I’m a little late to discovering his blog and work but Keith Grimaldi at Eurogene has some excellent thoughts in this post about why most human nutrition research is pretty weak, inconclusive, and misses the boat much of the time.   This line of thinking really struck a chord with me because ever since I’ve transitioned from my work in laboratory neurobiology to nutrition, I’ve been quite frustrated with the quality of the research evidence cited by many top nutrition folks to support their positions.

Grimaldi points out that many nutrition experiments are designed with too many confounding variables at play, and with goals directed more toward finding out what ’causes’ or ‘prevents’ cancer and chronic diseases.  Because we still understand so little about exactly how/why people get cancer, trying to look at what a few thousand people eat and then trace whether or not they end up getting cancer is a very imprecise and problematic schema.  Grimaldi proposes that a better option would be to pay attention to different genotypes present in the subjects that may interact with the foods to trigger or protect against DNA damage.   How often do I read a nutrition paper about vegetables or processed meats or red wine in which the genetic variance among the subjects is taken into account?  Not very.

When this approach is used, some very interesting and more precise information can be found.  Take, for example the difference in methods and approach between these 2 studies:

• Boffetta, et al.: Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC). This hugely expensive ‘epic’ study involved over 500,000 people and looked at cancer incidence (about 30,000 of them) over 8 years based on dietary reporting of a high fruit and veg group vs. a low fruit and veg group.  It turned out to be a real dud.  The study found no real difference between the two groups in preventing cancer and then we got headlines like this.

• Palli, et al.:  The effects of diet on DNA bulky adduct levels are strongly modified by GSTM1 genotype: a study on 634 subjects. Here, the study showed that DNA damage was reduced by a high fruit and vegetable diet but ONLY when the 634 subjects were grouped according to GSTM1+ or GSTM1null genotypes.

While the first study has a much grander scale, ambition, and cost, it turned out to be pretty pointless in the end. In hindsight, it was probably doomed from the beginning.  Grimaldi’s point is that trying to figure out with one grand study if eating more fruit and veggies will prevent cancer for everyone is a failing proposition.   The genotypes of the participants, clearly important in discovering those who are more vulnerable to DNA damage, were not taken into acocunt.  Nor were multiple variables concerning the types of fruits and veggies and methods of preparation, etc. Further, the line between DNA damage and developing cancer is still a murky one, with much left to be understood.  Perhaps a more modest but precise goal of looking at DNA damage would be of more value than simply these cohort studies that use questionaires and trace trajectories of who gets sick and who doesn’t over the years.

Certainly, some politics and money come into play here- just look at the titles of the two papers and the headlines generated by each (I’m guessing not many for the Palli paper).  We may need to adjust our goals and expectations for what can be discovered by any single study, just like the rest of the science world already has.  For some reason nutrition research often endeavors to solve the whole puzzle in one bluntly designed, imprecise, inconclusive study rather than take small steps toward discovery with many smaller, more precise, attainable studies.  They may not be as exciting individually, but the understanding that could be gained with confidence seems a lot greater.

Of course there is more to how we end up than simply looking at our genotypes.   I’m not proposing a reductionist view that should only look at the role of genes in nutrition and illness.  It’s true that epigenetics, the way our behavior influences our gene expression, plays a role, but it is still poorly understood.  That is exactly what more studies paying attention to genetics may help us understand.

Hopefully, we’ll see genetics and genomics start playing a bigger role in the larger, well-funded nutrition studies.  Part of the problem is undoubtedly the lack of interdisciplinary cooperation between nutrition science researchers and those in genetics, bioinformatics, molecular biology, and even neuroscience.  Great things can happen when cross-fertilization between disciplines and research methods occurs.  Good food for thought, and hopefully a better framework to consider the next time you see another nutrition cohort study touted in the news.

Absolute statements like this fill the nutrition and health headlines but are always off the mark. These and other extreme positions fail because they do not allow for the moderate forces of dose and context to enter the discussion. Much like absolutist positions in religion and politics, these beliefs are seductive because they oversimplify things and give people black and white rules on which to hang. When people employ these rules and see body or health improvements, their false beliefs are confirmed and they become emotional advocates for the position.

This is why anyone who posts a reasoned, evidence-based article pointing out the flaws in The China Study will likely be marked as an ‘enemy’ by vegetarians and flocked with attacks. It is also why the same kind of articles pointing out flawed ideology in the Paleo Diet or the fallacies behind ‘Clean Eating’ receive the same type of ire. People tend to take their own nutrition and exercise regimes very personally when they have seen seemingly good results from using them. Nutrition and workout become religion and any variance from their paths becomes blasphemy.  This is also why I tend to get puzzled looks from audiences when I don’t place myself in the camp of any one diet or exercise program as the gospel. It can be much more seductive and simple to espouse one way of eating and exercising as ‘the best’ and draw a line in the sand. But it is also dishonest to do so.

A much more honest and effective way to objectively look at nutrition and health is to take dose and context into account. These are moderating forces that allow rules to be flexible, avoid absolutes and extremes, and generally ensure a healthier, happier eating experience in the long term.  To be clear, dose means AMOUNT- and yes it does make a difference how much or little of something you are consuming and how often you are consuming it.   Context means what ELSE are you consuming most of the time, what is your INDIVIDUAL SITUATION in terms of background, body weight, medical issues, allergies, digestion, food preferences, individual goals, psychology, lifestyle, etc.  and countless other contextual factors that must be taken into account.

The Perils of Ignoring Dose and Context

For some simple examples at how we go wrong with ignoring dose and context- take a look at this well-intentioned lecture concerning the evils of fructose in the modern diet.  The take home message is that fructose in all forms is a cause of obesity, diabetes, and metabolic syndrome.  This message is echoed by some nutrition authors and advisers who are weary of fructose even in whole fruits and vegetables regardless of dose and context.  This can be very counterproductive advice to give new clients who are learning how to eat and fuel their bodies properly.  Instilling food fears and guilt is not a healthy way to teach someone what to eat.  The flaws in that presentation were pointed out well by Alan Aragon here and the comments again are filled with zealots defending the fructose is evil argument.

Super Size It!

Ignoring dose and context can also lead us astray in terms of foods or exercises that are thought to be good for us.  Especially here in the land of super-sizing everything, people often mistakenly think that if some of something is good, then a lot of it is even better. When some health benefits of soy became highly touted in the 1990′s after studying certain long-living Asian populations, we suddenly saw a surge in soy products lining the shelves.  Lots of people began substituting processed soy milk, soy protein, soy everything for fresh whole foods formerly in their diets.  But the traditional use of soy in traditional Asian diets (such as the Okinawans) was quite moderate in terms of daily consumption and the form of soy eaten was mostly fermented tofu and fresh soybeans.  The dose and context of soy consumption by traditional cultures was ignored and the message somehow became- eat soy and lots of it!  Well, not surprisingly, it has turned out that there is now a mountain of evidence showing the health problems that can be caused by overeating soy products.

