhyA8nizqNocy8MGyfzabl-TXT6BdNdlRiNjw7pUlQZBLdC9v8O8C4ACgontNAo-Eag9KHMQfC_d8t771exLmr0rNj_nXp/s1600/Diabetes+trends+%2528US%2529+small.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 230px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqrd-G8GJ0szEOJjgUtAk4-rjBHPZyrVqLRpZN0K2wcgWb95GhyA8nizqNocy8MGyfzabl-TXT6BdNdlRiNjw7pUlQZBLdC9v8O8C4ACgontNAo-Eag9KHMQfC_d8t771exLmr0rNj_nXp/s400/Diabetes+trends+%2528US%2529+small.jpg" alt="" id="BLOGGER_PHOTO_ID_5567018764666796754" border="0" /></a><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrjt2QPV8LCOb0La0xQOJdbWFowCfbC9H44ELKmxA8ZamHNVlIJbCGh51q1NfkHZW3xKadaIctIgUe8IE50XfckSpz_XED45JV_ImWXV5smYQ45-hVxfIptRhLkIyp6Q0tLtBB8_28Oy0d/s1600/Diabetes+trends+%2528US%2529+small.jpg"><span style="font-weight: bold;"></span></a><br /></div>These data are self-reported, and do not correct for differences in diagnosis methods, so they should be viewed with caution-- but they still serve to illustrate the trend. There was an increase in diabetes incidence that began in the early 1990s. More than 90 percent of cases are type 2 diabetics. Disturbingly, the trend does not show any signs of slowing.<br /><br />The diabetes epidemic has followed on the heels of the obesity epidemic with 10-20 years of lag time. Excess body fat is the number one risk factor for diabetes*. As far as I can tell, type 2 diabetes is caused by insulin resistance, which is probably due to energy intake exceeding energy needs (overnutrition), causing a state of cellular insulin resistance as a defense mechanism to protect against the damaging effects of too much glucose and fatty acids (<a href="http://www.ncbi.nlm.nih.gov/pubmed/19805130">3</a>). In addition, type 2 diabetes requires a predisposition that prevents the pancreatic beta cells from keeping up with the greatly increased insulin needs of an insulin resistant person**. Both factors are required, and not all insulin resistant people will develop diabetes as some people's beta cells are able to compensate by hypersecreting insulin.<br /><br />Why does energy intake exceed energy needs in modern America and in most affluent countries? Why has the typical person's calorie intake increased by 250 calories per day since 1970 (<a href="http://wholehealthsource.blogspot.com/2008/12/us-weight-lifestyle-and-diet-trends.html">4</a>)? I believe it's because the fat mass "setpoint" has been increased, typically but not always by industrial food. I've been developing some new thoughts on this lately, and potentially new solutions, which I'll reveal when they're ready.<br /><br /><br />* In other words, it's the best predictor of future diabetes risk.<br /><br />** Most of the common gene variants (of known function) linked with type 2 diabetes are thought to impact beta cell function (<a href="http://www.ncbi.nlm.nih.gov/pubmed/19924209">5</a>).Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-29124019915501996502011-01-27T10:08:00.000-08:002013-06-05T01:06:29.156-07:00Two Wheat Challenge Ideas from CommentersSome people have remarked that the blinded challenge method I posted is cumbersome. <br /><br />Reader "Me" suggested:<br /><blockquote>You can buy wheat gluten in a grocery store. Why not simply have your friend add some wheat gluten to your normal protein shake.</blockquote>Reader David suggested:<br /><blockquote>They sell empty gelatin capsules with carob content to opacify them. Why not fill a few capsules with whole wheat flour, and then a whole bunch with rice starch or other placebo. For two weeks take a set of, say, three capsules every day, with the set of wheat capsules in line to be taken on a random day selected by your friend. This would further reduce the chances that you would see through the blind, and it prevent the risk of not being able to choke the "smoothie" down. It would also keep it to wheat and nothing but wheat (except for the placebo starch).</blockquote>The reason I chose the method in the last post is that it directly tests wheat in a form that a person would be likely to eat: bread. The limitation of the gluten shake method is that it would miss a sensitivity to components in wheat other than gluten. The limitation of the pill method is that raw flour is difficult to digest, so it would be difficult to extrapolate a sensitivity to cooked flour foods. You might be able to get around that by filling the pills with powdered bread crumbs. Those are two alternative ideas to consider if the one I posted seems too involved.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-2968467481128756202011-01-24T18:30:00.000-08:002013-06-05T01:06:29.161-07:00Blinded Wheat ChallengeSelf-experimentation can be an effective way to improve one's health*. One of the problems with diet self-experimentation is that it's difficult to know which changes are the direct result of eating a food, and which are the result of preconceived ideas about a food. For example, are you more likely to notice the fact that you're grumpy after drinking milk if you think milk makes people grumpy? Maybe you're grumpy every other day regardless of diet? Placebo effects and conscious/unconscious bias can lead us to erroneous conclusions.<br /><br />The beauty of the scientific method is that it offers us effective tools to minimize this kind of bias. This is probably its main advantage over more subjective forms of inquiry**. One of the most effective tools in the scientific method's toolbox is a <span style="font-weight: bold;">control</span>. This is a measurement that's used to establish a baseline for comparison with the intervention, which is what you're interested in. Without a control measurement, the intervention measurement is typically meaningless. For example, if we give 100 people pills that cure belly button lint, we have to give a different group placebo (sugar) pills. Only the comparison between drug and placebo groups can tell us if the drug worked, because maybe the changing seasons, regular doctor's visits, or having your belly button examined once a week affects the likelihood of lint.<br /><br />Another tool is called <span style="font-weight: bold;">blinding</span>. This is where the patient, and often the doctor and investigators, don't know which pills are placebo and which are drug. This minimizes bias on the part of the patient, and sometimes the doctor and investigators. If the patient knew he were receiving drug rather than placebo, that could influence the outcome. Likewise, investigators who aren't blinded while they're collecting data can unconsciously (or consciously) influence it.<br /><br />Back to diet. I want to know if I react to wheat. I've been gluten-free for about a month. But if I eat a slice of bread, how can I be sure I'm not experiencing symptoms because I think I should? How about blinding and a non-gluten control?<br /><br /><span style="font-weight: bold;">Procedure for a Blinded Wheat Challenge</span><br /><br />1. Find a friend who can help you.<br /><br />2. Buy a loaf of wheat bread and a loaf of gluten-free bread.<br /><br />3. Have your friend choose one of the loaves <span style="font-style: italic;">without telling you which he/she chose</span>.<br /><br />4. Have your friend take 1-3 slices, blend them with water in a blender until smooth. This is to eliminate differences in consistency that could allow you to determine what you're eating. Don't watch your friend do this-- you might recognize the loaf.<br /><br />5. Pinch your nose and drink the "bread smoothie" (yum!). This is so that you can't identify the bread by taste. Rinse your mouth with water before releasing your nose. Record how you feel in the next few hours and days.<br /><br />6. Wait a week. This is called a "washout period". Repeat the experiment with the second loaf, attempting to keep everything else about the experiment as similar as possible.<br /><br />7. Compare how you felt each time. Have your friend "unblind" you by telling you which bread you ate on each day. If you experienced symptoms during the wheat challenge but not the control challenge, you may be sensitive to wheat.<br /><br />If you want to take this to the next level of scientific rigor, repeat the procedure several times to see if the result is consistent. The larger the effect, the fewer times you need to repeat it to be confident in the result.<br /><br /><br />* Although it can also be disastrous. People who get into the most trouble are "extreme thinkers" who have a tendency to take an idea too far, e.g., avoid all animal foods, avoid all carbohydrate, avoid all fat, run two marathons a week, etc.<br /><br />** More subjective forms of inquiry have their own advantages.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-26587527270386424572011-01-20T19:46:00.000-08:002013-06-05T01:06:29.168-07:00Eating Wheat Gluten Causes Symptoms in Some People Who Don't Have Celiac DiseaseIrritable bowel syndrome (IBS) is a condition characterized by the frequent occurrence of abdominal pain, diarrhea, constipation, bloating and/or gas. If that sounds like an extremely broad description, that's because it is. The word "syndrome" is medicalese for "we don't know what causes it." IBS seems to be a catch-all for various persistent digestive problems that aren't defined as separate disorders, and it has a very high prevalence: as high as 14 percent of people in the US, although the estimates depend on what diagnostic criteria are used (<a href="http://www.ncbi.nlm.nih.gov/pubmed/15932367">1</a>). It can be brought on or exacerbated by several different types of stressors, including emotional stress and infection.<br /><br />Maelán Fontes Villalba at Lund University recently forwarded me an interesting new paper in the <span style="font-style: italic;">American Journal of Gastroenterology</span> (<a href="http://www.ncbi.nlm.nih.gov/pubmed/21224837">2</a>). Dr. Jessica R. Biesiekierski and colleagues recruited 34 IBS patients who did not have celiac disease, but who felt they had benefited from going gluten-free in their daily lives*. All patients continued on their pre-study gluten-free diet, however, all participants were provided with two slices of gluten-free bread and one gluten-free muffin per day. The investigators added isolated wheat gluten to the bread and muffins of half the study group.<br /><br />During the six weeks of the intervention, patients receiving the gluten-free food fared considerably better on nearly every symptom of IBS measured. The most striking difference was in tiredness-- the gluten-free group was much less tired on average than the gluten group. Interestingly, they found that a negative reaction to gluten was not necessarily accompanied by the presence of anti-gluten antibodies in the blood, which is a test often used to diagnose gluten sensitivity.<br /><br />Here's what I take away from this study:<br /><ol><li>Wheat gluten can cause symptoms in susceptible people who do not have celiac disease.</li><li>A lack of circulating antibodies against gluten does not necessarily indicate a lack of gluten sensitivity.<br /></li><li>People with mysterious digestive problems may want to try avoiding gluten for a while to see if it improves their symptoms**.</li><li>People with mysterious fatigue may want to try avoiding gluten.<br /></li></ol>A previous study in 1981 showed that feeding volunteers a large dose of gluten every day for 6 weeks caused adverse gastrointestinal effects, including inflammatory changes, in relatives of people with celiac disease, who did not themselves have celiac (<a href="http://www.ncbi.nlm.nih.gov/pubmed/6111631">3</a>). Together, these two studies are the most solid evidence that gluten can be damaging in people without celiac disease, a topic that has not received much interest in the biomedical research community.<br /><br />I don't expect everyone to benefit from avoiding gluten. But for those who are really sensitive, it can make a huge difference. Digestive, autoimmune and neurological disorders associate most strongly with gluten sensitivity. Avoiding gluten can be a fruitful thing to try in cases of mysterious chronic illness. We're two-thirds of the way through <a href="http://www.glutenfreejan.com/">Gluten-Free January</a>. I've been fastidiously avoiding gluten, as annoying as it's been at times***. Has anyone noticed a change in their health?<br /><br /><br />* 56% of volunteers carried HLA-DQ2 or DQ8 alleles, which is slightly higher than the general population. Nearly all people with celiac disease carry one of these two alleles. 28% of volunteers were positive for anti-gliadin IgA, which is higher than the general population.<br /><br />** Some people feel they are reacting to the fructans in wheat, rather than the gluten. If a modest amount of onion causes the same symptoms as eating wheat, then that may be true. If not, then it's probably the gluten.<br /><br />*** I'm usually about 95% gluten-free anyway. But when I want a real beer, I want one brewed with barley. And when I want Thai food or sushi, I don't worry about a little bit of wheat in the soy sauce. If a friend makes me food with gluten in it, I'll eat it and enjoy it. This month I'm 100% gluten-free though, because I can't in good conscience encourage my blog readership to try it if I'm not doing it myself. At the end of the month, I'm going to do a blinded gluten challenge (with a gluten-free control challenge) to see once and for all if I react to it. Stay tuned for more on that.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-54825492859834759872011-01-13T10:00:00.000-08:002013-06-05T01:06:29.174-07:00Does Dietary Saturated Fat Increase Blood Cholesterol? An Informal Review of Observational StudiesThe diet-heart hypothesis states three things:<br /><ol><li>Dietary saturated fat increases blood cholesterol<br /></li><li>Elevated blood cholesterol increases the risk of having a heart attack</li><li>Therefore, dietary saturated fat increases the risk of having a heart attack<br /></li></ol>To evaluate the second contention, investigators have examined the relationship between blood cholesterol and heart attack risk. Many studies including MRFIT have shown that the two are related (<a href="http://www.ncbi.nlm.nih.gov/pubmed/2619783">1</a>):<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfCTdIrnRtcJKJVu2Q2lNl3M-c6f6S23knX81cRYMnJeDm2YxT08YrLINON6c2jNUlNIjJxYe6eFYPs1OP8qi5w1q7Pm7imjG1hym86fzSPlC4TP5Xvr-KQK7ICFqfnWQGGSjGnaNXZzwm/s1600/MRFIT.png"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 255px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfCTdIrnRtcJKJVu2Q2lNl3M-c6f6S23knX81cRYMnJeDm2YxT08YrLINON6c2jNUlNIjJxYe6eFYPs1OP8qi5w1q7Pm7imjG1hym86fzSPlC4TP5Xvr-KQK7ICFqfnWQGGSjGnaNXZzwm/s400/MRFIT.png" alt="" id="BLOGGER_PHOTO_ID_5560363497386167794" border="0" /></a><br />The relationship becomes much more complex when you consider lipoprotein subtypes, density and oxidation level, among other factors, but at the very least there is an association between habitual blood cholesterol level and heart attack risk. This is what you would want to see if your hypothesis states that high blood cholesterol causes heart attacks.<br /><br />Now let's turn to the first contention, the hypothesis that dietary saturated fat increases serum cholesterol. This idea is so deeply ingrained in the scientific literature that many authors don't even bother providing references for it anymore. When references are provided, they nearly always point to the same type of study: short-term controlled diet trials, in which volunteers are fed different fats for 2-13 weeks and their blood cholesterol measured (<a href="http://www.ncbi.nlm.nih.gov/pubmed/12716665">2</a>)*. These are the studies on which the diet-heart hypothesis was built.<br /><br />But now we have a problem. Nearly every high-quality (prospective) observational study ever conducted found that saturated fat intake is not associated with heart attack risk (<a href="http://www.ncbi.nlm.nih.gov/pubmed/20071648">3</a>). So if saturated fat increases blood cholesterol, and higher blood cholesterol is associated with an increased risk of having a heart attack, then why don't people who eat more saturated fat have more heart attacks?<br /><br />I'll begin to answer that question with another question: why do researchers almost never cite observational studies to support the idea that dietary saturated fat increases blood cholesterol? Surely if the hypothesis is correct, then people who habitually eat a lot of saturated fat should have high cholesterol, right? One reason may be that in most instances, when researchers have looked for a relationship between saturated fat intake and blood cholesterol, they haven't found one. Those findings have essentially been ignored, but let's have a look...<br /><br /><span style="font-weight: bold;">The Studies</span><br /><br />It's difficult to do a complete accounting of these studies, but I've done my best to round them up. I can't claim this post is comprehensive, but I doubt I missed very many, and I certainly didn't exclude any that I came across. If you know of any I missed, please add them to the comments.<br /><br />The earliest and perhaps most interesting study I found was published in the <span style="font-style: italic;">British Medical Journal</span> in 1963 and is titled "Diet and Plasma Cholesterol in 99 Bank Men" (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2123482/">4</a>). Investigators asked volunteers to weigh all food consumed at home for 1-2 weeks, and describe in detail all food consumed away from home. Compliance was good. This dietary accounting method was much more thorough than in most observational studies today**. Animal fat intake ranged from 55 to 173 grams per day, and blood cholesterol ranged from 154 to 324 mg/dL, yet there was no relationship whatsoever between the two. I'm looking at a graph of animal fat intake vs. blood cholesterol as I write this, and it looks like someone shot it with a shotgun at 50 yards. They twisted the data every which way, but were never able to squeeze even a hint of an association out of it:<br /><blockquote>Making the most out of the data in other ways- for example, by analysis of the men very stable in their diets, or in whom weighing of food intake was maximal, or where blood was taken close to the diet [measurement]- did not increase the correlation. Because the correlation coefficient is almost as often negative as positive, moreover, what is being discussed mostly is the absence of association, not merely association that is unexpectedly small.</blockquote>The next study to discuss is the 1976 Tecumseh study (<a href="http://www.ncbi.nlm.nih.gov/pubmed/998550">5</a>). This was a large cardiovascular observational study conducted in Tecumseh, Michigan, which is often used as the basis for comparison for other cardiovascular studies in the literature. Using the 24 hour dietary recall method, including an analysis of saturated fat, the investigators found that:<br /><blockquote>Cholesterol and triglyceride levels were unrelated to quality, quantity, or proportions of fat, carbohydrate or protein consumed in the 24-hr recall period.</blockquote>They also noted that the result was consistent with what had been reported in other previously published studies, including the Evans county study (<a href="http://www.ncbi.nlm.nih.gov/pubmed/14253896">6</a>), the massive Israel Ischemic Heart Disease Study (<a href="http://www.ncbi.nlm.nih.gov/pubmed/5365596">7</a>) and the Framingham study. One of the longest-running, most comprehensive and most highly cited observational studies, the Framingham study was organized by Harvard investigators and continues to this day. When investigators analyzed the relationship between saturated fat intake, serum cholesterol and heart attack risk, they were so disappointed that they never formally published the results. We know from multiple sources that they found no significant relationship between saturated fat intake and blood cholesterol or heart attack risk***.<br /><br />The next study is the Bogalusa Heart Study, published in 1978, which studied the diet and health of 10 year old American children (<a href="http://www.ncbi.nlm.nih.gov/pubmed/623054">8</a>). This study found an association by one statistical method, and none by a second method****. They found that the dietary factors they analyzed explained no more than 4% of the variation in blood cholesterol. Overall, I think this study lends little or no support to the hypothesis.<br /><br />Next is the Western Electric study, published in 1981 (<a href="http://www.ncbi.nlm.nih.gov/pubmed/7442730">9</a>). This study found an association between saturated fat intake and blood cholesterol in middle-aged men in Chicago. However, the correlation was small, and there was no association between saturated fat intake and heart attack deaths. They cited two other studies that found an association between dietary saturated fat and blood cholesterol (and did not cite any of the numerous studies that found no association). One was a very small study conducted in young men doing research in Antarctica, which did not measure saturated fat but found an association between total fat intake and blood cholesterol (<a href="http://www.ncbi.nlm.nih.gov/pubmed/5424267">10</a>). The other studied Japanese (Nagasaki and Hiroshima) and Japanese Americans in Japan, Hawai'i and California respectively (<a href="http://aje.oxfordjournals.org/content/97/6/372.short">11</a>).<br /><br />This study requires some discussion. Published in 1973, it found a correlation between saturated fat intake and blood cholesterol in Japan, Hawai'i but not in California. The strongest association was in Japan, where going from 5 to 75 g/day of saturated fat (a 15-fold change!) was associated with an increase in blood cholesterol from about 175 to 200 mg/dL. However, I don't think this study offers much support to the hypothesis upon closer examination. Food intake in Japan was collected by 24-hour recall in 1965-1967, when the diet was mostly white rice in some areas. The lower limit of saturated fat intake in Japan was 5g/day, 1/12th what was typically eaten in Hawai'i and California, and the Japanese average was 16g, with most people falling below 10g. That is an extraordinarily low saturated fat intake. I think a significant portion of the Japanese in this study, living in the war-ravaged cities of Nagasaki and Hiroshima, were over-reliant on white rice and perhaps bordering on malnourishment.<br /><br />In Japanese-Americans living in Hawai'i, over a range of saturated fat intakes between 5 and 110 g/day, cholesterol went from 210 to 220 mg/dL. That was statistically significant but it's not exactly knocking my socks off, considering it's a 22-fold change in saturated fat intake. In California, going from 15 to 110 g/day of saturated fat (7.3-fold change) was not associated with a change in blood cholesterol. Blood cholesterol was 20-30 mg/dL lower in Japan than in Hawai'i or California at any given level of saturated fat intake (e.g., Japanese eating 30g per day vs. Hawai'ians eating 30g per day). I think it's probable that saturated fat is not the relevant factor here, or at least it's being trumped by other factors. An equally plausible explanation is that people in the very low range of saturated fat intake are the rural poor who eat an impoverished diet that differs in many ways from the diets at the upper end of the range.<br /><br />The most recent study was the Health Professional Follow-up study, published in 1996 (<a href="http://www.ncbi.nlm.nih.gov/pubmed/8688759">12</a>). This was a massive, well funded study that found no hint of a relationship between saturated fat intake and blood cholesterol.<br /><br /><span style="font-weight: bold;">Conclusion</span><br /><br />Of all the studies I came across, only the Western Electric study found a clear association between habitual saturated fat intake and blood cholesterol, and even that association was weak. The Bogalusa Heart study and the Japanese study provided inconsistent evidence for a weak association. The other studies I cited, including the bank workers' study, the Tecumseh study, the Evans county study, the Israel Ischemic Heart study, the Framingham study and the Health Professionals Follow-up study, found no association between the two factors.<br /><br />Overall, the literature does not offer much support for the idea that long term saturated fat intake has a significant effect on the concentration of blood cholesterol. If it's a factor at all, it must be rather weak, which is consistent with what has been observed in multiple non-human species (<a href="http://wholehealthsource.blogspot.com/2009/07/animal-models-of-atherosclerosis-ldl.html">13</a>). I think it's likely that the diet-heart hypothesis rests in part on an over-interpretation of short-term controlled feeding studies. I'd like to see a more open discussion of this in the scientific literature. In any case, these controlled studies have typically shown that saturated fat increases both LDL and HDL, so even if saturated fat did have a small long-term effect on blood cholesterol, as hinted at by some of the observational studies, its effect on heart attack risk would still be difficult to predict.<br /><br /><a href="http://wholehealthsource.blogspot.com/2009/07/diet-heart-hypothesis-stuck-at-starting.html">The Diet-heart Hypothesis: Stuck at the Starting Gate</a><br /><a href="http://wholehealthsource.blogspot.com/2009/07/animal-models-of-atherosclerosis-ldl.html">Animal Models of Atherosclerosis: LDL</a><br /><br /><br />* As a side note, many of these studies were of poor quality, and were designed in ways that artificially inflated the effects of saturated fat on blood lipids. For example, using a run-in period high in linoleic acid, or comparing a saturated fat-rich diet to a linoleic acid-rich diet, and attributing the differences in blood cholesterol to the saturated fat. Some of them used hydrogenated seed oils as the saturated fat. Although not always consistent, I do think that overall these studies support the idea that saturated fat does have a modest ability to increase blood cholesterol in the short term.<br /><br />** Although I would love to hear comments from anyone who has done controlled diet trials. I'm sure this method had flaws, as it was applied in the 1960s.<br /><br />*** Reference cited in the Tecumseh paper: Kannel, W et al. The Framingham Study. An epidemiological Investigation of Cardiovascular Diseases. Section 24: The Framingham Diet Study: Diet and the Regulation of Serum Cholesterol. US Government Printing Office, 1970.<br /><br />**** Table 5 shows that the Pearson correlation coefficient for saturated fat intake vs. blood cholesterol is not significant; table 6 shows that children in the two highest tertiles of blood cholesterol have a significantly higher intake of saturated fat, unsaturated fat, total fat and sodium than the lowest tertile. The relationship between saturated fat and blood cholesterol shows no evidence of dose-dependence (cholesterol tertiles= 15.6g, 18.4g, 18.5g saturated fat). The investigators made no effort to adjust for confounding variables.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-77686318973046102282011-01-11T20:52:00.000-08:002013-06-05T01:06:29.180-07:00Dr. FatA blog reader recently made me a Wordle from Whole Health Source. A Wordle is a graphical representation of a text, where the size of each word represents how often it appears. Click on the image for a larger version.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibVSrU2nY2LvYqXT-c-z6xHMgEusviBySOaKF3tkbhKXvnkcGtqAzc641ekiNk8_uvjYEaW1808DrylNnHRbz94e1c2VSaxTpobSmHXUdiwH9EQqLXfN5q-fvQCTj7PGw1gdfs3Sdg5tdi/s1600/Wordle.PNG"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 534px; height: 254px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibVSrU2nY2LvYqXT-c-z6xHMgEusviBySOaKF3tkbhKXvnkcGtqAzc641ekiNk8_uvjYEaW1808DrylNnHRbz94e1c2VSaxTpobSmHXUdiwH9EQqLXfN5q-fvQCTj7PGw1gdfs3Sdg5tdi/s400/Wordle.PNG" alt="" id="BLOGGER_PHOTO_ID_5561157977584399266" border="0" /></a>Apparently, the two most common words on this blog are "Dr" and "fat." It occurred to me that Dr. Fat would be a great <span style="font-style: italic;">nom de plume</span>.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-61900189089158894012011-01-03T19:00:00.000-08:002013-06-05T01:06:29.276-07:00Paleolithic Diet Clinical Trials, Part VDr. Staffan Lindeberg's group has published a new paleolithic diet paper in the journal <span style="font-style: italic;">Nutrition and Metabolism, </span>titled "A Paleolithic Diet is More Satiating per Calorie than a Mediterranean-like Diet in Individuals with Ischemic Heart Disease"<span style="font-style: italic;"> </span>(<a href="http://www.ncbi.nlm.nih.gov/pubmed/21118562">1</a>).<br /><br />The data in this paper are from the same intervention as his group's 2007 paper in <span style="font-style: italic;">Diabetologia</span> (<a href="http://www.ncbi.nlm.nih.gov/pubmed/17583796">2</a>). To review the results of this paper, 12 weeks of a Paleolithic-style diet caused impressive fat loss and improvement in glucose tolerance, compared to 12 weeks of a Mediterranean-style diet, in volunteers with pre-diabetes or diabetes and ischemic heart disease. Participants who started off with diabetes ended up without it. A Paleolithic diet excludes grains, dairy, legumes and any other category of food that was not a major human food source prior to agriculture. I commented on this study a while back (<a href="http://wholehealthsource.blogspot.com/2008/10/paleolithic-diet-clinical-trials.html">3</a>, <a href="http://wholehealthsource.blogspot.com/2008/10/paleolithic-diet-clinical-trials-part.html">4</a>).<br /><br />One of the most intriguing findings in his 2007 study was the low calorie intake of the Paleolithic group. Despite receiving no instruction to reduce calorie intake, the Paleolithic group only ate 1,388 calories per day, compared to 1,823 calories per day for the Mediterranean group*. That's a remarkably low <span style="font-style: italic;">ad libitum</span> calorie intake in the former (and a fairly low intake in the latter as well).<br /><br />With such a low calorie intake over 12 weeks, you might think the Paleolithic group was starving. Fortunately, the authors had the foresight to measure satiety, or fullness, in both groups during the intervention. They found that satiety was almost identical in the two groups, despite the 24% lower calorie intake of the Paleolithic group. In other words, the Paleolithic group was just as full as the Mediterranean group, despite a considerably lower intake of calories. This implies to me that the body fat "set point" decreased, allowing a reduced calorie intake while body fat stores were burned to make up the calorie deficit. I suspect it also decreased somewhat in the Mediterranean group, although we can't know for sure because we don't have baseline satiety data for comparison.<br /><br />There are a few possible explanations for this result. The first is that the Paleolithic group was eating more protein, a highly satiating macronutrient. However, given the fact that absolute protein intake was scarcely different between groups, I think this is unlikely to explain the reduced calorie intake.<br /><br />A second possibility is that certain potentially damaging Neolithic foods (e.g., wheat and refined sugar) interfere with leptin signaling**, and removing them lowers fat mass by allowing leptin to function correctly. Dr. Lindeberg and colleagues authored a hypothesis paper on this topic in 2005 (<a href="http://www.ncbi.nlm.nih.gov/pubmed/16336696">5</a>).<br /><br />A third possibility is that a major dietary change of any kind lowers the body fat setpoint and reduces calorie intake for a certain period of time. In support of this hypothesis, both low-carbohydrate and low-fat diet trials show that overweight people spontaneously eat fewer calories when instructed to modify their diets in either direction (<a href="http://www.ncbi.nlm.nih.gov/pubmed/1951152">6</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/11126204">7</a>). More extreme changes may cause a larger decrease in calorie intake and fat mass, as evidenced by the results of low-fat vegan diet trials (<a href="http://www.ncbi.nlm.nih.gov/pubmed/16164885">8</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/16873779">9</a>). Chris Voigt's potato diet also falls into this category (<a href="http://wholehealthsource.blogspot.com/2010/12/interview-with-chris-voigt-of-20.html">10</a>, <a href="http://wholehealthsource.blogspot.com/2010/12/potato-diet-interpretation.html">11</a>). I think there may be something about changing food-related sensory cues that alters the defended level of fat mass. A similar idea is the basis of <a href="http://www.sethroberts.net/">Seth Roberts</a>' book <span style="font-style: italic;">The Shangri-La Diet</span>.<br /><br />If I had to guess, I would think the second and third possibilities contributed to the finding that Paleolithic dieters lost more fat without feeling hungry over the 12 week diet period.<br /><br /><br />*Intakes were determined using 4-day weighed food records.<br /><br />**Leptin is a hormone produced by body fat that reduces food intake and increases energy expenditure by acting in the brain. The more fat a person carries, the more leptin they produce, and hypothetically this should keep body fat in a narrow window by this form of "negative feedback". Clearly, that's not the whole story, otherwise obesity wouldn't exist. A leading hypothesis is that resistance to the hormone leptin causes this feedback loop to defend a higher level of fat mass.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-67249232104020303812010-12-22T08:00:00.000-08:002013-06-05T01:06:29.282-07:00A Gluten-free January<div><span style="font-weight: bold;">Are You Gluten Sensitive?</span><br /><br />Many people are totally unaware of the fact that they react poorly to gluten. Because they've been eating wheat, barley and/or rye products every day for virtually their entire lives, they don't know what their bodies feel like without gluten.<span style="font-weight: bold;"> </span>In susceptible people, eating gluten is linked to a dizzying array of health problems that stem from an immune reaction to gliadins and other proteins in gluten (<a href="http://wholehealthsource.blogspot.com/2008/12/gluten-sensitivity-celiac-disease-is.html">1</a>). Are you a susceptible person? How do you know?<span style="font-weight: bold;"><br /><br /></span>The gold standard way to detect a gluten sensitivity is to do a gluten "challenge" after a period of avoidance and see how you feel. People who react poorly to gluten may feel better after a period of avoidance. After a gluten challenge, symptoms can range from digestive upset, to skin symptoms, to fatigue or irritability within minutes to days of the gluten challenge. <span style="font-weight: bold;"><br /><br /></span>With 2011 approaching, why not make your new year's resolution to go gluten-free for a month?<span style="font-weight: bold;"> </span>A man named Matt Lentzner e-mailed me this week to ask if I would help with his (non-commercial) project, "A Gluten-free January". I said I'd be delighted. Although I don't typically eat much gluten, this January I'm going 100% gluten-free. Are you on board? Read on.<span style="font-weight: bold;"><br /><br />A Message from Matt Lentzner</span><br /><br />Hi There.</div><div><br /></div><div>My name is Matt Lentzner. I'm just some guy who lifts weights on his patio and tries to eat healthy. That's not important, but I have an idea that just might be.</div><div><br /></div><div>I am trying to get as many people as possible to go gluten-free for one month - <span style="border-bottom: 2px dotted rgb(54, 99, 136); cursor: pointer;" class="yshortcuts" id="lw_1292995277_0">this January 2011</span>. </div><div><br /></div><div>I've considered this whole ancestral diet thing and I've come to a conclusion. If you could only do just one thing to improve your health then not eating gluten would be it. This is not to say that avoiding other nasty things like fructose or industrial vegetable oil is not important. They are, but you'd get the most bang for your buck from not eating gluten. </div> <div><br /></div><div>"Eat No Gluten" is simple and easy to remember. I think that sometimes the rules get so complicated and overwhelming and people just give up on it. We're keeping it simple here. Even at this simplified level I see that it's difficult for a lot of folks. I think people, Americans especially, tend not to pay much attention to what they're eating - what it is, where it came from, etc. </div> <div><br /></div><div>Getting people to get out of their eating ruts and think a little about what goes into their mouths is a valuable exercise. It sets the stage for better choices in the future. I hope that some success with the simple step will encourage people to further improve their diets.</div> <div><br /></div><div>I have a website at <a rel="nofollow" target="_blank" href="http://www.glutenfreejan.com/"><span class="yshortcuts" id="lw_1292995277_1">www.glutenfreejan.com</span></a>. If you want to sign up just send an email with your first name, last initial, and town of residence to <a rel="nofollow" target="_blank" href="mailto:glutenfreejan@gmail.com"><span class="yshortcuts" id="lw_1292995277_2">glutenfreejan@gmail.com</span></a>. If you are on <span class="yshortcuts" id="lw_1292995277_3">Facebook</span> there's a community you can 'Like' called: Gluten Free January. So far I have over 120 people all over the world signed up. If you are already gluten-free then I still want you to sign up - the more the merrier. You can also use this opportunity to spread the word and sign up your family and friends.