Food Extremists

We also see this neglect of dose and context in the extreme all-or-nothing response.  This line of thinking says that if  a lot of something is bad for you, then any of it is bad for you.  An example is seen in raw food purists who refuse to eat anything that has been cooked or heated above a certain temperature, regardless of food type or method of cooking.  While it’s true that there are health benefits from consuming a portion of your food as raw vegetables and fruits, and that cooking can leech some nutrients from foods, this is extended to mean that cooking of anything is bad for you and that ONLY raw food should be eaten to stay healthy.   This is an extreme position that often leads to serious malnutrition and digestive problems- and is wholly unnecessary in order to be healthy.

This all-or-nothing mindset seems to also be suffered by those who demonize certain food groups or macronutrients across the board.  We are only recently recovering from decades of fat-phobia, the incorrect and harmful assumption that eating dietary fat is what makes us fat and causes heart disease and diabetes.  Some poorly interpreted epidemiological studies resulted in the conclusion that dietary fat not only correlated with heart disease, it caused it.  The old correlation is not causation problem.  The context in which fat was consumed was ignored, the differences between different types of dietary fat was not taken into account, and the removal of healthy fats from the diet often results in substituting high levels refined carbohydrates, only making things worse.

Pot Calling the Kettle Black

I should note that those on the other sides of these arguments can be just as guilty of ignoring dose and context and taking extreme positions.  Avid meat eaters can get too religious about their holy red meat and start making claims that all vegetarians are unhealthy, too skinny, and dying of malnutrition.  The fact is, these days many people are able to stay quite healthy, lean, and strong without eating red meat or any meat for that matter.  Many different things work for lots of different people.  There are some basic nutrition and caloric requirements, but those can be obtained in a variety of healthy ways.  It’s hard for some people to wrap their heads around that fact.

Current Trend: Carb Phobia and Demonizing Grains

We are not learning from history in demonizing an entire macronutrient because these days it seems we have moved from fat to carbohydrates as the ‘evil food group’.  The same mistakes are being made again, as extremists tout very-low or even zero carb diets as the best way to health.  Much like the raw food purists, the low-carb Taliban takes a reasonable concept of moderating carbohydrate intake relative to the SAD, and warps it by advocating complete removal of an entire macronutrient from the diet.   This line of thinking can be extended to many advocates of the Paleo Diet, which demonizes all wheat/grains as ‘neolithic’ foods that we are not evolved to digest properly and which always cause health problems.  Few would argue that refined flour and wheat is overeaten by many SAD-eaters and should be reduced to make room for more nutritious lower calorie foods.  It’s also true that a small minority of the population suffers from celiac disease and other forms of gluten intolerance and should avoid wheat completely.  But many Paleo folks view wheat as the devil incarnate for everyone, even those who are not celiacs and do not have demonstrable gluten sensitivity issues.  While getting into the arguments for and against the Paleo Diet will be covered in an upcoming post, suffice it to say for now that I think it can be a very healthy diet as long as flexibility and moderation are allowed.  Many of the speculative claims behind the diet are problematic, not necessarily the food choices.  However, many people stay quite healthy and lean not following a Paleo Diet and regularly including grains, legumes, dairy, and other ‘forbidden’ foods.   Carbophobia (and fat-phobia and other food phobias) can be an unhealthy mindset for lifelong eating, creating unnecessary stigmas around certain foods and possibly depriving a person of important nutrition.

So the next time a sweeping headline comes across the screen touting the health benefits of a superberry or the dangers of bacon or the secret to youth found in a population, remember to check for dose and context in the claims and don’t be seduced by extreme positions and over-simplified rules.  They aren’t necessary to eat delicious, healthy food and they aren’t healthy for most of us in the long-run.

After reviewing some of my previous blog posts, I’ve decided to try to improve the content and presentation by simplifying and clarifying the take-home messages I’m trying to get across.  I encourage you to read beyond the one-liners because that is where the true understanding comes in.  The process of educating yourself about nutrition and wellness means rolling up your sleeves a bit and getting your hands dirty.  However, I also see the power in distilling the info down to brass tacks so you can pop in, get what you need, and move on with your life!  I have to remember that not everyone is as much of a science geek as me about this stuff

Quick Take-Home Message

The best way to get the Omega-3′s you need is to eat three 4-6 oz. portions of oily fish per week while greatly reducing Omega-6 intake.

Omega-3 Fats are essential and usually lacking in the diet

Omega-3 fats are absolutely essential in the diet and most modern eaters don’t get enough of them.  They are key for fighting inflammation, immune function, brain function, mood, sleep, body composition, fat loss, and healthy weight.  Our bodies convert the omega-3′s in our diet into two especially important fatty acids that are vital for the above functions: EPA and DHA.

The best sources of omega-3 fatty acids are from eating cold water oily fish.  Salmon, mackerel, swordfish, albacore tuna, trout, herring, and sardines all have high omega-3 content per serving.   The best plant sources are from flax, hemp, pumpkin seeds, and walnuts.  However, fish is much superior to plant sources both in omega-3 content and conversion to EPA/DHA- meaning our bodies convert the oil in whole fish to the essential fatty acids we need much more efficiently than we convert the plant oils, including flax.  Plant omega-3 sources are of the short-chain variety that must first be converted from ALA (alpha-linoleic acid).  Research shows that the body’s synthesis of EPA and DHA relying only on conversion from plant-sourced ALA is very limited, especially in DHA conversion.  For more on the numbers and a great explanation of why plant sources of omega-3 do not measure up, see this great post at The Healthy Skeptic: Why fish stomps flax as a source of omega-3. The bottom line: get most of your omega-3 from good fish sources and if you don’t eat fish look for a suitable EPA/DHA supplement to make sure you are getting enough.

As I’ve pointed out elsewhere on the site, the best fish to eat are of the sustainably wild-caught variety as opposed to most farmed or harvested fish.  This is because wild fish will usually have a higher omega-3 content compared to omega-6 due to eating their natural diet of smaller fish and marine algae.  Farmed fish, especially from large industrial operations, are often fed cheap grain-based feeds that are the equivalent of low grade cat food- this stuff is much lower in omega-3 and higher in omega-6.  As a caveat, I have noticed a growing awareness of how to properly feed harvested fish and many smaller, sustainable operations do farm healthy fish with a nice omega-3 content.  So do your research if you are buying and eating harvested fish.  In a regular grocery store, I would assume the farmed fish is to be avoided.  If cost is an issue, and quality wild fish does tend to be pricier, you’ll be happy to know that wild canned salmon and sardines are loaded with omega-3′s can be found at very reasonable prices.

As stated in the take-home message above, eating three 4-6 oz. portions of omega-3 rich fish per week will give you all of the good stuff you need without supplementation assuming you follow through on the other half of the program: reducing your omega-6 intake.

Omega-6 Fats are greatly over-consumed and promote inflammation

Omega-6 fats are essential as well but most modern eaters get far too many of them, which is harmful to our health.  They are culprits in systemic inflammation, weakening immunity, mood disorders, attention deficit, obesity, and a host of other ills.  Systemic inflammation ends up being a major underlying process in metabolic syndrome, obesity, diabetes, degenerative diseases of aging, autoimmune disorders, and even cancer. One of the main goals of a healthy diet should be to eat foods that have anti-inflammatory properties and avoid inflammation promoters.  The key is to eat a proper balance of the omega 3 and 6 fats in our diet.  This ratio has swung far out of whack in the SAD (standard American diet) and even many other supposedly healthy diets because so many modern foods are loaded with omega-6.    A ratio of omega-6 to omega-3 of 2 -3:1 is optimal but most Americans have a ratio of 10-20:1, yikes!

The bulk of the omega-6 intake that many people get without realizing it comes from the many varieties of processed vegetable and seed oils that are used to prepare food in most restaurants and in packaged/processed foods.  ‘Vegetable’, corn, soybean, sunflower, cottonseed, safflower, peanut, canola, sesame, and grapeseed oils (plus a few I’m sure I’m forgetting!) are all examples of high omega-6 oils that should be greatly limited in the diet.  Partially hydrogenated oils in packaged snack and fast foods are also to blame.  Look at the ingredients of chips, desserts, crackers, tv dinners, popcorn, nut/trail mix, salad dressings, and anything else that comes in box or package and find out what oils are in the food.    Even things that claim to be made from olive oil or healthy stuff will often have omega-6 oils hidden in the ingredient list -like THIS or this- so be vigilant!

Other dietary sources of high omega-6 content are the fat in grain-fed industrial meat, poultry, pork, and eggs.  These animals are fed a grain-based factory feed far from their natural diets and are often injected with hormones to make them fatter- both of these add up to much reduced omega-3 and increased omega-6 in these mass produced animal foods.  Deli and other highly processed meats like hot dogs, bacon, and sausage especially from these same industrial sources are also loaded with omega-6 (and other bad stuff) and should be limited.  If you must purchase or eat these industrial grain-fed meats, always opt for the leanest cuts and low-fat options to reduce your omega-6 exposure.  I should also note that nearly all human studies comparing meat eaters and vegetarians are using subjects who eat these poor quality meats in the highly processed variety- that is, the QUALITY of the meat they are eating is not considered.  Nevermind the host of other confounders that enters the picture (smoking, drinking, sedentary, trans fats, refined carbohydrate intake, etc..)  A huge oversight that always results in a fraudulent and dishonest appraisal of the health benefits that come from eating quality meat, seafood, and dairy.

Nuts are another big omega-6 culprit.  All of them with the exception of macadamia are quite high in omega-6.  Nuts do have some other healthy properties and are a good alternative snack food to processed junk.  So if you eat them, always opt for the fresh, raw or minimally processed variety with no added oils.  Packaged nuts almost always have added oils. Even pastured pork, poultry, eggs, and avocado have a decent amount of omega-6 in them but if these are the main sources of it in your diet you are on the right track!

Fish oil supplements

Many diet gurus and nutritionists are big proponents of fish oil supplements because of the abundance of omega-6.  It is true that if you are regularly eating in restaurants, eating factory meat, processed foods, and vegetable oils you are likely going to need extra omega-3 in your diet to counter this and keep your ratio in a semi-reasonable range.  However, what often gets overlooked is that even omega-3 fats are polyunsaturated and highly oxidizable in large doses.  That means that even too many omega-3′s, especially from supplements,  is probably not healthy and can be inflammatory.  So just wolfing down gobs of fish oil caps or liquid everyday in an attempt to ‘balance out’ your omega-6 does not seem to be a good strategy health-wise as well as being quite costly in the long term.

A much better strategy to obtain a good omega-6:3 ratio and minimize inflammation is to greatly reduce the omega-6 intake in your diet by making a habit of avoiding processed vegetable oils and cooking with pastured butter, tallow, coconut or palm oil and using olive oil in cold dressings.   Combine this with preparing most of your meals at home and limiting intake of processed foods and factory-farmed industrial meats and animal products and you are on the way greatly improved health.

On days or weeks when life gets the better of you and you are forced to eat some high omega-6 foods for whatever reason (traveling, family affair, gnarly restaurant, fast food, in a rush, etc) that may be a good time to have a quality fish oil supplement on hand for a temporary basis.  But in the long term, if you are eating the right way most of the time, you can get all the omega-3 you need without supplementation by following this strategy.   But, I do not disagree that lower regular doses of a quality fish oil supplement in the range of 1-3g/day of EPA/DHA are not a bad idea for most people, given the ubiquity of omega-6 out there.  I’m just outlining a way to live without them and be healthy.

*If you do want to use a low-dose fish oil supplement, I have found no better resource for how to choose one than Chris Kresser’s outstanding Definitive Fish Oil Buyer’s Guide, again over at The Healthy Skeptic.  Thanks for doing the heavy lifting Chris!

The benefits of getting most of your food from sustainable local and regional sources are many:

• You remove the anonymity present in the mass food chain.  You know exactly who grew your tomatoes, how they grew them, and where they grew them- plus what they did and didn’t spray them with.
• You find a source of free-range natural fed beef, poultry, eggs along with sustainably wild-caught seafood and reap the benefits of the better omega-3 content, lean protein, and lack of antibiotics and hormones.
• You remove your reliance on an unsustainable, disconnected mass food production industry, its price collusion, unhealthy conditions, and questionable safety practices (see the recent egg salmonella outbreak that occurred in mass produced caged, grain fed, sickly chickens housed like concentration camp prisoners).
• You keep your food money in your own community or region, supporting local farmers and ranchers, strengthening your local economy, and encouraging further growth of these practices.
• You eat a colorful variety of in-season produce.  Maybe even discover a new veggie or fruit to add to your arsenal, cook at home more often, and learn about seasons and cycles.  Get inspired to grow some of your own food!