</div> <div><br /></div><div>Merry Christmas - Looking forward to a gluten-free New Year.</div><div><br /></div><div>Matt</div>Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-1478386292222667512010-12-20T14:00:00.000-08:002013-06-05T01:06:29.288-07:00Dairy Fat and Diabetes<span style="font-weight: bold;">Introduction</span><br /><br />Having access to embargoed news from the Annals of Internal Medicine is really fun. I get to report on important studies at the same time as the news media. But this week, I got my hands on a study that I'm not sure will be widely reported (Mozaffarian et al. <span style="font-style: italic;">Trans</span>-palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in US Adults. Ann Internal Med. 2010). Why? Because it suggests that dairy fat may protect against diabetes.<br /><br />The lead author is Dr. Dariush Mozaffarian, whose meta-analysis of diet-heart controlled trials I recently criticized (<a href="http://wholehealthsource.blogspot.com/2010/03/leave-your-brain-at-door.html">1</a>). I think this is a good opportunity for me to acknowledge that Dr. Mozaffarian and his colleagues have published some brave papers in the past that challenged conventional wisdom. For example, in a 2005 study, they found that postmenopausal women who ate the most saturated fat had the slowest rate of narrowing of their coronary arteries over time (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1270002/">2</a>). It wasn't a popular finding but he has defended it. His colleague Dr. Walter Willett thinks dietary fat is fine (although he favors corn oil), whole eggs can be part of a healthy diet, and there are worse things than eating coconut from time to time. Dr. Willett is also a strong advocate of unrefined foods and home cooking, which I believe are two of the main pillars of healthy eating.<br /><span style="font-weight: bold;"><br />Let's hit the data </span><br /><br />Investigators collected two measures of dairy fat intake in 3,736 Americans:<br /><ol><li>24 hour dietary recall questionnaires, six times. This records volunteers' food intake at the beginning of the study.</li><li>Blood (plasma phospholipid) content of <span style="font-style: italic;">trans</span>-palmitoleate. Dairy fat and red meat fat are virtually the only sources of this fatty acid, so it reflects the intake of these foods. Most of the <span style="font-style: italic;">trans</span>-palmitoleate came from dairy in this study, although red meat was also a significant source. </li></ol>After adjustment for confounding factors, <span style="font-style: italic;">trans</span>-palmitoleate levels were associated with a smaller waist circumference, higher HDL cholesterol, lower serum triglycerides, lower C-reactive protein, lower fasting insulin and lower calculated insulin resistance. Furthermore, people with the highest <span style="font-style: italic;">trans</span>-palmitoleate levels had 1/3 the risk of developing diabetes over the three years volunteers were followed. Keep in mind, however, that this is an observational study and does not prove that dairy fat prevents diabetes.<br /><br />Even though certain blood fatty acids partially represent food intake, they can also represent metabolic conditions. For example, people on their way to type II diabetes tend to have more saturated blood lipids, independent of diet (<a href="http://www.ncbi.nlm.nih.gov/pubmed/20861175">3</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/12060056">4</a>)*. So it's reassuring to see that dietary <span style="font-style: italic;">trans</span>-palmitoleate intake was closely related to the serum level. The investigators also noted that "greater whole-fat dairy consumption was associated with lower risk for diabetes," which increases my confidence that serum <span style="font-style: italic;">trans</span>-palmitoleate is actually measuring dairy fat intake to some degree. However, in the end, I think the striking association they observed was partially due to dairy fat intake, but mostly due to metabolic factors that had nothing to do with dairy fat**.<br /><br />Here's a nice quote:<br /><blockquote>Our findings support potential metabolic benefits of dairy consumption and suggest that <span style="font-style: italic;">trans</span>-palmitoleate may mediate these effects***. They also suggest that efforts to promote exclusive consumption of low-fat and nonfat dairy products, which would lower population exposure to <span style="font-style: italic;">trans</span>-palmitoleate, may be premature until the mediators of the health effects of dairy consumption are better established.</blockquote>Never thought I'd see the day! Not bad, but I can do better:<br /><blockquote>Our findings support eating as much butter as possible****. Don't waste your money on low-fat cream, either (half-n-half). We're sorry that public health authorities have spent 30 years telling you to eat low-fat dairy when most studies are actually more consistent with the idea that dairy fat reduces the risk obesity and chronic disease. </blockquote>What are these studies suggesting that dairy fat may be protective, you ask? That will be the topic of another post, my friends.<br /><br /><br />*Probably due to uncontrolled <span style="font-style: italic;">de novo</span> lipogenesis because of insulin resistance. Many studies find that serum saturated fatty acids are higher in those with metabolic dysfunction, independent of diet. They sometimes interpret that as showing that people are lying about their diet, rather than that serum saturated fatty acids don't reflect diet very well. For example, in one study I cited, investigators found no relationship between dietary saturated fat and diabetes risk, but they did find a relationship between serum saturated fatty acids and diabetes risk (<a href="http://www.ncbi.nlm.nih.gov/pubmed/20861175">5</a>). They then proceeded to refer to the serum measurements as "objective measurements" that can tease apart "important associations with diabetes incidence that may be missed when assessed by [food questionnaires]." They go on to say that serum fatty acids are "useful as biomarkers for fatty acid intake," which is true for some fatty acids but not remotely for most of the saturated ones, according to their own study. Basically, they try to insinuate that dietary saturated fat is the culprit, and the only reason they couldn't measure that association directly is that people who went on to develop diabetes inaccurately reported their diets! A more likely explanation is that elevated serum saturated fatty acids are simply a marker of insulin resistance (and thus uncontrolled <span style="font-style: italic;">de novo</span> lipogenesis), and had nothing to do with diet.<br /><br />**Why do I say that? Because mathematically adjusting for dairy and meat fat intake did not substantially weaken the association between phospholipid <span style="font-style: italic;">trans</span>-palmitoleate and reduced diabetes risk (Table 4). In other words, if you believe their math, dairy/meat fat intake only accounted for a small part of the protective association. That implies that healthy people maintain a higher serum phospholipid <span style="font-style: italic;">trans</span>-palmitoleate level than unhealthy people, even if both groups eat the same amount of <span style="font-style: italic;">trans</span>-palmitoleate. If they hadn't mentioned that full-fat dairy fat intake was directly associated with a lower risk of diabetes, I would not find the study very interesting because I'd have my doubts that it was relevant to diet.<br /><br />***I find it highly doubtful that <span style="font-style: italic;">trans</span>-palmitoleate entirely mediates the positive health outcomes associated with dairy fat intake. I think it's more likely to simply be a marker of milk fat, which contains a number of potentially protective substances such as CLA, vitamin K2, butyric acid, and the natural <span style="font-style: italic;">trans</span> fats including <span style="font-style: italic;">trans</span>-palmitoleate. In addition, dairy fat is low in omega-6 polyunsaturated fat. I find it unlikely that their fancy math was able to tease those factors apart, because those substances all travel together in dairy fat. <span style="font-style: italic;">trans</span>-palmitoleate pills are not going to replace butter.<br /><br />****That's a joke. I think butter can be part of healthy diet, but that doesn't mean gorging on it is a good idea. This study does not prove that dairy fat prevents diabetes, it simply suggests that it may.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-23132021323844673432010-12-19T13:00:00.000-08:002013-06-05T01:06:29.384-07:00Potato Diet InterpretationIf you read my post on December 16th, you know that Chris Voigt saw remarkable fat loss and improvements in health markers as a result of two months of eating almost nothing but potatoes. This has left many people scratching their heads, because potatoes are not generally viewed as a healthy food. This is partially due to the fact that potatoes are very rich in carbohydrate, which also happens to be a quickly digested type, resulting in a high glycemic index. The glycemic index refers to the degree to which a particular food increases blood glucose when it's eaten, and I've questioned the relevance of this concept to health outcomes in the past (<a href="http://wholehealthsource.blogspot.com/2009/03/its-time-to-let-go-of-glycemic-index.html">1</a>, <a href="http://wholehealthsource.blogspot.com/2009/03/more-thoughts-on-glycemic-index.html">2</a>, <a href="http://wholehealthsource.blogspot.com/2010/08/saturated-fat-glycemic-index-and.html">3</a>). I think Mr. Voigt's results once again argue against the importance of the glycemic index as a diet-health concept.<br /><br />It's often pointed out that potatoes are low in vitamins and minerals compared to vegetables on a per-calorie basis, but I think it's a misleading comparison because potatoes are much more calorie-dense than most vegetables. Potatoes compare favorably to other starchy staples such as bread, rice and taro.<br /><br />Over the course of two months, Mr. Voigt lost 21 pounds. No one knows exactly how much of that weight came out of fat and how much out of lean mass, but the fact that he reported a decrease in waist and neck circumference indicates that most of it probably came out of fat. Previous long-term potato feeding experiments have indicated that it's possible to maintain an athletic muscle mass on the amount of protein in whole potatoes alone (<a href="http://wholehealthsource.blogspot.com/2010/10/potatoes-and-human-health-part-iii.html">4</a>). So yes, Mr. Voigt lost fat on a very high-carbohydrate diet (75-80% carbohydrate, up to 440g per day).<br /><br />On to the most interesting question: <span style="font-style: italic;">why</span> did he lose fat? Losing fat requires that energy leaving the body exceed energy entering the body. But as Gary Taubes would say, that's obvious but it doesn't get us anywhere. In the first three weeks of his diet, Mr. Voigt estimates that he was only eating 1,600 calories per day. Aha! That's why he lost weight! Well, yes. But let's look into this more deeply. Mr. Voigt was not deliberately restricting his calorie intake at all, and he did not intend this as a weight loss diet. In my interview, I asked him if he was hungry during the diet. He said that he was not hungry, and that he ate to appetite during this period, realizing only after three weeks that he was not eating nearly enough calories to maintain his weight*. I also asked him how his energy level was, and he said repeatedly that it was very good, perhaps even better than usual. Those were not idle questions.<br /><br />Calorie restriction causes a predictable physiological response in humans that includes hunger and decreased energy. It's the starvation response, and it's powerful in both lean and overweight people, as anyone knows who has tried to lose fat by decreasing calorie intake alone. The fact that he didn't experience hunger or fatigue implies that his body <span style="font-style: italic;">did not think it was starving</span>. Why would that be?<br /><br />I believe Mr. Voigt's diet lowered his fat mass 'setpoint'. In other words, for whatever reason, the diet made his body 'want' to be leaner that it already was. His body began releasing stored fat that it considered excess, and therefore he had to eat less food to complete his energy needs. You see this same phenomenon very clearly in rodent feeding studies. Changes in diet composition/quality can cause dramatic shifts in the fat mass setpoint (<a href="http://www.ncbi.nlm.nih.gov/pubmed/11742822">5</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/9486299">6</a>). Mr. Voigt's appetite would eventually have returned to normal once he had stabilized at a lower body fat mass, just as rodents do.<br /><br />Rodent studies have made it clear that diet composition has a massive effect on the level of fat mass that the body will 'defend' against changes in calorie intake (<a href="http://www.ncbi.nlm.nih.gov/pubmed/11742822">5</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/9486299">6</a>). Human studies have shown similar effects from changes in diet composition/quality. For example, in controlled diet trials, low-carbohydrate dieters spontaneously reduce their calorie intake quite significantly and lose body fat, without being asked to restrict calories (<a href="http://www.ncbi.nlm.nih.gov/pubmed/18635428">7</a>). In Dr. Staffan Lindeberg's Paleolithic diet trials, participants lost a remarkable amount of fat, yet a recent publication from his group shows that the satiety (fullness) level of the Paleolithic group was not different from a non-Paleolithic comparison group despite a considerably lower calorie intake over 12 weeks (<a href="http://www.ncbi.nlm.nih.gov/pubmed/17583796">8</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/21118562">9</a>). I'll discuss this important new paper soon. Together, this suggests that diet composition/quality can have a dominant impact on the fat mass setpoint.<br /><br />One possibility is that cutting the wheat, sugar, most vegetable oil and other processed food out of Mr. Voigt's diet was responsible for the fat loss. I think that's likely to have contributed. Many people find, for example, that they lose fat simply by eliminating wheat from their diet. <br /><br />Another possibility that I've been exploring recently is that changes in palatability (pleasantness of flavor) influence the fat mass setpoint. There is evidence in rodents that it does, although it's not entirely consistent. For example, rats will become massively obese if you provide them with chocolate flavored Ensure (a meal replacement drink), but not with vanilla or strawberry Ensure (<a href="http://www.ncbi.nlm.nih.gov/pubmed/11742822">10</a>). They will defend their elevated fat mass against calorie restriction (i.e. they show a physiological starvation response when you try to bring them down to a lower weight by feeding them less chocolate Ensure) while they're eating chocolate Ensure, but as soon as you put them back on unpurified rodent pellets, they will lose fat and defend the lower fat mass. Giving them food in liquid or paste form often causes obesity, while the same food in solid pellet form will not. Eating nothing but potatoes is obviously a diet with a low overall palatability.<br /><br />So I think that both a change in diet composition/quality and a decrease in palatability probably contributed to a decrease in Mr. Voigt's fat mass setpoint, which allowed him to lose fat mass without triggering a starvation response (hunger, fatigue).<br /><br />The rest of his improvements in health markers were partially due to the fat loss, including his decreased fasting glucose, decreased triglycerides, and presumably increased insulin sensitivity. They may also have been partially due to a lack of industrial food and increased intake of certain micronutrients such as magnesium.<br /><br />One of the most striking changes was in his calculated LDL cholesterol ("bad" cholesterol), which decreased by 41%, putting him in a range that's more typical of healthy non-industrial cultures including hunter-gatherers. Yet hunter-gatherers didn't eat nothing but potatoes, often didn't eat much starch, and in some cases had a high intake of fat and saturated fat, so what gives? It's possible that a reduced saturated fat intake had an impact on his LDL, given the relatively short timescale of the diet. But I think there's something mysterious about this setpoint mechanism that has a much broader impact on metabolism than is generally appreciated. For example, calorie restriction in humans has a massive impact on LDL, much larger than the impact of saturated fat (<a href="http://www.ncbi.nlm.nih.gov/pubmed/15096581">11</a>). And in any case, the latter appears to be a short-term phenomenon (<a href="http://wholehealthsource.blogspot.com/2009/07/diet-heart-hypothesis-stuck-at-starting.html">12</a>). It's just beginning to be appreciated that energy balance control systems in the brain influence cholesterol metabolism.<br /><br />Mr. Voigt's digestion appeared to be just fine on his potato diet, even though he generally ate the skins. This makes me even more skeptical of the idea that potato glycoalkaloids in common potato varieties are a health concern, especially if you were to eliminate most of the glycoalkaloids by peeling.<br /><br />I asked Mr. Voigt about what foods he was craving during the diet to get an idea of whether he was experiencing any major deficiencies. The fact that Mr. Voigt did not mention craving meat or other high-protein foods reinforces the fact that potatoes are a reasonable source of complete protein. The only thing he craved was crunchy/juicy food, which I'm not sure how to interpret.<br /><br />He also stopped snoring during the diet, and began again immediately upon resuming his normal diet, perhaps indicating that his potato diet reduced airway inflammation. This could be due to avoiding food allergies and irritants (wheat anyone?) and also fat loss.<br /><br />Overall, a very informative experiment! Enjoy your potatoes.<br /><br /><br />*Until the last 5.5 weeks, when he deliberately stuffed himself beyond his appetite because his rapid weight loss worried him. Yet, even with deliberate overfeeding up to his estimated calorie requirement of 2,200 calories per day, he continued to lose weight. He probably was not quite reaching his calorie goal, or his requirement is higher than he thought.