The Challenges

I rarely talk to anyone who doesn’t support this idea and isn’t enthusiastic about jumping in with both feet, but I’m willing to bet that the number of people you know who actually do this can be counted on one hand.  So I thought to myself, why is this?  With so many folks conscious of the benefits and eager to be involved, there is a disconnect in knowing how to get started and where to get things.

Often local farms are not the best at marketing themselves and making the process easy and affordable for the individual- requiring large up front membership fees for 12 months at a time- which is understandable in order for the farm to stay in business, but not as attractive for many would-be clients.  Pickup locations and delivery times are sometimes not convenient and the habit of going to the grocery store for this stuff when you need it can be a hard one to break.  Price in general can also definitely be a detractor, especially if someone has been used to buying cheap, industrial conventional produce and meat.

The Solution: A Community Food Hub

A solution we have come up with is to initiate the idea of the neighborhood ‘hub’ for farm-to-table food.  Our hub will be a one-stop shop for people in our food group.  We take care of sourcing an in-season variety of fresh local produce either weekly, bi-weekly, or monthly.  We also take care of sourcing regional providers of free range, grass fed beef and pastured poultry, eggs, and pork (and maybe even milk, cream, butter, tallow, olive oil, and more!).  The strength of joining our food group, aside from the ease and convenience of  using our hub, will be our combined buying power.  By pooling our resources, we will get much better individual prices on produce and meat- the larger our group grows, the less expensive our food will be and the more we can order!

The other benefit of our hub will be to local farmers and regional ranchers who will have their businesses promoted and supported by our hub, as new customers will brought in by our promotional efforts and word-of-mouth and we will be able to order larger quantities on a regular basis.

My best thought on how to make this work is to offer a food group subscription program that gives the members choices on what they’d like sign up for and how often they’d like to receive it.  When it comes to the meat, unfortunately there is not even ONE local free range, grass fed beef ranch in San Diego that sells to the public (I hope this changes soon!)- so we will likely be ordering from ranches in other parts of California, Nevada, Colorado, and Montana.  The most economical way to buy this kind of delicious, super healthy meat is to add an extra meat freezer to your home and get all the cuts you like to cover you for the month or even 2 months at a time.  You save a ton of money and have a great variety of stuff to cook up in your own way at home- the best way to eat it!

So what’s in it for us?  We will charge a small premium to each subscriber to pay for our time, transportation, overhead costs, and promotional efforts to grow the group (and drive down our prices even more)- even with this charge, the per unit price for food boxes in a decent-sized group will be a bargain considering the high quality food and the convenience of the one-stop shop.   Using us as your hub also gives us the opportunity to connect with more like-minded healthy eaters in our community, let them know about our nutrition and wellness programs, and in turn learn about what great stuff they may have going on that we can benefit from.  But the #1 reason that we benefit is that it makes our neighborhood, community, and city better to live in and helps us meet, connect, and learn from our neighbors.  This isn’t some utopian hippie ideal, this is just common sense, real-world thriving community stuff.  Everyone wants this whether they are liberal or conservative, hippie or yuppie, tech geek or woodworker.

We will promote and grow our food group by involvement at neighborhood events, farmers markets, online info and subscription page, and your word-of-mouth and social networking.  I really think this is a great solution to getting local healthy food on your table at a great price without the hassle by using the hub.  We will have regular pickup locations and possibly even add a delivery service to your door for an extra charge if there is enough demand.

The food choices we will initially offer to subscribers are:

• Fresh, local,  in-season variety organic vegetables and fruit- delivered in small, medium, and large box weekly, biweekly, or monthly.   Lists of what will be included in boxes each season will be updated on our website and email newsletter.
• Free-range grass-fed beef, buffalo, bison, lamb, and pastured pork raised sustainably by a small regional family-run ranch. Variety of cuts delivered frozen in vac-packs monthly.   When local options become available they will be included.
• Free-range fresh pastured poultry and eggs, raised sustainably by a local farm.  Delivered biweekly or monthly.
• Possible extras include pastured butter, milk, cream, tallow, spices, herbs, and organic local olive oil and vinegars.

Other member benefits could include

• Discounts, catering, and other arrangements with like-minded local eateries.
• A home-grown produce barter program!  Trade extras of what you grow in your yard with others who grow stuff you want.  Use online sign-up sheet with what you have to offer and what you want and connect with others in the group.
• Share home-growing knowledge, gardening info, cooking ideas, recipes, etc to make our group a valuable open-source community.

So if you are in the Greater San Diego area and are interested in being part of our food group, drop me a line at info@abundantbrain.com with ‘Food Group’ in the subject heading and let me know what part of town you are in and any other thoughts, suggestions, or wishlists that you have.   This group is still in the planning stages, but based on the level of interest and involvement we hope to launch soon and will be putting up a food group page on the site with more info as we have it.   Thanks for your comments and interest!

9/15/10 UPDATE: We’ve had a great response in just one day of posting this so it looks like we will be launching the food group sooner than I thought!  Everyone who emails will be updated when we formally put together the group and will be sent a link on where to sign up and how.   Thanks!

In a much-publicized brouhaha this week, Dr. Dean Ornish wrote an article in the Huffington Post summing up his take on a recent observational study comparing animal and plant-based diets.  The cohort study, which was published last week in the Annals of Internal Medicine, studied long-term mortality rates among groups of men and women from two earlier studies who ate  ‘animal-based’ and ‘plant-based’ diets for a period of time.  There is so much wrong going on here that I’m not even sure where to start- but there are two major reasons why Ornish’s article is so wrong and misleading (and, dare I say dishonest?).

First, Ornish titles his article “Atkins Diet Increases All-Cause Mortality” and then proceeds to justify this title by discussing the cohort study.  The problem is, the cohort study did not examine the mortality of anyone who followed the Atkins Diet.  Huhh?  That’s right, if you examine the paper you find that not one participant actually was instructed to eat the Atkins Diet.  If you look at what all participants ate, you’ll find that none of them did eat the Atkins Diet or anything close to it.  Now I’m not here to defend the Atkins Diet, but if I titled an article that way, I’d damn well want the study I cite as proof for my title to actually be relevant!  So the very basis of the article is not only completely wrong but also entirely misleading to the average Joe or Josephine who reads the Huffington Post and takes a respected M.D. and well-known diet author’s words at face value.   Nevermind the fact that the point of Ornish titling the article in this manner stems from a long-standing feud he had with Dr. Atkins and others today about what constitutes a healthy diet- and that the faulty conclusions reached by the authors of the study seem to support the kind of diet he has been selling in his books and speaking engagements for years.