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-66893237418328213532010-12-18T13:48:00.000-08:002013-06-05T01:06:29.481-07:00Trouble With RSS Feed?I've received several comments that my blog posts are no longer showing up in peoples' RSS feeds. I've gone into my settings, and the blog is still set to full feed mode, so I don't know why that would be. I'm trying to understand if the problem is widespread or only affects a few people. Please let me know in the comments section if new posts (since the potatoes and human health series) are not showing up in your reader. Also, please let me know if new posts are showing up. Thanks!Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-56393356617038923722010-12-16T19:00:00.000-08:002013-06-05T01:06:29.591-07:00Interview with Chris Voigt of 20 Potatoes a Day<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglcaus1XOVToh3DOOqK8YHtAMjDw2_BNHpMUNJXCoXD3z_GyM2XUSNwDe6_5rB9RoCWuiTlqP-cO0S_B1KqDo2PMSgWS3J3CWorVY1d77b6Sha0PFffpiBRYQX_VlEnyA8D1bgLtshnOeJ/s1600/Voigt.jpg"><img style="float: left; margin: 0pt 10px 10px 0pt; cursor: pointer; width: 193px; height: 261px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglcaus1XOVToh3DOOqK8YHtAMjDw2_BNHpMUNJXCoXD3z_GyM2XUSNwDe6_5rB9RoCWuiTlqP-cO0S_B1KqDo2PMSgWS3J3CWorVY1d77b6Sha0PFffpiBRYQX_VlEnyA8D1bgLtshnOeJ/s400/Voigt.jpg" alt="" id="BLOGGER_PHOTO_ID_5552622924599917618" border="0" /></a><span style="font-weight: bold;">Introduction</span><br /><br />Chris Voigt is the executive director of the Washington State Potato Commission, which supports and promotes the Washington state potato industry (<a href="http://www.potatoes.com/About.cfm">1</a>). On October 1st, Mr. Voigt began a two month, potato-only diet to raise awareness about the health properties of potatoes. It was partially in response to the recent decision by the federal WIC (Women, Infants and Children) low-income assistance program to remove potatoes from the list of vegetables it will pay for. Mr. Voigt's potato diet has been a media sensation, leading to widespread coverage in several countries. He maintains a website and blog called <a href="http://www.20potatoesaday.com/">20 Potatoes a Day</a>.<br /><br /><span style="font-weight: bold;"><br />Diet Facts</span><br /><br />For 60 days, Mr Voigt's diet consisted of nothing but potatoes and a small amount of cooking oil (canola and olive), with no added nutritional supplements. Based on what he has told me, I estimate that 10-15% of his calories came from fat, 10% from protein and 75-80% from high-glycemic carbohydrate. His calorie intake ranged from 1,600 kcal (first 3 weeks) to 2,200 kcal (remaining 5.5 weeks) per day. Prior to the diet, he estimated that his calorie requirement was 2,200 kcal, so he attempted to stay as close to that as possible.<br /><br /><span style="font-weight: bold;">Health Markers</span><br /><br />Mr. Voigt has posted the results of physical examinations, including bloodwork, from the beginning, middle and end of the diet. The change he experienced during that time is nothing short of remarkable. He shed 21 pounds, his fasting glucose decreased by 10 mg/dL (104 to 94 mg/dL), his serum triglycerides dropped by nearly 50%, his HDL cholesterol increased slightly, and his calculated LDL cholesterol dropped by a stunning 41% (142 to 84 mg/dL). The changes in his HDL, triglycerides and fasting glucose are consistent with improved insulin sensitivity (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292689/">2</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/14623617">3</a>), and are not consistent with a shift of LDL particle size to the dangerous "small, dense" variety (<a href="http://www.ncbi.nlm.nih.gov/pubmed/14564088">4</a>).<br /><br /><span style="font-weight: bold;">Interview</span><br /><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> <w:lidthemeother>EN-US</w:LidThemeOther> <w:lidthemeasian>X-NONE</w:LidThemeAsian> <w:lidthemecomplexscript>X-NONE</w:LidThemeComplexScript> <w:compatibility> 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semihidden="false" unhidewhenused="false" qformat="true" name="Intense Reference"> <w:lsdexception locked="false" priority="33" semihidden="false" unhidewhenused="false" qformat="true" name="Book Title"> <w:lsdexception locked="false" priority="37" name="Bibliography"> <w:lsdexception locked="false" priority="39" qformat="true" name="TOC Heading"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> <p class="MsoListParagraph" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>I averaged about 2 tablespoons 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locked="false" priority="66" semihidden="false" unhidewhenused="false" name="Medium List 2 Accent 6"> <w:lsdexception locked="false" priority="67" semihidden="false" unhidewhenused="false" name="Medium Grid 1 Accent 6"> <w:lsdexception locked="false" priority="68" semihidden="false" unhidewhenused="false" name="Medium Grid 2 Accent 6"> <w:lsdexception locked="false" priority="69" semihidden="false" unhidewhenused="false" name="Medium Grid 3 Accent 6"> <w:lsdexception locked="false" priority="70" semihidden="false" unhidewhenused="false" name="Dark List Accent 6"> <w:lsdexception locked="false" priority="71" semihidden="false" unhidewhenused="false" name="Colorful Shading Accent 6"> <w:lsdexception locked="false" priority="72" semihidden="false" unhidewhenused="false" name="Colorful List Accent 6"> <w:lsdexception locked="false" priority="73" semihidden="false" unhidewhenused="false" name="Colorful Grid Accent 6"> <w:lsdexception locked="false" priority="19" semihidden="false" 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mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> </p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">How was your digestion?</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"><span style="color: rgb(148, 54, 52);"><span style="color: rgb(0, 0, 0);"><blockquote>Potatoes are pretty easy on the digestive system. I actually got a lot of emails from people who suffer from severe digestive disorders and literally, potatoes are the only thing they can eat. My 60 days of potatoes was nothing compared to some folks with these digestive disorders. I was getting a lot of fiber so things were pretty regular, but not too regular :)<br /></blockquote></span><span style="font-family:webdings;"></span></span><span style="color: rgb(148, 54, 52);font-family:Wingdings;" ><span style=""></span></span><span style="color: rgb(148, 54, 52);"></span></p> <p class="MsoListParagraph" style="margin-bottom: 0.0001pt; text-indent: -0.25in;"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> <w:lidthemeother>EN-US</w:LidThemeOther> <w:lidthemeasian>X-NONE</w:LidThemeAsian> <w:lidthemecomplexscript>X-NONE</w:LidThemeComplexScript> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> 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semihidden="false" unhidewhenused="false" qformat="true" name="Intense Reference"> <w:lsdexception locked="false" priority="33" semihidden="false" unhidewhenused="false" qformat="true" name="Book Title"> <w:lsdexception locked="false" priority="37" name="Bibliography"> <w:lsdexception locked="false" priority="39" qformat="true" name="TOC Heading"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> </p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">Do you think you were able to meet your calorie goal of 2,200 calories per day?<span style=""> </span>Were you hungry during the diet?<span style=""> </span></p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>I was not meeting the goal of 2,200 calories a day during the first 3 weeks of the diet.<span style=""> </span>During the first three weeks of the diet I only ate until I was full.<span style=""> </span>I didn’t realize that potatoes would give me such a high sense of fullness after each meal.<span style=""> </span>So for those first 3 weeks, I was only consuming about 1,600 calories a day.<span style=""> </span>After the third week I had lost 12 pounds and realized that I needed to change strategy.<span style=""> </span>I then began to eat more potatoes despite the sense of fullness I was experiencing.<span style=""> </span>So for the remaining 5 ½ weeks I was very diligent about eating the 2,200 calories.<span style=""> </span>I continued to lose weight but at a slower place.<span style=""> </span>I lost an additional 9 pounds over the course of those remaining 5 1/2 weeks.<span style=""> </span>At the start of my diet I estimated, via a couple different on line calorie calculators, that I burn about 2,200 calories a day.<span style=""> </span>Since I continued to lose weight, I’m assuming I actually burn closer to 2,800 calories a day.<span style=""> </span>Something that may have also played a role in continued weight loss was the amount of resistant starch I was getting from potatoes.<span style=""> </span>I ate a lot of cooked potatoes that had been refrigerated.<span style=""> </span>These are generally higher in resistant starch.<span style=""> </span>If I were to do the diet again, I would like to set up an experiment to gauge the effect of resistant starch.</blockquote><p></p> <!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> 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unhidewhenused="false" qformat="true" name="Book Title"> <w:lsdexception locked="false" priority="37" name="Bibliography"> <w:lsdexception locked="false" priority="39" qformat="true" name="TOC Heading"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> <p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">What foods did you crave the most?</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>I craved mostly foods that had a “juicy crunch”, like an apple, or cucumbers, or carrots, or celery.<span style=""> </span>I never acquired a taste for raw potatoes so virtually all the potatoes I consumed were cooked.<span style=""> </span>No matter how you cook your potatoes, you always get that same soft cooked texture.<span style=""> </span>I craved foods with a crisper texture.</blockquote><p></p><p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> <w:lidthemeother>EN-US</w:LidThemeOther> <w:lidthemeasian>X-NONE</w:LidThemeAsian> <w:lidthemecomplexscript>X-NONE</w:LidThemeComplexScript> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> 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Grid Accent 6"> <w:lsdexception locked="false" priority="19" semihidden="false" unhidewhenused="false" qformat="true" name="Subtle Emphasis"> <w:lsdexception locked="false" priority="21" semihidden="false" unhidewhenused="false" qformat="true" name="Intense Emphasis"> <w:lsdexception locked="false" priority="31" semihidden="false" unhidewhenused="false" qformat="true" name="Subtle Reference"> <w:lsdexception locked="false" priority="32" semihidden="false" unhidewhenused="false" qformat="true" name="Intense Reference"> <w:lsdexception locked="false" priority="33" semihidden="false" unhidewhenused="false" qformat="true" name="Book Title"> <w:lsdexception locked="false" priority="37" name="Bibliography"> <w:lsdexception locked="false" priority="39" qformat="true" name="TOC Heading"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> </p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">How was your energy level?</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>My energy level was very good the entire time of the diet.<span style=""> </span>I really didn’t notice a change in energy at the start of the diet so I assumed that the potato diet didn’t have a positive or negative effect on my energy level.<span style=""> </span>It wasn’t until I finished the diet and started to consume other foods that I noticed my energy level has seemed to drop a bit.<span style=""> </span></blockquote><span style=""></span><p></p> <p 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class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">How did you feel overall?<span style=""> </span>Were there any unexpected effects of the diet?</p> <p class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0.0001pt;"><span style="color: rgb(148, 54, 52);"></span></p><p class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote><p class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);">I felt really good on the diet.<span style=""> </span>I had lots of energy, slept good at night, and seemed to avoid the cold viruses that circulated at home and work.<span style=""> </span></p> <p class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"><br /></p><p class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);">The only unusual thing that occurred is what my wife told me.<span style=""> </span>I’m a habitual snorer.<span 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font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> </p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">Your fasting glucose went from 104 mg/dL, which I consider high, to 94 mg/dL, which is on the high side for someone eating a high-carbohydrate diet, but within the clinically normal range.<span style=""> </span>Do you have a family history of diabetes? </p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>No history of diabetes.<span style=""> </span>My parents are in their early eighties and their parents lived to their 70’s and 80’s with no history of type one or two diabetes.<span style=""> </span></blockquote><span style=""></span><p></p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> 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<w:lsdexception locked="false" priority="33" semihidden="false" unhidewhenused="false" qformat="true" name="Book Title"> <w:lsdexception locked="false" priority="37" name="Bibliography"> <w:lsdexception locked="false" priority="39" qformat="true" name="TOC Heading"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> </p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">Reading your blog posts, it seemed like you were having a hard time with the diet at first, but after a while you complained less and even seemed to enjoy it at times.<span style=""> </span>Did you get used to it?</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>I would say that week 2 and 3 were probably the hardest.<span style=""> </span>The first week was easy probably because of the novelty of the diet.<span style=""> </span>Then reality set in for week 2 and 3.<span style=""> </span>After that, I found my groove and it got easier.<span style=""> </span>During the work week was easy but weekends, particularly Sunday’s, were the hardest.<span style=""> </span>During the work week I did most of my eating at my desk so I wasn’t around a lot of other people eating or surrounded by other foods.<span style=""> </span>Weekends were more difficult because I was around other people every meal and always had other foods in front of me at home.</blockquote><p></p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"><!--[if gte mso 9]><xml> 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semihidden="false" unhidewhenused="false" name="Medium Grid 3 Accent 6"> <w:lsdexception locked="false" priority="70" semihidden="false" unhidewhenused="false" name="Dark List Accent 6"> <w:lsdexception locked="false" priority="71" semihidden="false" unhidewhenused="false" name="Colorful Shading Accent 6"> <w:lsdexception locked="false" priority="72" semihidden="false" unhidewhenused="false" name="Colorful List Accent 6"> <w:lsdexception locked="false" priority="73" semihidden="false" unhidewhenused="false" name="Colorful Grid Accent 6"> <w:lsdexception locked="false" priority="19" semihidden="false" unhidewhenused="false" qformat="true" name="Subtle Emphasis"> <w:lsdexception locked="false" priority="21" semihidden="false" unhidewhenused="false" qformat="true" name="Intense Emphasis"> <w:lsdexception locked="false" priority="31" semihidden="false" unhidewhenused="false" qformat="true" name="Subtle Reference"> <w:lsdexception locked="false" priority="32" semihidden="false" unhidewhenused="false" qformat="true" name="Intense Reference"> <w:lsdexception locked="false" priority="33" semihidden="false" unhidewhenused="false" qformat="true" name="Book Title"> <w:lsdexception locked="false" priority="37" name="Bibliography"> <w:lsdexception locked="false" priority="39" qformat="true" name="TOC Heading"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> </p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">What kinds of potatoes did you eat?</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>I literally ate every kind of potato I could get my hands on.<span style=""> </span>I ate yellow skin/yellow flesh potatoes, red skin/white flesh, red skin/red flesh, purple skin/white flesh, purple skin/purple flesh, russet potatoes with white flesh, russet potatoes with yellow flesh, white potatoes, yellow potatoes with white flesh, purple fingerlings, yellow fingerlings, red fingerlings and numerous experimental varieties.</blockquote><p></p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> 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</w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> </p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">Did you peel them or eat the skin?</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>I ate the skin at least 90% of the time if not more.<span style=""> </span>There is a myth that all the nutrition in a potato is in the skin or right under the skin.<span style=""> </span>That’s not true, there are nutrients spread throughout the potato but 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</p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">What variety of potato is your favorite?</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>It really depended on the cooking method.<span style=""> </span>For frying, I preferred russet potatoes.<span style=""> </span>For baking, I preferred red potatoes.<span style=""> </span>For mashed, I preferred yellow potatoes.<span style=""> </span>For roasting, a toss-up between russets and reds.</blockquote><p></p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> 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</w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> </p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">How long did it take you after the diet ended to eat another potato?</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote>As strange as it sounds, potatoes were my first two meals after my diet ended.<span style=""> </span>I was saving my first non-potato meal for a special event that was planned at the local Head Start facility.<span style=""> </span>The beef, dairy, apple, and potato producers put together a nice dinner event and nutrition workshop for all the kids and their parents at the Head Start center in Moses Lake.<span style=""> </span>I still eat potatoes pretty regularly, but most of the time now I’m eating them with more than just seasonings.</blockquote><p></p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> <w:lidthemeother>EN-US</w:LidThemeOther> <w:lidthemeasian>X-NONE</w:LidThemeAsian> <w:lidthemecomplexscript>X-NONE</w:LidThemeComplexScript> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> 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mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} </style> <![endif]--> </p><p class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0.0001pt;">Are there any other facts about potatoes you think Whole Health Source readers might find interesting?</p> <p class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p><blockquote><p class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);">Just a reminder that I’m not encouraging anyone to follow in my footsteps and eat just potatoes.<span style=""> </span>This diet is not intended to be the next “fad” diet but was simply a bold statement to remind people that there is a tremendous amount of nutrition in a potato.<span style=""> </span>There is no one food product that can meet all of your nutritional needs.<span style=""> </span>I fully support a well balanced healthy diet, which potatoes can be a part of.</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"><br /></p><p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);">In 2008, the United Nations declared it to be the “Year of the Potato”.<span style=""> </span>This was done to bring attention to the fact that the potato is one of the most efficient crops for developing nations to grow, as a way of delivery a high level of nutrition to growing populations, with fewer needed resources than other traditional crops.<span style=""> </span>In the summer of 2010, China approved new government policies that positioned the potato as the key crop to feed its growing population.<span style=""> </span>The Chinese government formed a partnership with the International Potato Center in Peru to help them facilitate this new emphasis on the potato.</p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"></p></blockquote><p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; font-weight: bold;">Thanks Chris, for doing your experiment and taking the time to share these details with us!</p><p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;">In the next post, I'll give my interpretation of all this.<br /></p><p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"><br /><span style="color: rgb(148, 54, 52);"><span style="color: rgb(0, 0, 0);"></span></span></p><p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt;"><span style="color: rgb(148, 54, 52);"><span style=""></span></span></p> <p class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0.0001pt; color: rgb(0, 0, 0);"></p>Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-47717515346475052952010-12-05T13:00:00.000-08:002013-06-05T01:06:29.639-07:00Interview with a KitavanKitava is a Melanesian island that has maintained an almost entirely traditional, non-industrial diet until very recently. It was the subject of a study by Dr. Staffan Lindeberg and colleagues, which I have written about many times, in which they demonstrated that Kitavans have a very low (undetectable) rate of heart attack, stroke, diabetes and overweight. Dr. Lindeberg described their diet as consisting mostly of yam, sweet potato, taro, cassava, coconut, fruit, fish and vegetables. Over the seven days that Dr. Lindeberg measured food intake, they ate 69% of their calories as carbohydrate, 21% as fat (mostly from coconut) and 10% as protein.<br /><br />I recently received an e-mail from a Kitavan by the name of Job Daniel. He's working at the Papua New Guinea Institute of Medical Research in Madang, studying the social and economic impacts of malaria and related health issues in Papua New Guinea. He recalls many details of Dr. Lindeberg's visit to Kitava, which Dr. Lindeberg has confirmed are correct. Job generously offered to answer some of my questions about the traditional Kitavan diet. My questions are in bold, and his responses are below.<br /><br /><span style="font-weight: bold;">How many meals a day do Kitavans eat?</span><br />People on the island eat <u>mostly</u> two meals a day. But nowadays, breakfast is mainly comprised of tubers (yam and <span style="border-bottom: 2px dotted rgb(54, 99, 136); cursor: pointer;" class="yshortcuts" id="lw_1291009673_0">sweet potato</span> and greens all cooked in <span style="cursor: pointer; background: none repeat scroll 0% 0% transparent;" class="yshortcuts" id="lw_1291009673_1">coconut cream</span> and salt) and dinner is the same with the inclusion of fish as protein most often. In between these two meals, lunch is seen as a light refreshment with fruits or young coconut only to mention these two popular ones. In between the morning and the evening, we mostly eat fruits as snack or lunch. Generally speaking, there are only two main meals per day, i.e breakfast and dinner.<br /><span style="font-weight: bold;"><br />Do Kitavans eat any fermented food?</span><br />There are fermented fruits and nuts like you've said for breadfruit, nuts, yams and not forgetting fish. We ferment them by using the traditional method of drying them over the fire for months. And this fermented foods last for almost one to two years without getting stale or spoiled. <span class="yshortcuts" id="lw_1291009673_2">Food preservation</span> is a skill inherited from our great grand fathers taking into consideration the island's location and availability of food. Foods such as bread fruit and fish are fermented and preserved to serve as substitutes to fresh food in times of trouble or shortage. Otherwise, they're eaten along the way.<br /><br /><span style="font-weight: bold;">Is this really fermentation or simply drying?</span><br />To your query about the fermentation methods we use, apart from drying food over the fire, we also use this method like the Hawaiians do with taro [poi- SJG]. For our case we bury a special kind of fruit collected from the tree and buried in the ground to ripen, which takes about 2 - 3 days. I don't really know the English name, but we call it 'Natu' in vernecular. There's also a certain nut when it falls from the tree, women collect them and peel off the rotten skin, then mumu [earth oven- SJG] them in the ground covered with leaves to protect them from burning from the extreme heat of the fire, both from the open fire on top and hot stones underneath. After a day, the nuts are removed from the mumu and loaded into very big baskets which are then shifted to the sea for fermentation. This takes a week (minimum) to ferment or be ready for consumption at last. After the fermentation period is over, i.e one week some days or two<br />weeks to be exact, then the nuts are finally ready for eating. The length of time it takes before the nuts are no longer edible is roughly one week.<br /><br /><span style="font-weight: bold;">What parts of the fish are eaten?</span><br />As islanders, we eat almost every creature and body part of a <span class="yshortcuts" id="lw_1291009673_3">sea creature</span>. Especially fish eggs, it is one of the favorites of children. They always prefer it burnt on the fire and consumed greedily. Every part of the fish is eaten except for the feces, <span style="cursor: pointer; background: none repeat scroll 0% 0% transparent;" class="yshortcuts" id="lw_1291009673_4">gall bladder</span>, bones and the scales.<br /><br /><span style="font-weight: bold;">Is food shortage really rare on Kitava?</span><br />Generally speaking it is rare. BUT sometimes we run out of food only if there is a drought and the sea is useless. Otherwise, we tend to use the preserved or fermented foods on the dryer in the kitchen. As you would understand, we have seasons and they affect the type and availability of food on the island. In the beginning of the year, we eat sweet potato, cassava and mostly tuna for protein. During mid year, before yam comes in to replace sweet potato and cassava, taro is then ready for harvest. And then yams are ready for harvesting so the food supply is continued on. OK when yams are harvested, some are eaten, some are stored away for reserve and seedlings. In this way, we don't run out food towards the end of the year before sweet potato would be ready for harvest. So as you can see, the food supply on the island is somewhat planned by our ancestral economists where it continues throughout the year without stopping.<br /><br /><span style="font-weight: bold;">Do Kitavans traditionally eat pork, and if so, how often?</span><br />We do eat pork but not that often because pork meat is chiefly regarded important on the island. We only eat pork on special occasions so I'd rather say that pork is only eaten occasionally. In most cases in the middle of the year when the yams are harvested (yam harvest celebrations and towards the end of the year for certain rites and activities). Otherwise the everyday meal is always topped with fish.<br /><br /><span style="font-weight: bold;">How long are infants breast fed on Kitava?</span><br />Women breast feed for a minimum of 2 years. But breast feeding is again determined by the size and health situation of the baby. If the baby is looking healthy and big, it is most likely that this baby would be adopted temporarily by someone else so as to be removed from breast milk after two years of age minimum. Child care nowadays is paramount as people start to realize the <span style="cursor: pointer; background: none repeat scroll 0% 0% transparent;" class="yshortcuts" id="lw_1291009673_5">importance of health and hygiene</span> in general. But Kitavans are well known in that part of the country for their hygiene practices. They also got the provincial and district awards for a 'clean community' in early 90s and right now, they still maintain their hygiene level and awareness.<br /><br /><span style="font-weight: bold;">Are there any other foods that are commonly eaten on Kitava that I might not be aware of?</span><br />Bananas, pineapple, corn and watermelons. For watermelon and corn, they are plentiful especially at this time of the year.<br /><br /><span style="font-weight: bold;">Thanks for your help, Job! I know many people will appreciate reading these responses.</span>Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-38348184480104509422010-12-02T18:30:00.000-08:002013-06-05T01:06:29.736-07:00Diet-Heart Controlled Trials: a New Literature ReviewMany controlled studies have measured the cardiovascular effects of replacing animal ("saturated") fats with seed oils (predominantly the omega-6 polyunsaturated fat linoleic acid) in humans. A number of these studies recorded heart attacks and total mortality during the following 1-8 years. Several investigators have done meta-analyses (literature reviews) to try to tease out overall conclusions from these studies.<br /><br />I'm pleased to point out a new meta-analysis of these controlled trials by Dr. Christopher Ramsden and colleagues (<a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7930322&fulltextType=RV&fileId=S0007114510004010">1</a>). This paper finally cleans up the mess that previous meta-analyses have made of the diet-heart literature. One recent paper in particular by Dr. Dariush Mozaffarian and colleagues concluded that overall, the controlled trials show that replacing animal fat with linoleic acid (LA)-rich seed oils reduces heart attack risk (<a href="http://www.plosmedicine.org/article/info:doi%2F10.1371%2Fjournal.pmed.1000252">2</a>). I disagreed strongly with their conclusion because I felt their methods were faulty (<a href="http://wholehealthsource.blogspot.com/2010/03/leave-your-brain-at-door.html">3</a>).<br /><br />Dr. Ramsden and colleagues pointed out several fundamental flaws in the review paper by Dr. Mozaffarian and colleagues, as well as in the prevailing interpretation of these studies in the scientific literature in general. These overlap with the concerns that I voiced in my post (<a href="http://wholehealthsource.blogspot.com/2010/03/leave-your-brain-at-door.html">4</a>):<br /><ol><li>Omission of unfavorable studies, including the Rose corn oil trial and the Sydney diet-heart trial.</li><li>Inclusion of weak trials with major confounding variables, such as the Finnish mental hospital trial.</li><li>Failure to distinguish between omega-6 and omega-3 fatty acids.</li><li>Failure to acknowledge that seed oils often replaced large quantities of industrial <span style="font-style: italic;">trans</span> fats in addition to animal fat in these trials.<br /></li></ol>Dr. Ramsden and colleagues accounted for all of these factors in their analysis, which has never been done before. They chose inclusion criteria* that made sense, and stuck with them. In addition, they did an impressive amount of historical work, digging up old unpublished data from these trials to determine the exact composition of the control and experimental diets. The paper is published in the British Journal of Nutrition, an excellent journal, and overall is written in a scientific and professional manner.<br /><br />What did they find?<br /><ul><li>Interventions that replaced animal and <span style="font-style: italic;">trans</span> fat with seed oils that were rich in LA but low in omega-3 caused a non-significant trend toward increased heart attacks (13% increase) and overall mortality.<br /></li><li>Interventions that replaced animal and <span style="font-style: italic;">trans</span> fat with a combination of LA and omega-3 fats significantly reduced heart attacks (by 22%). The numbers for total mortality followed a similar trend. </li></ul>In other words, LA-rich seed oils do not prevent heart attacks (and may actually promote them), but correcting an omega-3 deficiency and reducing industrial <span style="font-style: italic;">trans</span> fat intake may be protective. This is similar to what I've been saying for a while now, based on my own interpretation of the same studies and others. However, Dr. Ramsden and colleagues have taken the idea to a new level by their thorough and sophisticated detective work and analysis. For example, I didn't realize that in virtually all of these controlled trials, the intervention group reduced its <span style="font-style: italic;">trans</span> fat intake substantially in addition to reducing animal fat. From the paper:<br /><blockquote>...experimental diets replaced common ‘hard’ margarines, industrial shortenings and other sources of [<span style="font-style: italic;">trans</span> fat] in all seven of the [controlled trials] included in the meta-analysis by Mozaffarian et al. The mean estimated [<span style="font-style: italic;">trans</span> fat] content of the seven control diets was 3·0 [% of calories] (range 1·5–9·6 [%]).<br />...the displacement of [<span style="font-style: italic;">trans</span> fat], rather than the substitution of mixed n-3/n-6 [polyunsaturated fat] for [saturated fat], may account for some or all of the 22% reduction in non-fatal [heart attacks and heart attack] death in our meta-analysis. By contrast, the increased [heart attack] risks from n-6 specific [polyunsaturated fat] diets in our meta-analysis may be underestimated as n-6 [polyunsaturated fat] also replaced substantial quantities of [<span style="font-style: italic;">trans</span> fat] (Table 3). The consistent trends towards increased [heart attack] risk of n-6 specific [polyunsaturated fat] diets may have become significant if the n-6 [polyunsaturated fat] replaced only [saturated fat], instead of a combination of [saturated fat] and [<span style="font-style: italic;">trans</span> fat].</blockquote>In other words, it looks like <span style="font-style: italic;">trans</span> fat is probably the issue, not animal fat, but these trials replaced both simultaneously so we can't know for sure. I will note here that <span style="font-style: italic;">trans</span> fat does not generally promote atherosclerosis (thickening and hardening of arteries) in animal models, so if it does truly increase heart attack risk as many studies suggest, it's probably through a mechanism that is independent of atherosclerosis.<br /><br />The article also contains an excellent discussion of the Finnish mental hospital trial (<a href="http://www.ncbi.nlm.nih.gov/pubmed/4116551">5</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/393644">6</a>) and why it was excluded from the meta-analysis, in which Dr. Ramsden and colleagues point out major design flaws, some of which I was not aware of. For example, <span style="font-style: italic;">trans</span> fat intake was on average <span style="font-style: italic;">13 times higher</span> in the control groups than in the experimental groups. In addition, one of the control groups received more than twice as much of the antipsychotic drug thioridazine, which is known to be highly toxic to the heart, as any other group. Ouch. I'm glad to see this study finally discussed in an open and honest manner. I discussed my own problems with the Finnish trial in an earlier post (<a href="http://wholehealthsource.blogspot.com/2009/07/finnish-mental-hospital-trial.html">7</a>).<br /><br />I was also glad to see an open discussion of the Oslo Diet-heart study (<a href="http://www.ncbi.nlm.nih.gov/pubmed/5228820">8</a>), in which diet changes led to a reduction in heart attack risk over five years. Dr. Mozaffarian and colleagues included it in their analysis as if it were a controlled trial in which animal fat was replaced by seed oils only. In reality, the investigators changed many variables at once, which I had also pointed out in my critique of Dr. Mozaffarian's meta-analysis (<a href="http://wholehealthsource.blogspot.com/2010/03/leave-your-brain-at-door.html">9</a>). Here's what Dr. Ramsden and colleagues had to say about it:<br /><blockquote>First, experimental dieters were instructed to substitute fish, shellfish and ‘whale beef’ for meats and eggs, and were actually supplied with ‘considerable quantities of Norwegian sardines canned in cod liver oil, which proved to be popular as a bread spread’(32)... Second, the experimental group consumed massive amounts of soybean oil, which provided large quantities of both LA (15·6 en %) and ALA (2·7 en %). ALA consumption was about 4·5 times average US intake(42), or about twelve typical flax oil pills (1 g pill ¼ 560 mg ALA) per d. In addition, the fish and cod liver oil consumption provided Oslo (598N latitude) dieters with 610 IU (15·25 mg) of daily vitamin D3, recently linked to lower blood pressure, plaque stabilisation, and reduced [heart attack risk] (64). Furthermore, experimental dieters were encouraged to eat more nuts, fruits, and vegetables; to limit animal fats; and to restrict their intake of refined grains and sugar.