Using a false and misleading title to support your position is bad, but the second reason why Ornish is wrong is much more important to discuss.   He’s wrong because the very study he cites is so problematic in terms of the conclusions reached by the authors versus what the study actually finds.  This is a point I try to drive home to my medical and pre-med students when teaching them how to read scientific papers- the truth in any study resides in its data and the methods used to obtain the data, not in whatever conclusions the authors decide to draw from them.  This doesn’t mean that authors’ conclusions are not valid sometimes, it just means that you must look at the data they are using to draw those conclusions and how that data was obtained in order to judge how well or how poorly they state their case.  The fact that Dr. Ornish, the founder and president of Preventive Medicine Research Institute and Clinical Professor of Medicine at the University of California, San Francisco, either does not know how to properly analyze an epidemiological study or intentionally wrote a misleading and incorrect analysis of the study is what troubles me most.   The fact that the actual authors of the study, Fung et al., drew such faulty conclusions from the data they examined is of course troubling as well.   I will explain why their conclusions are so wrong in my analysis below.

Once we see how flawed the conclusions and design of this study are, it becomes obvious not only how wrong Ornish is in his article but how scary it is that someone so highly regarded and respected by the mainstream can get away with writing such rubbish and pulling the wool over so many unsuspecting readers’ eyes.  As someone who works in the nutrition field trying to help educate and inform people about what they should be eating for long-term health, seeing articles like this pop up in the mainstream media drives me crazy!  It’s like spending most of your waking hours teaching people why 2+2=4 and then clicking on a link from Google News to an article by a much older, more experienced, more respected authority than I stating that 2+2=7.  Madness.

Why the Study Ornish Cites is Wrong Too

By citing this observational study, not only did Ornish title his article incorrectly and misleadingly (because it doesn’t study the Atkins Diet at all!), he also cited a study whose authors reach conclusions that are not merited based on what the actual data and design of the study tell us.  So let’s roll up our sleeves and actually look at this study.

The study is titled “Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality. Two Cohort Studies”.  It looks at data from two previously conducted epidemiological diet studies: the Nurses Health Study and the Health Professionals Follow-Up Study.  Together, these consist of groups of men and women who ate ‘low-carbohydrate animal-based diets’ and ‘low-carbohydrate plant-based diets’ as reported to experimenters in self-reported questionaires.  Now, there are inherent problems with diet studies that use self-reporting versus clinical studies conducted in a metabolic ward in which food intake is precisely controlled and measured by the experimenters.   Much is written about the documented problems with self-reporting elsewhere so I’m not going harp on it here.  Chris Masterjohn has done a funny and smart analysis of the questionaires used in this study that is worth checking out if you’re interested. Suffice it to say that epidemiological diet studies have some inherent problems partly due to self-reporting, which is often far from accurate.  This doesn’t mean they aren’t useful though as a means of looking at large sample groups who obviously can’t be caged in a ward and have all their meals measured.

Nobody Ate a Low-Carb Diet in This Study!

The big problem arises when we look at what the subjects actually ate and try to make that jive with what the experimenters call ‘low-carb’, ‘animal-based’, and ‘plant-based’.

This study uses a decile system which scores participants based on adherence.  A score of 1 is given for worst adherence and 10 for best adherence.  If you look at the % of daily calories eaten as carbohydrate in these ‘low-carb’ dieters you will see a range of 60ish% eaten by decile 1 and 35-40ish% eaten by decile 10.  What??  So they are calling a low-carbohydrate diet one in which a range of 35-60% of daily calories are coming from carbs.   This means that all participants are really eating anywhere from a moderate to high-carb diet.  Dr. Ornish knows that the Atkins Diet prescribes a much lower carb intake than this, which shows why his whole article is flawed to begin with.  And it also means that the title of the whole study is incorrect and the conclusions it reaches about low-carbohydrate diets are incorrect too- because it didn’t look at people eating low-carb diets!   Arggg!

But there’s more.  To see a thorough and excellent dissection of the problems with this paper, check out Denise Minger’s analysis.  I’m going to summarize the other main problems I found with the study, many of which she details as well:

Confounding Variables Everywhere!

So what do we find about the best adhering animal eaters and the plant eaters in this study?  Well first, we see a very common indicator of a problem that arises when studying meat eaters versus vegetarians or even those who emphasize plant foods in their diets- the average meat eater in large studies is often less health conscious in general and leads a less healthy lifestyle than the vegetarian or plant food enthusiast.  So the meat eaters often turn out to be smokers who have higher BMI’s, are more overweight, less actice, drink more alcohol, and engage in lots of other health risks that turn out to have nothing to do with eating meat.  While vegetarians, and plant-based eaters tend to be more clued into healthy lifestyles and engage in less of those risk factors.  That is what we see in this study- in the best adhering groups, the animal-based eaters have a higher incidence of smoking and higher BMI’s.  So other factors can be contributing to mortality in this group.   Sometimes the researchers in this studies do adjust for some of these variables and Minger smartly points out that when they do, we consistently see that mortality rates for the animal group drop and mortality rates for the vegetable group rise.

The Vegetable Eaters Ate Plenty of Meat!

The vegetable eaters in this study were still eating lots of animal products- about 30% of daily calories from animal fat and protein.  Certainly not vegetarians!  So that definitely muddies the waters.  Minger even points out that in the 5th decile they ate more animal food than the meat eaters!  And by the way, this same 5th decile group of meat-eating vegetable eaters (huh?) had a lower CV mortality hazard than the less-meat eating meat eaters.   I’m confused.

The mortality from cancer and CVD in the lowest adhering vegetable group was lower than in the best adhering group.  Yet, these 2 groups ate about the same amount of red meat and other animal products.  Yikes.

The lowest mortality rate among the vegetable eaters was not seen in the group eating the most vegetables and the least meat.  It was seen in the 6th and 7th decile groups, who were certainly eating less plant foods than the better adhering groups.

The Animal Eaters Ate More Refined Carbs!

The vegetable eaters ate a higher proportion of their carbohydrates from fruits, veggies, and whole grains.  But, as we discovered above, the animal eaters still ate pretty sizeable amounts of carbohydrates.  So what kinds of carbs where they eating other than fruits, veggies, whole grains?  We are never told and have to wonder about the refined carb intake that is likely increased in the meat eaters.  Yet another possible confounding variable not addressed.

The Real Conclusions

So it turns out that what the paper touted by Ornish really compares are:

1. A very bad diet consisting of meat, lots of refined carbs and less veggies/fruit eaten by people who tend to lead a less healthy lifestyle.

VS.

2. A slightly better diet consisting of some meat and more veggies and fruits eaten by people who tend to lead a healthier lifestyle.

Guess which one had the higher mortality?  Not a headline by any stretch of the imagination.