</blockquote><span style="font-style: italic;">trans</span> fat intake was also reduced substantially by excluding margarine in the experimental group. Other review papers have used this trial as a justification to replace animal fat with seed oils. Hmm... The only reason they get away with this is because the trial was published in 1966 and almost no one today has actually read it.<br /><br />One criticism I have of Dr. Ramsden's paper is that they used the Oslo trial in their analysis, despite the major limitation described above. However, they were extremely open about it and discussed the problem in detail. Furthermore, the overall result would have been essentially the same even if they had excluded the Oslo trial from the analysis.<br /><br />Overall, the paper is an excellent addition to the literature, and I hope it will bring a new level of sophistication to the dialogue on dietary prevention of cardiovascular disease. In the meantime, brace yourselves for an avalanche of criticism from the seed oil brigade.<br /><br /><br />* Guidelines that determine which studies to include in the analysis. For example, you want to exclude any study that wasn't randomized, because it will not be interpretable from a statistical standpoint. You also want to exclude trials where major variables differ between groups besides the specific variable you're trying to test. The Finnish mental hospital trial fails by both criteria.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-31638645372316837242010-11-29T19:30:00.000-08:002013-06-05T01:06:29.833-07:00Choline and Fatty LiverI've been writing about non-alcoholic fatty liver disorder (NAFLD) since the early days of this blog, because it's an alarmingly common disorder (roughly a quarter of Americans affected) that is typically undiagnosed. It often progresses into its more serious cousin non-alcoholic steatohepatitis (NASH), an inflammatory condition that causes liver damage and can progress to cancer. In a number of previous posts, I pinpointed excess sugar and seed oil consumption as culprits in NAFLD and NASH (<a href="http://wholehealthsource.blogspot.com/2009/06/letter-to-editor.html">1</a>, <a href="http://wholehealthsource.blogspot.com/2010/03/fatty-liver-its-not-just-for-grown-ups.html">2</a>, <a href="http://wholehealthsource.blogspot.com/2009/04/excess-omega-6-fat-damages-infants.html">3</a>, <a href="http://wholehealthsource.blogspot.com/2008/09/nonalcoholic-fatty-liver-disease.html">4</a>, <a href="http://wholehealthsource.blogspot.com/2008/09/how-to-fatten-your-liver.html">5</a>).<br /><br />Chris Masterjohn recently published two very informative posts on NAFLD/NASH that add a major additional factor to the equation: choline (<a href="http://blog.cholesterol-and-health.com/2010/11/sweet-truth-about-liver-and-egg-yolks.html">6</a>, <a href="http://blog.cholesterol-and-health.com/2010/11/does-choline-deficiency-contribute-to.html">7</a>). Choline is an essential nutrient that's required for the transport of fat out of the liver (<a href="http://www.jlr.org/content/9/4/437.abstract">8</a>). NAFLD can be caused, and cured, simply by removing or adding dietary choline, and it appears to be dominant over other dietary factors including fat, sugar and alcohol. Apparently, certain researchers have been aware of this for some time, but it hasn't entered into the mainstream consciousness. <br /><br />Could that be because the richest dietary sources are liver and eggs*? Choline is also found in smaller amounts in a variety of whole animal and plant foods. Most people don't get the officially recommended amount. From a recent review article (<a href="http://www.ncbi.nlm.nih.gov/pubmed/19906248">9</a>):<br /><blockquote>Mean choline intakes for older children, men, women, and pregnant women are far below the adequate intake level established by the [Institute of Medicine]. Given the importance of choline in a wide range of critical functions in the human body, coupled with less-than-optimal intakes among the population, dietary guidance should be developed to encourage the intake of choline-rich foods.</blockquote>I've dubbed beef liver the Most Nutritious Food in the World, Nature's Multivitamin, and I'll probably invent other titles for it in the future. Add yours to the comments. Learn to love liver! I think it's an excellent food to eat on a weekly basis.<br /><br />Head over to Chris's blog and read about the classic studies he unearthed. And add The Daily Lipid to your RSS reader, because there's more interesting material to come!<br /><br /><a href="http://blog.cholesterol-and-health.com/2010/11/sweet-truth-about-liver-and-egg-yolks.html">The Sweet Truth about Liver and Egg Yolks</a><br /><a href="http://blog.cholesterol-and-health.com/2010/11/does-choline-deficiency-contribute-to.html">Does Choline Deficiency Contribute to Fatty Liver in Humans?</a><br /><br /><br />* For the brave: brain is actually the richest source of choline.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-33596103261408651632010-11-20T17:00:00.000-08:002013-06-05T01:06:29.930-07:00Glucose Tolerance in Non-industrial Cultures<span style="font-weight: bold;">Background</span><br /><br />Glucose is the predominant blood sugar and one of the body's two main fuel sources (the other is fatty acids). Glucose, in one form or another, is also the main form of digestible dietary carbohydrate in nearly all human diets. Starch is made of long chains of glucose molecules, which are rapidly liberated and absorbed during digestion. Sucrose, or table sugar, is made of one glucose and one fructose molecule, which are separated before absorption.<br /><br />Blood glucose is essential for life, but it can also be damaging if there is too much of it. Therefore, the body tries to keep it within a relatively tight range. Normal fasting glucose is roughly between 70 and 90 mg/dL*, but in the same individual it's usually within about 5 mg/dL on any given day. Sustained glucose above 160 mg/dL or so causes damage to multiple organ systems. Some people would put that number closer to 140 mg/dL.<br /><br />The amount of glucose contained in a potato far exceeds the amount contained in the blood, so if all that glucose were to enter the blood at once, it would lead to a highly damaging blood glucose level. Fortunately, the body has a hormone designed to keep this from happening: insulin. Insulin tells cells to internalize glucose from the blood. It's released by the pancreas in response to eating carbohydrate, and protein to a lesser extent. The amount of insulin released is proportional to the amount of carbohydrate ingested, so that glucose entering the blood is cleared before it can accumulate.<br /><br />Insulin doesn't clear all the glucose as it enters the bloodstream, however. Some of it does accumulate, leading to a spike in blood glucose. This usually doesn't exceed 160 mg/dL in a healthy person, and even if it approaches that level it's only briefly. However, diabetics have reduced insulin signaling, and eating a typical meal can cause their glucose to exceed 300 mg/dL due to reduced clearance. In affluent nations, this is typically due to type II diabetes, which begins as insulin resistance, a condition in which insulin is actually higher than normal but cells fail to respond to it.<br /><br />The precursor to diabetes is called <span style="font-style: italic;">glucose intolerance</span>, or pre-diabetes. In someone with glucose intolerance, blood glucose after a typical meal will exceed that of a healthy person, but will not reach the diabetic range (a common definition of diabetes is 200 mg/dL or higher, 2 hours after ingesting 75g of glucose). <span style="font-style: italic;">Glucose tolerance</span> refers to a person's ability to control blood glucose when challenged with dietary glucose, and can be used in some contexts as a useful predictor of diabetes risk and general metabolic health. Doctors use the oral glucose tolerance test (OGTT), which involves drinking 60-100g glucose and measuring blood glucose after one or two hours, to determine glucose tolerance.<br /><br /><span style="font-weight: bold;">Why do we care about glucose tolerance in non-industrial cultures?</span><br /><br />One of the problems with modern medical research is that so many people in our culture are metabolically sick that it can be difficult to know if what we consider "normal" is really normal or healthy in the broader sense. Non-industrial cultures allow us to examine what the human metabolism is like in the absence of metabolic disease. I admit this rests on certain assumptions, particularly that these people aren't sick themselves. I don't think all non-industrial cultures are necessarily healthy, but I'm going to stick with those that research has shown have an exceptionally low prevalence of diabetes (by Western standards) and other "diseases of civilization" for the purposes of this post.<br /><br />Here's the question I really want to answer in this post: do healthy non-industrial cultures with a very high carbohydrate intake have an excellent glucose tolerance, such that their blood glucose doesn't rise to a high level, or are they simply resistant to the damaging effects of high blood glucose?<br /><br /><span style="font-weight: bold;">The data</span><br /><br />I'm going to start with an extreme example. In the 1960s, when it was fashionable to study non-industrial cultures, researchers investigated the diet and health of a culture in Tukisenta, in the highlands of Papua New Guinea. The eat practically nothing but sweet potatoes, and their typical daily fare is 94.6 percent carbohydrate. Whether or not you believe that exact number, their diet was clearly extraordinarily high in carbohydrate. They administered 100g OGTTs and measured blood glucose at one hour, which is a very stringent OGTT. They compared the results to those obtained in the 1965 Tecumseh study (US) obtained by the same method. Here's what they found (<a href="http://www.ncbi.nlm.nih.gov/pubmed/4718949">1</a>):<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghijpwudMehCaNvYOwyjqX30AUWdOdDpQAplYEQy4c8v6GYyFeefgWb3BrK1QE1f59tmZNoMAuGF0tjZThv5SCZoLJc4G1E15P31H-g8QJOCkyDJiMRXV1JcmZax4UOgBYDC95bkwaD6QH/s1600/PNG+glucose.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 308px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghijpwudMehCaNvYOwyjqX30AUWdOdDpQAplYEQy4c8v6GYyFeefgWb3BrK1QE1f59tmZNoMAuGF0tjZThv5SCZoLJc4G1E15P31H-g8QJOCkyDJiMRXV1JcmZax4UOgBYDC95bkwaD6QH/s400/PNG+glucose.jpg" alt="" id="BLOGGER_PHOTO_ID_5541128879471819298" border="0" /></a>Compared to Americans, in Tukisenta they had an extraordinary glucose tolerance at all ages. At one hour, their blood glucose was scarcely above normal fasting values, and glucose tolerance only decreased modestly with age. In contrast, in Americans over 50 years old, the <span style="font-style: italic;">average</span> one-hour value was approaching the diabetic range!<br /><br />Now let's take a look at the African Bantu in the Lobaye region of the Central African Republic. The Bantu are a large ethnic group who primarily subsist on a diverse array of starchy foods including grains, beans, plantains and root crops. One hour after a 100g OGTT, their blood glucose was 113 mg/dL, compared to 139 mg/dL in American controls (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC302138/">2</a>). Those numbers are comparable to what investigators found in Tukisenta, and indicate an excellent glucose tolerance in the Bantu.<br /><br />In South America, different investigators studied a group of native Americans in central Brazil that subsist primarily on cassava (a starchy root crop) and freshwater fish. Average blood glucose one hour after a 100g OGTT was 94 mg/dl, and only 2 out of 106 people tested had a reading over 160 mg/dL (both were older women) (<span style="font-style: italic;">Western Diseases: Their Emergence and Prevention</span>, p. 149). Again, that indicates a phenomenal glucose tolerance by Western standards.<br /><br />I have to conclude that high-carbohydrate non-industrial cultures probably don't experience damaging high blood glucose levels, because their glucose tolerance is up to the task of shuttling a huge amount of glucose out of the bloodstream before that happens.<br /><br /><span style="font-weight: bold;">Not so fast...</span><br /><br />Now let's turn our attention to another study that may throw a wrench in the gears. A while back, I found a paper containing OGTT data for the !Kung San (also called the Bushmen), a hunter-gatherer group living in the Kalahari desert of Africa. I reported in an earlier post that they had a good glucose tolerance. When I revisited the paper recently, I realized I had misread it and in fact, their glucose tolerance was actually pretty poor (come on guys, you have to call me on this stuff!).<br /><br />Investigators administered a 50g OGTT, half what the other studies used. At one hour, the San had blood glucose readings of 169 mg/dL, compared to 142 mg/dL in Caucasian controls (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1799259/">3</a>)! I suspect a 100g OGTT would have put them close to the diabetic range.<br /><br />Wait a minute, these guys are hunter-gatherers living the ancestral lifestyle; aren't they supposed to be super healthy?? While I was mulling this over, I recalled a discussion on Peter's blog <a href="http://high-fat-nutrition.blogspot.com/">hyperlipid</a> where commenters were discussing their diabetic OGTT values while on a low-carbohydrate diet. Apparently, carbohydrate refeeding for a few days generally reverses this and allows a normal OGTT in most people. It turns out this effect has been known for the better part of a century.<br /><br />So what were the San eating? The study was conducted in October of 1970. The San diet changes seasonally, however their main staple food is the mongongo nut, which is mostly fat and which is available year-round (according to <span style="font-style: italic;">The !Kung San: Men, Women and Work in a Foraging Society</span>). Their carbohydrate intake is generally low by Western standards, and at times of the year it is very low. This varies by the availability of other foods, but they generally don't seem to relish the fibrous starchy root crops that are available in the area, as they mostly eat them when other food is scarce. Jean-Louis Tu has posted a nice analysis of the San diet on BeyondVeg (<a href="http://www.beyondveg.com/tu-j-l/raw-cooked/raw-cooked-3f.shtml">4</a>). Here's a photo of a San man collecting mongongo nuts from <span style="font-style: italic;">The !Kung San: Men, Women and Work in a Foraging Society</span><span>:</span><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixshcam-DECyB4uxYZn5qHirOmV_MTaSP2vVdIPMB06J3pB7M1esdMbMMLJYcqKIHURxCfhT3jUGHM_i3aB8JlBp9aH7qT1ZURL6oDBfQxkhxie6v-Qh6g-HFsHFMZzPJT37t0pUPDI-Zn/s1600/Mongongo.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 373px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixshcam-DECyB4uxYZn5qHirOmV_MTaSP2vVdIPMB06J3pB7M1esdMbMMLJYcqKIHURxCfhT3jUGHM_i3aB8JlBp9aH7qT1ZURL6oDBfQxkhxie6v-Qh6g-HFsHFMZzPJT37t0pUPDI-Zn/s400/Mongongo.jpg" alt="" id="BLOGGER_PHOTO_ID_5541804824672981026" border="0" /></a>What did the authors of the OGTT study have to say about their diet? Acknowledging that prior carbohydrate intake may have played a role in the OGTT results of the San, they made the following remark:<br /><blockquote>a retrospective dietary history (M. J. Konner, personal communication, 1971) indicated that the [San], in fact, consumed fairly large amounts of carbohydrate-rich vegetable food during the week before testing.</blockquote>However, the dietary history was not provided, nor has it been published, so we have no way to assess the statement's accuracy or what was meant by "fairly large amounts of carbohydrate-rich vegetable food." Given the fact that the San diet generally ranges from moderately low to very low in carbohydrate, I suspect they were not getting much carbohydrate as a percentage of calories. Looking at the nutritional value of the starchy root foods they typically ate in appendix D of <span style="font-style: italic;">The !Kung San: Men, Women and Work in a Foraging Society</span>, they are fibrous and most contain a low concentration of starch compared to a potato for example. The investigators may have been misled by the volume of these foods eaten, not realizing that they are not as rich in carbohydrate as the starchy root crops they are more familiar with.<br /><br />You can draw your own conclusions, but I think the high OGTT result of the San probably reflect a low habitual carbohydrate intake, and not pre-diabetes. I have a very hard time believing that this culture wasn't able to handle the moderate amount of carbohydrate in their diet effectively, as observers have never described diabetic complications among them.<br /><br /><span style="font-weight: bold;">Putting it all together</span><br /><br />This brings me to my hypothesis. I think a healthy human body is extraordinarily flexible in its ability to adapt to a very broad range of carbohydrate intakes, and adjusts glucose tolerance accordingly to maintain carbohydrate handling in a healthy range. In the context of a healthy diet and lifestyle (from birth), I suspect that nearly anyone can adjust to a very high carbohydrate intake without getting dangerous blood glucose spikes. A low carbohydrate intake leads to lower glucose handling and better fat handling, as one would expect. This can show up as impaired glucose tolerance or diabetes on an OGTT, but that does not necessarily reflect a pathological state in my opinion.<br /><br />Every person is different based on lifestyle, diet, personal history and genetics. Not everyone in affluent nations has a good glucose tolerance, and some people will never be able to handle starch effectively under any circumstances. The best way to know how your body reacts to carbohydrate is to test your own post-meal blood glucose using a glucose meter. They are inexpensive and work well. For the most informative result, eat a relatively consistent amount of carbohydrate for a week to allow your body to adapt, then take a glucose measurement 1 and 2 hours after a meal. If you don't eat much carbohydrate, eating a potato might make you think you're diabetic, whereas after a week of adaptation you may find that a large potato does not spike your blood glucose beyond the healthy range.<br /><br />Exercise is a powerful tool for combating glucose intolerance, as it increases the muscles' demand for glucose, causing them to transport it out of the blood greedily after a meal. Any exercise that depletes muscle glycogen should be effective.<br /><br /><br />* Assuming a typical carbohydrate intake. Chris Kresser recently <a href="http://thehealthyskeptic.org/when-your-%E2%80%9Cnormal%E2%80%9D-blood-sugar-isn%E2%80%99t-normal-part-2">argued</a>, based on several studies, that true normal fasting glucose for a person eating a typical amount of carbohydrate is below 83 mg/dL. Low-carbohydrate eating may raise this number, but that doesn't necessarily indicate a pathological change. High-carbohydrate cultures such as the Kitavans, Aymara and New Guineans tend to have fasting values in the low 60s to low 70s. I suspect that a very high carbohydrate intake generally lowers fasting glucose in healthy people. That seems to be the case so far for Chris Voigt, on his diet of <a href="http://www.20potatoesaday.com/">20 potatoes a day</a>. Stay tuned for an interview with Mr. Voigt in early December.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-16555115094730280212010-11-16T19:00:00.000-08:002013-06-05T01:06:30.028-07:00Impressions from the Wise Traditions Conference<!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> <w:lidthemeother>EN-US</w:LidThemeOther> <w:lidthemeasian>X-NONE</w:LidThemeAsian> <w:lidthemecomplexscript>X-NONE</w:LidThemeComplexScript> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> <w:splitpgbreakandparamark/> 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mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} </style> <![endif]--> <p class="MsoNormal" style="margin-bottom: 0.0001pt;">I spent last weekend at the Weston A. Price Foundation Wise Traditions conference in King of Prussia, PA.<span style=""> </span>Here are some highlights:</p> <p class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-weight: bold;">Spending time with several people</span> in the diet-health community who I’ve been wanting to meet in person, including <a href="http://www.cholesterol-and-health.com/">Chris Masterjohn</a>, <a href="http://huntgatherlove.com/">Melissa McEwen</a> and <a href="http://hunter-gatherer.com/">John Durant</a>.<span style=""> </span>John and Melissa are the public face of the New York city paleo movement.<span style=""> </span>The four of us spent most of the weekend together tossing around ideas and making merry.<span style=""> </span>I’ve been corresponding with Chris quite a bit lately and we’ve been thinking through some important diet-health questions together.<span style=""> </span>He is brimming with good ideas. I also got to meet Sally Fallon Morell, the founder and president of the WAPF.</p> <p class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-weight: bold;">Attending talks</span>.<span style=""> </span>The highlight was Chris Masterjohn’s talk “Heart Disease and Molecular Degeneration: the New Paradigm”, in which he described his compelling theory on oxidative damage and cardiovascular disease, among other things.<span style=""> </span>You can read some of his earlier ideas on the subject <a href="http://www.cholesterol-and-health.com/Does-Cholesterol-Cause-Heart-Disease-Myth.html">here</a>.<span style=""> </span>Another talk I really enjoyed was by Anore Jones, who lived with an isolated Inuit group in Alaska for 23 years and ate a mostly traditional hunter-gatherer diet.<span style=""> </span>The food and preparation techniques they used were really interesting, including various techniques for extracting fats and preserving meats, berries and greens by fermentation.<span style=""> </span>Jones has published books on the subject that I suspect would be very interesting, including <i style="">Nauriat Niginaqtuat, Plants that We Eat</i>, and <i style="">Iqaluich Niginaqtuat, Fish that We Eat</i>.<span style=""> </span>The latter is freely available on the web <a href="http://alaska.fws.gov/asm/pdf/fisheries/reports/02-023final.pdf">here</a>.<span style=""> </span><br /></p><p class="MsoNormal" style="margin-bottom: 0.0001pt;">I attended a speech by Joel Salatin, the prolific Virginia farmer, writer and agricultural innovator, which was fun.<span style=""> </span>I enjoyed Sally Fallon Morell’s talk on US school lunches and the politics surrounding them.<span style=""> </span>I also attended a talk on food politics by Judith McGeary, a farmer, attorney and and activist, in which she described the reasons to oppose or modify senate bill 510.<span style=""> </span>The gist is that it will be disproportionately hard on small farmers who are already disfavored by current regulations, making high quality food more difficult to obtain, more expensive or even illegal.<span style=""> </span>It’s designed to improve food safety by targeting sources of food-borne pathogens, but how much are we going to have to cripple national food quality and farmer livelihood to achieve this, and will it even be effective?<span style=""> </span>I don’t remember which speaker said this quote, and I’m paraphrasing, but it stuck with me: “I just want to be able to eat the same food my grandmother ate.”<span style=""> </span>In 2010, that’s already difficult to achieve.<span style=""> </span>Will it be impossible in 2030?</p> <p class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-weight: bold;">Giving my own talk</span>.<span style=""> </span>I thought it went well, although attendance was not as high as I had hoped.<span style=""> </span>The talk was titled “Kakana Dina: Diet and Health in the Pacific Islands”, and in it I examined the relationship between diet and health in Pacific island cultures with different diets and at various stages of modernization.<span style=""> </span>I’ve covered some of this material on my blog, in my posts on Kitava, Tokelau and sweet potato eating cultures in New Guinea, but other material was new and I went into greater detail on food habits and preparation methods.<span style=""> </span>I also dug up a number of historical photos dating back as far as the 1870s.</p> <p class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-weight: bold;">The food</span>.<span style=""> </span>All the meat was pasture-raised, organic and locally sourced if possible.<span style=""> </span>There was raw pasture-raised cheese, milk and butter.<span style=""> </span>There was wild-caught fish.<span style=""> </span>There were many fermented foods, including sauerkraut, kombucha and sourdough bread.<span style=""> </span>I was really impressed that they were able to put this together for an entire conference.</p> <p class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-weight: bold;">The vendors</span>.<span style=""> </span>There was an assortment of wholesome and traditional foods, particularly fermented foods, quality dairy and pastured meats.<span style=""> </span>There was an entire farmer’s market on-site on Saturday, with a number of Mennonite vendors selling traditional foods.<span style=""> </span>I bought a bottle of beet kvass, a traditional Russian drink used for flavor and medicine, which was much better than the beet kvass I’ve made myself in the past.<span style=""> </span>Beets are a remarkable food, in part due to their high nitrate content—beet juice has been shown to reduce high blood pressure substantially, possibly by increasing the important signaling molecule nitric oxide.<span style=""> </span>I got to meet Sandeep Agarwal and his family, owners of the company <a href="http://www.pureindianfoods.com/">Pure Indian Foods</a>, which domestically produces top-quality pasture-fed ghee (Indian-style clarified butter).<span style=""> </span>They now make tasty spiced ghee in addition to the plain flavor.<span style=""> </span>Sandeep and family donated ghee for the big dinner on Saturday, which was used to cook delicious wild-caught salmon steaks donated by <a href="http://www.vitalchoice.com/shop/pc/home.asp">Vital Choice</a>.<span style=""> </span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt;">There were some elements of the conference that were not to my taste.<span style=""> </span>But overall I’m glad I was able to go, meet some interesting people, give my talk and learn a thing or two.<span style=""> </span></p>Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-37757504236083573662010-11-05T19:00:00.000-07:002013-06-05T01:06:30.224-07:00Observations from FranceI recently got back from a trip to the UK and France visiting family and friends. It was great to see everyone, eat great food and even do some unexpected foraging (chestnuts, mushrooms, walnuts, blackberries). French people are in better general health than most industrialized nations. The obesity, diabetes and heart disease rates are all considerably lower than in the US, although still much higher than in non-industrial cultures. Here are a few of my observations about French food:<br /><br /><ol><li><span style="font-weight: bold;">The French diet generally contains a lot of fat</span>, mostly from traditional animal sources such as dairy and pork fat. Industrial seed oils have crept into the diet over the course of the 20th century, although not to the same degree as in most affluent nations. People seem to think that eating a lot of fat is unhealthy, particularly the younger generation, but they do it anyway. I had dinner with my family at a traditional restaurant in Lyon (a "bouchon Lyonnais" called Stepharo) last week. Before we ordered, they immediately brought out crispy fried chunks of pork skin and fat (I'm not claiming this is healthy!). The entree was a salad: a bed of lettuce piled high with chicken livers, herring, and "pig's feet". The pigs feet were essentially gobs of pork fat. It was a very good meal that I'll continue describing later in the post. I think it's worth pointing out that Lyon is in Southern France. Is this the "Mediterranean diet"?<br /></li><li><span style="font-weight: bold;">French people eat organs</span>. Yes, they never got the memo that muscle meat is the only edible tissue. A typical butcher or even grocery store will have liver, tripe, kidney and blood sausage on full display next to the meat. If you want to make a French person angry, try selling them a chicken or a rabbit without the liver, gizzard and heart. The main course at Stepharo was a large "andouilette", or tripe sausage, baked in mustard sauce. This was a typical traditional restaurant, not a hangout for gastronauts. <br /></li><li><span style="font-weight: bold;">French people fiercely defend the quality of their food</span>. Have you heard of the abbreviation AOC? It stands for "Appellation d’Origine Contrôlée", or controlled designation of origin. A familiar example is Champagne, which has the AOC label. You can't call your sparkling wine Champagne unless it comes from the region Champagne. However, that's only half the story. AOC also designates a specific, traditional production method, in this case called the "méthode champenoise." The AOC label can apply to a variety of food products, including wine, butter, cheese, honey, mustard and seafood, and is a guarantee of quality and tradition. 44 cheeses currently have the AOC designation, and these are commonly available in markets and grocery stores throughout the country (<a href="http://en.wikipedia.org/wiki/List_of_Appellation_d%27Origine_Contr%C3%B4l%C3%A9e_cheeses">1</a>). These are not fancy products that only the wealthy can afford-- many of them are quality foods that are accessible to nearly everyone. AOC defines many aspects of cheese production, often requiring a minimum amount of pasture time and specifying livestock breeds. The US has a few products that are regulated in a similar fashion, such as Bourbon whiskey, but generally we are far behind in assuring food quality and transparency. </li><li><span style="font-weight: bold;">French people cook</span>. There is less outsourcing of food processing in France, for several reasons. One reason is that restaurants are generally expensive. That trend is changing however. </li></ol>I don't think the French diet is optimal by any means. They eat a lot of white flour, some sugar, seed oils and other processed foods. But I do think the French diet has many good qualities, and it certainly poses a number of problems for the mainstream concept of healthy food. Hence the "French paradox."Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-1180583531238228212010-10-20T19:00:00.000-07:002013-06-05T01:06:30.321-07:00Obesity and the BrainNature Genetics just published a paper that caught my interest (<a href="http://www.nature.com/ng/journal/vaop/ncurrent/abs/ng.686.html">1</a>). Investigators reviewed the studies that have attempted to determine associations between genetic variants and common obesity (as judged by body mass index or BMI). In other words, they looked for "genes" that are suspected to make people fat.<br /><br />There are a number of gene variants that associate with an increased or decreased risk of obesity. These fall into two categories: rare single-gene mutations that cause dramatic obesity, and common variants that are estimated to have a very small impact on body fatness. The former category cannot account for common obesity because it is far too rare, and the latter probably cannot account for it either because it has too little impact*. Genetics can't explain the fact that there were half as many obese people in the US 40 years ago. Here's a wise quote from the obesity researcher Dr. David L. Katz, quoted from an interview about the study (<a href="http://www.businessweek.com/lifestyle/content/healthday/644136.html">2</a>):<br /><blockquote>Let us by all means study our genes, and their associations with our various shapes and sizes... But let's not let it distract us from the fact that our genes have not changed to account for the modern advent of epidemic obesity -- our environments and lifestyles have.</blockquote>Exactly. So I don't usually pay much attention to "obesity genes", although I do think genetics contributes to how a body reacts to an unnatural diet/lifestyle. However, the first part of his statement is important too. Studying these types of associations can give us insights into the biological mechanisms of obesity when we ask the question "what do these genes do?" The processes these genes participate in should be the same processes that are most important in regulating fat mass.<br /><br />So, what do the genes do? Of those that have a known function, nearly all of them act in the brain, and most act in known body fat regulation circuits in the hypothalamus (a brain region). The brain is the master regulator of body fat mass. It's also the master regulator of nearly all large-scale homeostatic systems in the body, including the endocrine (hormone) system. Now you know why I study the neurobiology of obesity.<br /><br /><br />* The authors estimated that "together, the 32 confirmed BMI loci explained 1.45% of the inter-individual variation in BMI." In other words, even if you were unlucky enough to inherit the 'fat' version of all 32 genes, which is exceedingly unlikely, you would only have a slightly higher risk of obesity than the general population.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-83964635201564082922010-10-13T18:00:00.000-07:002013-06-05T01:06:30.443-07:00VacationI'll be out of town until the beginning of November, so I won't be responding to comments or e-mails for a while. I'm going to set up a post or two to publish while I'm gone. <br /><br />As an administrative note, I get a number of e-mails from blog readers each day. I apologize that I can't respond to all of them, as it would require more time than I currently have to spare. The more concise your message, the more likely I'll read it and respond. Thanks for your understanding.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-38711449856666320162010-10-11T23:50:00.000-07:002013-06-05T01:06:30.539-07:00Sleep Post CorrectionAn astute commenter pointed out that I misread the numbers in the paper on sleep and fat loss. I wrote that out of the total 3.0 kg lost, the high-sleep group lost 2.4 kg as fat, and the low-sleep group lost 1.4 kg of fat out of 2.9 kg total.<br /><br />In fact, the high-sleep group lost 1.4 out of 2.9 kg as fat, and the low-sleep group lost 0.6 out of 3.0 kg as fat. So I got the numbers all mixed up. Sorry for the mistake. The main point of the post still stands though: sleep deprivation negatively influences body composition.<br /><br />The correct numbers are even more interesting than the ones I made up. Even in the high-sleep group, nearly half the body weight lost by simple calorie restriction was lean mass. That doesn't make calorie restriction look very good!<br /><br />In the sleep-deprived group, 80% of the weight lost by calorie restriction came out of lean mass. Ouch!<br /><br />That illustrates one of the reasons why I'm skeptical of simple calorie restriction as a means of fat loss. When the body "wants" to be fat, it will sacrifice lean mass to preserve fat tissue. For example, the genetically obese Zucker rat cannot be starved thin. If you try to put it on a severe calorie-restricted diet, it will literally die fat because it will cannibalize its own lean mass (muscle, heart, brain, etc.) to spare the fat. That's an extreme example, but it illustrates the point.<br /><br />The key is not only to balance energy intake with expenditure (which the brain does automatically when it's working correctly), but to allocate energy appropriately to lean and fat mass.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-73191560039332100742010-10-04T14:00:00.000-07:002013-06-05T01:06:30.635-07:00The Big SleepThis blog usually focuses on diet, because that's my specialty. But if you want Whole Health, you need the whole package: a diet <span style="font-style: italic;">and</span> lifestyle that is broadly consistent with our evolutionary heritage. I think we all know that on some level, but a recent paper has reminded me of it.<br /><br />I somehow managed to get on the press list of the Annals of Internal Medicine. That means they send me embargoed papers before they're released to the general public. That journal publishes a lot of high-impact diet studies, so it's a great privilege for me. I get to write about the studies, and publish my analysis at the time of general release, which is the same time the news outlets publish their stories.<br /><br />One of the papers they sent me recently is a fat loss trial with an interesting twist (1; see below). All participants were told to eat 10% fewer calories that usual for two weeks, however half of them were instructed to sleep for 8 and a half hours per night, and the other half were instructed to sleep for 5 and a half hours*. The actual recorded sleep times were 7:25 and 5:14, respectively.<br /><br />Weight loss by calorie restriction causes a reduction of both fat and lean mass, which is what the investigators observed. Both groups lost the same amount of weight. However, 80% of the weight was lost as fat in the high-sleep group (2.4/3.0 kg lost as fat), while only 48% of it was lost as fat in the low-sleep group (1.4/2.9 kg lost as fat). Basically, the sleep-deprived group lost as much lean mass as they did fat mass, which is not good!