Moral of the Story

No this isn’t proof that eating animal-based foods is bad for you or causes higher mortality.   No this is isn’t proof that being a vegetarian is healthier than eating meat.  No this isn’t proof that the Ornish Diet is the healthiest.   No this isn’t proof that the Atkins Diet leads to higher all-cause mortality as Ornish titled his article.  So my questions remain.  Did Dr. Ornish not read the paper and just trust the authors’ conclusions?  Highly unlikely given his experience and position.   So if he did read the paper, did he not see the glaring faults present?  Or did he see them and brush them aside because he liked the conclusion so much?  And how did he connect the dots to Atkins based on this paper exactly?  The only answers can be that either he was not able to properly analyze the paper in order to invalidate its conclusions or he knew the invalidity of the conclusions but touted them anyway because they jive with his recommendations and diet books.   Either way, he’s wrong.

**NOTE:

Just because I’m disagreeing with Dr. Ornish’s article and the conclusions reached in this paper does not mean I’m promoting the Atkins Diet or any other diet.  I continue to believe it is irresponsible and over-simplistic for a health and nutrition professional to tout any ONE diet for everyone.  Yes there are some universal guidelines that should be followed for healthy eating, but they can obtained in a variety of ways suited to each person’s unique goals and situation.

9/13/10-ADDENDUM: I have edited a few places in the original article to correct an error found by a commenter- I had originally stated that the participants in the original diet studies ate ‘prescribed’ diets when they actually reported their diets to the experimenters in questionaires and were then divided into deciles based on adherence to the animal/plant based diets. While a nonessential detail in terms of my point that the conclusions of the study were unwarranted, I corrected it for accuracy.  Whether the participants ate prescribed diets or just self-reported their own eating and were then decile ranked, the study’s conclusions are just as wrong and so is  Ornish in his article. Constructive comments are always appreciated.

As I continue to work with a diverse group of nutrition clients, I notice certain trends among them in what they have been eating and drinking previously to working with me.  One thing I see popping up regularly are folks who are in the habit of using energy drinks to get them through the day.  This can become habitual and people will start to rely on these drinks to jumpstart their day and keep them going to prevent afternoon fatigue.  One of the first rules I set with new clients is to drop these energy drinks and learn to boost and stabilize energy levels through healthy nutrition and lifestyle behaviors.

The best way to improve energy levels during the day and keep them consistent is to normalize blood glucose levels by eliminating excess sugars and refined carbohydrates from the diet.  These foods/drinks spike blood sugar levels causing a big rush in energy to be soon followed by a big crash.  It is a vicious cycle that becomes a domino effect and ends up hurting sleep quality, stress levels, and performance throughout the day.   Once blood glucose levels are reset and we are eating a healthy, balanced diet with enough calories, macronutrients, and vitamins/minerals to support our energy levels, we can combine this with smart exercise and stress reduction techniques which promote deep, restful regular sleep- and walla: no more need for energy drinks!

I find nothing wrong with moderate consumption of espresso, coffee, and tea if you enjoy them.  A nice boost of caffeine from good tasting, fresh coffee or tea in the morning is a pleasant way to start the day and includes beneficial antioxidants and bitter herbs that promote health.  But being tethered to energy drinks in order to get through your day is no way to live and ends up hurting more than helping over time.  Having one once in awhile won’t kill you and isn’t the end of the world- but just be aware of what is and isn’t in these things and try to focus on the healthy ways to improve energy.  You’ll feel and perform so much better- and save some money too.

On that note- here is a breakdown of what is in the popular ’5 Hour Energy’, those small red bottles we see everywhere these days.

5 Hour Energy= concentrated shot of over-priced caffeine and artificial sweeteners plus a bunch of other stuff you mostly pee out.

I admire the business model and marketing of whoever created these things.  There are now everywhere- every counter of every 7-11, gas station, drug store.  So someone is getting rich.

As we all know, a sucker is born every minute.  That continues to be true here.  These things sell for about $3.99 for a single 2 oz bottle.  That works out to about 2 bucks an ounce!  Let’s see what you’re paying for:

Ingredients:

1. Niacin (Vit B3) 30mg: Niacin deficiency is not an issue in the western world as it is so easily and readily available in the foods most of us eat.   The upper limit for adults is 35 mg/day so this 30mg hit will possibly make your skin flush, get itchy and red, and give you a shaky/buzzing sensation.  That’s called the niacin flush and some people sensitive to niacin react this way if they take in high doses.  This may be part of ‘feeling’ the drink working when it’s just chemical trickery by od’ing you on niacin.  Niacin is vitamin B3, readily available in meat, fish, eggs, green vegetables.  In the third world niacin deficiency can lead to pellagra- I haven’t seen a pellagra case in the US lately if you know what I mean.
Since we only ‘need’ about 14-16mg of niacin per day and it is a water soluble vitamin- guess what happens to the excess?  That’s right- it leaves in the urine.

2. Vitamin B6 40mg: If you like to pee, this will add to your enjoyment.  We need about 1-1.5mg of this per day and get plenty of it in meats, whole grains, veggies, nuts, bananas. We also have a large capacity to absorb this from our digestive tracts so we usually absorb much greater quantities than we need.  So the 40mg here- while cheap to include and looks impressive on the label- is probably entirely urinated out.

3. Folic Acid (Vit B9) 400mcg: This dosage is the entire RDA level for adults.  It is present in high amounts in leafy veggies, beans, peas, bakers yeast, fortified grains/pasta/cereals, sunflower seeds.  Unless you are deficient you are peeing most of this out too.  Even if you are deficient, it’s doubtful you will absorb it all since its dissolved in liquid and not part of a dense fibrous matrix in whole foods that is digested slower, allowing for more complete absorption.  So again, out in the urine.

4. Vitamin B12 500mcg: Ok so the RDA on this is 2-3 mcg per day.  You are getting a whopping 8333% dosage here.  Luckily even high levels are non-toxic and, yes you guessed it, leave in the urine.

5. Sodium 18mg: neglibible.

And now my favorite ingredient:

6. ‘Energy Blend’ 1870 mg
Contains unspecified amounts of- Taurine/Malic Acid/N-Acetyl L-Tyrosine, L-Phenylalanine, Caffeine, Citicoline.
Let’s breakdown this proprietary energy blend.

The only ingredient that will act as a nervous system stimulant and make you feel ‘energized’ is caffeine.  Big surprise.  You are likely getting a highly concentrated shot of caffeine that hits fast, lasts for a decent amount of time, and then fades away.  So the one ingredient that actually does its job here is caffeine and that is what you are paying for- at $2 an ounce. You can get a double shot of the highest quality premium espresso (about 2 oz) in a cafe for half that price.