<br /><br />There are many observational studies showing associations between insufficient sleep, obesity and diabetes. However, I think studies like that are particularly vulnerable to confounding variables, so I've never known quite what to make of them. Furthermore, they often show that long sleep duration associates with poor health as well, which I find highly unlikely to reflect cause and effect. I discussed one of those studies in a post a couple of years ago (<a href="http://wholehealthsource.blogspot.com/2008/06/two-things-that-get-on-my-nerves-part.html">2</a>). That's why I appreciate this controlled trial so much.<br /><br />Another sleep restriction trial published in the Lancet in 1999 showed that restricting healthy young men to four hours of sleep per night caused them to temporarily develop glucose intolerance, or pre-diabetes (<a href="http://www.ncbi.nlm.nih.gov/pubmed/10543671"><span style="text-decoration: underline;">3</span></a>).<br /><br />Furthermore, their daily rhythm of the hormone cortisol became abnormal. Rather than the normal pattern of a peak in the morning and a dip in the evening, sleep deprivation blunted their morning cortisol level and enhanced it in the evening. Cortisol is a stress hormone, among other things, and its fluctuations may contribute to our ability to feel awake in the morning and ready for bed at night.<br /><br />The term "adrenal fatigue", which refers to the aforementioned disturbance in cortisol rhythm, is characterized by general fatigue, difficulty waking up in the morning, and difficulty going to sleep at night. It's a term that's commonly used by alternative medical practitioners but not generally accepted by mainstream medicine, possibly because it's difficult to demonstrate and the symptoms are fairly general. Robb Wolf talks about it in his book <span style="font-style: italic;">The Paleo Solution</span>.<br /><br />The investigators concluded:<br /><blockquote>Sleep debt has a harmful impact on carbohydrate metabolism and endocrine function. The effects are similar to those seen in normal ageing and, therefore, sleep debt may increase the severity of age-related chronic disorders.</blockquote>So there you have it. Besides making us miserable, lack of sleep appears to predispose to obesity and diabetes, and probably sets us up for the Big Sleep down the line. I can't say I'm surprised, given how awful I feel after even one night of six hour sleep. I feel best after 9 hours, and I probably average about 8.5. Does it cut into my free time? Sure. But it's worth it to me, because it allows me to enjoy my day much more.<br /><br />Keep your room as dark as possible during sleep. It also helps to avoid bright light, particularly in the blue spectrum, before bed (<a href="http://www.ncbi.nlm.nih.gov/pubmed/15585546">4</a>). "Soft white" bulbs are preferable to full spectrum in the evening. If you need to use your computer, dim the monitor and adjust it to favor warm over cool colors. For people who sleep poorly due to anxiety, meditation before bed can be highly effective. I posted a tutorial <a href="http://wholehealthsource.blogspot.com/2008/06/meditation.html">here</a>.<br /><br />1. Nedeltcheva, AV et al. "Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity." Annals of Internal Medicine. 2010. Advanced publication.<br /><br /><br />* The study was a randomized crossover design with a 3 month washout period, which I consider a rigorous design. I think the study overall was very clever. The investigators used calorie restriction to cause rapid changes in body composition so that they could see differences on a reasonable timescale, rather than trying to deprive people of sleep for months and look for more gradual body fat changes without dietary changes. The latter experiment would have been more interesting, but potentially impractical and unethical.Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0tag:blogger.com,1999:blog-4243647911776768447.post-72748847351209814762010-10-02T09:00:00.000-07:002013-06-05T01:06:30.732-07:00Potatoes and Human Health, Part III<span style="font-weight: bold;">Potato-eating Cultures: the Quechua</span><br /><br />The potato is thought to have originated in what is now Peru, on the shores of lake Titicaca. Native Peruvians such as the Quechua have been highly dependent on the potato for thousands of years. A 1964 study of the Quechua inhabitants of Nu<span><span style="font-size:100%;">ñ</span></span>oa showed that they obtained 74% of their calories from potatoes (fresh and chu<span><span style="font-size:100%;">ños), 10% from grains, 10% from <span style="font-style: italic;">Chenopodia</span></span></span> (quinoa and ca<span><span style="font-size:100%;">ñ</span></span>ihua), and 4% from animal foods. Total energy intake was 3,170 calories per day (<a href="http://www.ajcn.org/cgi/content/citation/15/6/341">1</a>).<br /><br />In 2001, a medical study of rural Quechua men reported an average body fat percentage of 16.4% (<a href="http://www.ncbi.nlm.nih.gov/pubmed/11400225">2</a>). The mean age of the volunteers was 38. Body fat did increase slowly with age in this population, and by age 65 it was predicted to be about 20% on average. That's below the threshold of overweight, so I conclude that most men in this population are fairly lean, although there were a few overweight individuals.<br /><br />In 2004, a study in rural Quechua women reported a body fat percentage of 31.2% in volunteers with a mean age of 35 (<a href="http://www.ncbi.nlm.nih.gov/pubmed/15072714">3</a>). Body fat percentage was higher in a group of Quechua immigrants to the Peruvian capital of Lima. Among rural women, average fasting insulin was 6.8 uIU/mL, and fasting glucose was 68.4 mg/dL, which together suggest fairly good insulin sensitivity and glucose control (<a href="http://wholehealthsource.blogspot.com/2009/12/whats-ideal-fasting-insulin-level.html">4</a>). Insulin and glucose were considerably lower in the rural group than the urban group. Blood pressure was low in both groups. Overall, this suggests that Quechua women are not overweight and are in reasonably good metabolic health.<br /><br />Rural Quechua are characteristically short, with the average man standing no more than 5' 2" (<a href="http://www.ncbi.nlm.nih.gov/pubmed/11400225">2</a>). One might be tempted to speculate that this reflects stunting due to a deficient diet. However, given the fact that nearly all non-industrial populations, including contemporary hunter-gatherers, are short by modern standards, I'm not convinced the Quechua are abnormal. A more likely explanation is that industrial foods cause excessive tissue growth in modern populations, perhaps by promoting overeating and excessive insulin and IGF-1 production, which are growth factors. I first encountered this hypothesis in Dr. Staffan Lindeberg's book <span style="font-style: italic;">Food and Western Disease</span>.<br /><br />I don't consider the Quechua diet to be optimal, but it does seem to support a reasonable level of metabolic health. It shows that a lifetime high-carbohydrate, high glycemic index, high glycemic load diet doesn't lead to insulin resistance and obesity in the context of a traditional diet and lifestyle. Unfortunately, I don't have more detailed data on other aspects of their health, such as digestion.<br /><span style="font-weight: bold;"><br />Potato-eating Cultures: the Aymara<br /></span><span><br />The Aymara are another</span><span> potato-dependent people of the Andes, who span Peru, Bolivia and Chile. The first paper I'll discuss is titled "Low Prevalence of Type II Diabetes Despite a High Body Mass Index in the Aymara Natives From Chile", by Dr. Jose Luis Santos and colleagues (<a href="http://www.ncbi.nlm.nih.gov/pubmed/11369169">5</a>). In the paper, they show that the prevalence of diabetes in this population was 1.5%, and the prevalence of pre-diabetes was 3.6%. The prevalen</span><span>ce of both remained low even in the elderly. Here's a comparison of those numbers with figures from the modern United States (<a href="http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf">6</a>):<br /><br /></span><span style="font-weight: bold;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizEuX2ekmDZqkE7SoRAAfFl56nf_-QdxatJqjXEPTbw1sULmhl64qKH_RM9oSsZ5empjXpNAMIO34F-Q72zSOb7OzCAtDi92ALYEXDDjG9o3rGXB68e1IlTbM19BQtBrG3u2sRRmEIxlbm/s1600/Aymara+diabetes.png"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 284px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizEuX2ekmDZqkE7SoRAAfFl56nf_-QdxatJqjXEPTbw1sULmhl64qKH_RM9oSsZ5empjXpNAMIO34F-Q72zSOb7OzCAtDi92ALYEXDDjG9o3rGXB68e1IlTbM19BQtBrG3u2sRRmEIxlbm/s400/Aymara+diabetes.png" alt="" id="BLOGGER_PHOTO_ID_5523254818899476914" border="0" /></a></span><span>That's quite a difference! The prevalence of diabetes in this population is low, but not as low as in some cultures such as the Kitavans (<a href="http://wholehealthsource.blogspot.com/2008/08/cardiovascular-risk-factors-on-kitava_17.html">7</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/10535381">8</a>).<br /><br />Now to discuss the "high body mass index" referenced in the title of the paper. The body mass index (BMI) is the relation between height and weight, and typically reflects fatness. The average BMI of this population was 24.9, which is very close to the cutoff between normal and overweight (25).<br /><br />Investigators were surprised to find such a low prevalence of diabetes in this population, despite their apparent high prevalence of overweight. Yet if you've seen pictures of rural native South Americans, you may have noticed they're built short and thick, with wide hips and big barrel chests. Could this be confounding the relationship between BMI and body fatness? To answer that question, I found another paper that estimated body fat using skinfold measurements (<a href="http://onlinelibrary.wiley.com/doi/10.1002/%28SICI%291520-6300%281996%298:3%3C331::AID-AJHB4%3E3.0.CO;2-2/abstract">9</a>). That study found a body fat percentage of 15.4%, which is lean by any standard. Based on this paper and others, it appears that investigators shouldn't extrapolate BMI standards from modern Caucasian populations to traditional native American groups.<br /><br />Back to the first paper. In this Aymara group, blood pressure was on the high side. Serum cholesterol was also a bit high for a traditionally-living population, but still lower than most modern groups (~188 mg/dL). I find it very interesting that the cholesterol level in this population that eats virtually no fat was the same as on Tokelau, where nearly half of calories come from highly saturated coconut fat (<a href="http://wholehealthsource.blogspot.com/2009/01/tokelau-island-migrant-study.html">10</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/7462380">11</a>). Fasting insulin is also on the high side in the Aymara, which is also interesting given their good glucose tolerance and low prevalence of diabetes.<br /></span><span style="font-weight: bold;"><br />Potato-eating Cultures: the Irish</span><br /><br />Potatoes were introduced to Ireland in the 17th century. They were well suited to the cool, temperate climate, and more productive than any other local crop. By the early 18th century, potatoes were the main source of calories, particularly for the poor who ate practically nothing else. In 1839, the average Irish laborer obtained 87% of his calories from potatoes (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1139421/">12</a>). In 1845, the potato blight <span style="font-style: italic;">Phytophthora infestans</span> struck, decimating potato plantations nationwide and creating the Great Famine. <span style="visibility: visible;" id="main"><span style="visibility: visible;" id="search"><span class="f"><cite><br /><br /></cite></span></span></span>There isn't much reliable information on the health status of the Irish prior to the famine, besides reports of vitamin A deficiency symptoms (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1139421/">13</a>). However, they had a very high fertility rate, and anecdotal reports described them as healthy and attractive (<a href="http://www.jstor.org/stable/2596554">14</a>):<br /><blockquote>As far as fecundity is concerned, the high nutritional value of the potato diet might have played a significant role, but little supportive evidence has been presented so far... What is known is that the Irish in general and Irish women in particular were widely described as healthy and good-looking. Adam Smith's famous remark that potatoes were "peculiarly suitable to the health of the human constitution" can be complemented with numerous observations from other contemporary observers to the same effect.</blockquote><span style="font-weight: bold;">Controlled Feeding Studies</span><br /><br />Starting nearly a century ago, a few eccentrics decided to feed volunteers a potato-only diet to see if it could be done. The first such experiment was carried out by a Dr. M. Hindhede and published in 1913 (described in <a href="http://www.jbc.org/content/30/2/201.full.pdf">15</a>). Hindhede's goal was to explore the lower limit of the human protein requirement and the biological quality of potato protein. He fed three healthy adult men almost nothing but potatoes and margarine for 309 days (margarine was not made from hydrogenated seed oils at the time), all while making them do progressively more demanding physical labor. They apparently remained in good physical condition. Here's a description of one of his volunteers, a Mr. Madsen, from another book (described in <a href="http://books.google.com/books?id=PKKURClINjoC">16</a>; thanks to <a href="http://www.mattmetzgar.com/matt_metzgar/2010/06/the-allpotato-diet-ii.html">Matt Metzgar</a>):<br /><blockquote>In order to test whether it was possible to perform heavy work on a strict potato diet, Mr. Madsen took a place as a farm laborer... His physical condition was excellent. In his book, Dr. Hindhede shows a photograph of Mr. Madsen taken on December 21st, 1912, after he had lived for almost a year entirely on potatoes. This photograph shows a strong, solid, athletic-looking figure, all of whose muscles are well-developed, and without excess fat. ...Hindhede had him examined by five physicians, including a diagnostician, a specialist in gastric and intestinal diseases, an X-ray specialist, and a blood specialist. They all pronounced him to be in a state of perfect health.</blockquote>Dr. Hindhede discovered that potato protein is high quality, providing all essential amino acids and high digestibility. Potato protein alone is sufficient to sustain an athletic man (although that doesn't make it optimal). A subsequent potato feeding study published in 1927 confirmed this finding (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1252113/">17</a>). Two volunteers, a man and a woman, ate almost nothing but potatoes, lard and butter for 5.5 months. The man was an athlete but the woman was sedentary. Body weight and nitrogen balance (reflecting protein gain/loss from the body) remained constant throughout the experiment, indicating that their muscles were not atrophying at any appreciable rate, and they were probably not putting on fat. The investigators remarked:<br /><blockquote>The digestion was excellent throughout the experiment and both subjects felt very well. They did not tire of the uniform potato diet and there was no craving for change.</blockquote>In one of his Paleo Diet newsletters titled "Consumption of Nightshade Plants (Part 1)", Dr. Loren Cordain referenced two feeding studies showing that potatoes increase the serum level of the inflammatory cytokine interleukin-6 (<a href="http://www.ncbi.nlm.nih.gov/pubmed/18469276">22</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/19158207">23</a>). However, one study was not designed to determine the specific role of potato in the change (two dietary factors were altered simultaneously), and the other used potato chips as the source of potato. So you'll have to pardon my skepticism that the findings are relevant to the question at hand.<br /><br />Just yesterday, Mr. Chris Voigt of the Washington State Potato Commission embarked on his own n=1 potato feeding experiment as a way to promote Washington state potatoes. He'll be eating nothing but potatoes and fat for two months, and getting a full physical at the end. Check out his website for more information and updates (<a href="http://www.20potatoesaday.com/">18</a>). Mr. Voigt has graciously agreed to a written interview with Whole Health Source at the end of his experiment. He pointed out to me that the Russet Burbank potato, the most popular variety in the United States, is over 135 years old. Stay tuned for more interesting facts from Mr. Voigt in early December.<br /><br /><span style="font-weight: bold;">Observational Studies</span><br /><br />With the recent interest in the health effects of the glycemic index, a few studies have examined the association between potatoes and health in various populations. The results are all over the place, with some showing positive associations with health, and others showing negative associations (<a href="http://www.ncbi.nlm.nih.gov/pubmed/18039989">19</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/16469985">20</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/20573797">21</a>). As a whole, I find these studies difficult to interpret and not very helpful.<br /><br /><span style="font-weight: bold;">Anecdotes</span><br /><br />Some people feel good when they eat potatoes. Others find that potatoes and other members of the nightshade family give them digestive problems, exacerbate their arthritis, or cause fat gain. I haven't seen any solid data to substantiate claims that nightshades aggravate arthritis or other inflammatory conditions. However, that doesn't mean there aren't individuals who are sensitive. If potatoes don't agree with you, by all means avoid them.<br /><br /><span style="font-weight: bold;">The Bottom Line</span><br /><br />You made it to the end! Give yourself a pat on the back. You deserve it.<br /><br />In my opinion, the scientific literature as a whole, including animal and human studies, suggests rather consistently that potatoes can be a healthy part of a varied diet for most people. Nevertheless, I wouldn't recommend eating nothing but potatoes for any length of time. If you do choose to eat potatoes, follow these simple guidelines:<br /><ul><li>Don't eat potatoes that are green, sprouting, blemished or damaged</li><li>Store them in a cool, dark place. They don't need to be refrigerated but it will extend their life<br /></li><li>Peel them before eating<br /></li></ul>Enjoy your potatoes!Anonymoushttp://www.blogger.com/profile/03732393787779511295noreply@blogger.com0