Taurine- no evidence to have any effect on energy levels or act as a stimulant.  You will see this included in most energy drinks, but there is not one shred of proof that it’s doing anything to act as a stimulant.  It’s also probably included at such a low dosage that it has no therapeutic effect whatsoever.  Here is the conclusion of a safety study review of energy drinks:

“The amounts of guarana, taurine, and ginseng found in popular energy drinks are far below the amounts expected to deliver either therapeutic benefits or adverse events. However, caffeine and sugar are present in amounts known to cause a variety of adverse health effects.”   The full paper can be accessed here: http://www.ncbi.nlm.nih.gov/pubmed/18595815

Glucurolactone- no evidence to have any effect on energy levels or act as a stimulant.

Malic Acid- provides the tart flavor of the drink- not a stimulant.

Tyrosine- an amino acid we can synthesize from phenylalanine and get in lots of food sources- no stimulant effect proven. *ADDENDUM: many people do supplement with L-Tyrosine for a reported stimulant effect purpotedly due to increased catecholamine release and anecdotally do report stimulant results, especially in combination with other stimulants like caffeine.  So this MAY be contributing to the stimulant effect here- but again we are given NO dosage information about how much is included and its perceived effects may be entirely due to the caffeine- impossible to tell.  Some bodybuilders and others using stimulants for enhanced performance or ergogenic effects take tyrosine on an empty stomach and get a big stimulant result.  But my original statement stands that there is no solid, peer-reviewed evidence in a randomized controlled human trial that L-tyrosine acts as a stimulant.  If I am wrong please send a link to the papers and I will stand corrected.

Phenylalanine- an amino acid present in many food sources- no effect as a stimulant.

Citicoline- some evidence as a useful supplement for ADD, stress hormone problems.  no evidence for stimulant effect.

Also note that individual amounts of all ingredients in the proprietary blend are not given- therefore it is likely that most of that 1870 mg is caffeine and if they even put a tiny drop of citicoline in the bottle (which will have zero effect) they can include it in the ingredients and look really impressive.

Other ingredients:

Water
Natural and Artificial Flavors- duh
Sucralose- better known as the artificial sweetener in Splenda.
Potassium Sorbate- preservative
Sodium Benzoate- preservative
EDTA- preservative

So the bottom line- you are paying $2/ounce for concentrated caffeine mixed with excess B vitamins that you will pee out, unspecified (probably tiny) amounts of amino acids, flavor enhancers, and supplements, plus artificial sweeteners and preservatives.

Personally, if I want to get caffeinated I’d rather give my money to this guy and have him take care of me right:

http://www.youtube.com/v/hEb1rXP3aTU&rel=0&color1=0xb1b1b1&color2=0xd0d0d0&hl=en_US&feature=player_e

The Meal Frequency Myth

The idea that eating 5 or 6 small, more frequent meals throughout the day is a better strategy for weight loss, maintenance, and energy levels when compared to eating a 2-3 larger meals with an equivalent number of calories and macronutrients is still quite prevalent in the mainstream nutrition/weight loss community.  The reasoning behind this assumption is that eating smaller, more frequent meals somehow ‘stokes’ your metabolic rate by keeping your body processing smaller amounts food more frequently throughout the day.   This is explained by the idea that eating more frequently increases your metabolic rate and calorie burning via an increased TEF (Thermic Effect of Food)- that is the energy required to process your food digestion.  This indeed does occur but it turns out that eating fewer but larger meals can increase TEF just as much if not MORE than more frequent small meals.  So whole thing turns out to be a wash.

There is also the claim that more frequent meals is a better strategy for regulating blood sugar and insulin levels since you never let them drop too low from long periods without eating and never let them rush too high by eating smaller meals.  While on their face each of these claims seems reasonable, it turns out, as is often the case when it comes to biology and metabolism, that seeming reasonable does not equal being true.   In fact, both of these claims have been roundly refuted in solid peer-reviewed scientific literature AND empirically by the experiences of many individuals doing exactly the opposite and achieving excellent, sustainable results.

The facts show that when caloric levels are kept within energy requirements and protein levels are sufficient, that there is no benefit to smaller, more frequent meals- and in fact, eating larger high protein meals less frequently may even be more beneficial. Protein does seem to be the key limiting factor here, as it is the most satiating macronutrient and is required to preserve lean body mass- that is, the portion of body weight that is not body fat.   But once someone has their caloric load and macronutrients (especially protein) dialed in, there is no inherent metabolic or weight loss benefit to reduced portions and increased meal frequency.

I also find that actually decreasing meal frequency over the long-term is a healthier, more natural way for people to eat sustainably and be satisfied.  Our culture keeps us somewhat addicted to food and beverages and having them around all the time.  Most of this is clever marketing, but whatever the cause, we are surrounded by food/drinks 24/7 most of the time and many of us seem tethered to having snacks all day and a drink of some sort in our hands.  The truth is we evolved for most of human existence with a much more intermittent feeding pattern that certainly didn’t consist of constant snacking on packaged foods and sweetened beverages for most of the day.  Often, people who feel that they need to eat frequently have appetite control problems due to high blood glucose and fasting insulin levels and so feel very low on energy, lethargic and cranky if they don’t eat every few hours.  Once people reset their metabolisms and normalize their blood sugar and insulin levels, they regain their natural appetite control and are able to go much longer without food and not drop energy, get headaches, or feel emotional and cranky.

So if you are not eating enough protein to remain satiated and retain your lean body mass and are overeating carbohydrates, trans fats, and drinking sweetened beverages (less satiating foods that produce blood sugar spikes and crashes), you probably do indeed feel and perform better on a regimen of smaller, more frequent meals.  This is because your blood sugar addiction demands frequent feeding and the symptoms that arise during fasted periods between meals are so unpleasant that you avoid them by eating all the time.

This is why when people begin working with me for weight loss and/or body composition improvement, they are often surprised at how much protein I have them eating.  However, in the big picture of human evolution and the nutritional conditions to which we are best adapted to thrive, these levels are not ‘high’ protein at all.  What has happened in the modern Western diet is that protein, which tends to be the most expensive food, has been minimized and supplanted with carbohydrates and trans fats, the cheapest most abundant foods.

When you order a sandwich or hamburger in most inexpensive restaurants/shops, it consists of mainly bread and condiments with a small portion of protein in the middle.  If you were to just eat what was between the slices of bread, you would certainly still be hungry and have a tiny meal in front of you.  So it turns out that most meals bought in traditional restaurants/shops go very heavy on the carbohydrates (bread, rice, potatoes, sauces, sweets) and light on the protein.  When you remove these superfluous sources of mostly-empty calories and high carbohydrate levels and substitute them with protein and healthy fats, people seem shocked at how much REAL nutritious food they are eating, when in reality it’s still less calories and junk than they were eating before.

This does not mean that I support a ‘low-carb’ diet for all people, but it does usually mean that I endorse a LOWER carb intake for people who have been eating the Standard American Diet (SAD), as it is an extremely high-carb diet that skews macronutrient intake and favors high calorie, low-nutrient foods.   Once these folks have their blood sugar levels reduced and get adapted to the reduced sugar load, their energy levels go up and remain high throughout the day- no 3pm slump, no insomnia, no headaches.

It’s also much more convenient for most people to not have to worry about eating every few hours and not having to have tupperware bins full of meals and snacks in their bag to sustain them throughout the day.  This is simply not necessary if we are eating the right kinds of foods in the right amounts for our needs.  However, although it’s not advantageous for weight loss or overall health- if eating small frequent meals gels better with your schedule, preferences, appetite, etc. then by all means go for it.  Just don’t be deluded into thinking there is anything special about it that would be lost if you ate more food less frequently.

More evidence here:

http://www.ncbi.nlm.nih.gov/pubmed/19943985

http://www.ncbi.nlm.nih.gov/pubmed/9155494

The Meal Timing Myth

Along with the meal frequency myth often is packaged the meal timing myth.  That is, the mistaken belief that eating a meal later in the evening has a somehow more deleterious effect on weight loss/maintenance than if it were eaten earlier in the day.   The problem is that there is absolutely no scientific evidence or empirical proof to support this idea.  The reasoning behind this claim is that the meal eaten later in the day will be stored as fat more easily because we are less active while sleeping and therefore cannot use the calories eaten in the meal as we would if it were eaten earlier in the day.  However, if we are still eating within our daily energy requirements and getting the proper proportions of macronutrients, the timing of the meal bears no effect on how easily it will be stored as fat.

Of course, that is a big IF- because the problems that often occur with late night eating stem from the fact that many people are ADDING to their total daily caloric intake when eating at this time and usually eating high sugar/bad fat junk foods and binge foods.  If they ate these foods earlier in the day they’d have the same effect- it’s just that many folks are less likely to do so in the morning or mid-day.  So it’s really the fact that lots of late night eating is putting people in excess of their caloric requirements and is filled with non-nutritious junk foods, especially when alcohol is involved.  I find that if my clients are being sure to eat enough satiating, nutritious foods each day, they are much less likely to binge or overeat late at night.  People who attempt unrealistic diets that deprive them of satiety and appropriate calorie levels are much more likely to breakdown and binge out on junk before bed because they are ravenous.

But, in people whose eating is dialed in and calories are within daily needs, eating healthy meals/snacks later in the evening is perfectly fine if it fits with their schedules and preferences- assuming it doesn’t interfere with their sleep or cause indigestion.  In a new ‘metabolic-rehab’ client who is recovering from overeating on the SAD diet, I will restrict late-night eating for a month or two just to remove the possibility of the binge factor- but this is more psychological than biological.   Note that this myth extends to the idea that eating carbs at night is worse than earlier in the day- simply not true.  As respected nutrition expert Alan Aragon says, “There are no night-time insulin fairies ready & waiting to store carbs in the fat tissue — at least not at any greater rate than they would do so during the day.”

Hopefully that clears things up a bit on the whole meal frequency and timing issue.  Both subjects tie in nicely to a future post I’m working on about intermittent fasting, which can be an excellent strategy for the more advanced nutrition and fitness jedi.   Feel free to comment here or contact me directly with your observations or questions.

One Month Follow-Up with male client 41 years old 5’10″.  On initial consultation- complaining of low energy, heartburn, digestive distress, poor body composition (excess belly fat), insomnia, and appetite control problems:

“When I went to see you I weighed 184 or 186 (i can’t remember) and my scale said 28-33% body fat.  This morning I weighed 171 and 24%.  I haven’t had heartburn ONE SINGLE TIME.  No gas, no indigestion or grumbling & rumbling. I sleep better.  I’m never hungry and I feel like I eat A LOT.  I just had two lamb chops, two eggs, and a bowl of alfalfa sprouts with olive oil. ….

Losing weight was never my goal per se, but I’m not complaining.  I know I’m just losing fat.  I haven’t been working out except for work.   I plan on getting back into that a bit soon.   I’m really happy with my ‘results’,  but can I just keep eating this way forever?  I don’t miss bread products much.  I’m over the caffeine , and the diet sodas. (I do have a beer or two).

The way I’ve been eating, thanks to you, is already just ‘our life’ now.  It’s not like some trial period thing or some diet. It’s just how we eat.   And we’re stoked.  I guess my question is this: Can I just use that 30 day plan for life?  Thanks Preston.”

RESULTS AT END OF WEEK 4:

• Lost 13-15 lbs, 4-9% body fat decrease
• Complete resolution of heartburn, gas, bloating, and digestive distress
• Greatly improved sleep quality and resolution of insomnia
• Improved and consistent energy levels with removal of reliance on caffeine/energy drinks
• Much improved body composition with large reduction in belly fat
• Resolution of appetite control problems- no chronic hunger, binging, junk food, simple sugars

No better confirmation than getting feedback like this.  Notice that he still has a few beers here and there and doesn’t feel deprived at all.  The flexible, livable eating plan I designed for him is something he will be able to use for the rest of his life and continue achieving great results.   It’s not a ‘diet’ and doesn’t feel like one for him.  That’s because it allows for eating to satiety with the right foods, supplies adequate nutrition to fuel energy levels, turbo-starts fat burning and improved body composition, and still allows for eating non-ideal foods/drinks in moderation.

The other factor in achieving his great results has more to do with him.  It is one thing to want to do something but it’s another thing to be truly willing to do it.  He came to me ready to take action on the plan I gave him and made a commitment t by investing in his health and changing his lifestyle.   Now he is reaping the benefits and has learned how to eat nourishing, delicious food for the rest of his life.  He has shared this with his family and they are off and running!

Denise Minger, a raw food enthusiast and freelance writer from Portland, Oregon  has done an incredible job of really digging through The China Study and tearing it apart piece by piece.  The China Study is Campbell’s misguided attempt at defending veganism on health grounds.  It is an often-cited ‘proof’ of why eating animal products is unhealthy and has become something of a bible for vegans and vegetarians who want support for their diet on health/science grounds.   The problem is, the conclusions reached by the study and the way the data was selected and used by Campbell are just flat out wrong in nearly every way.

Don’t get me wrong- I definitely respect the right of people to choose not to eat animal products on moral grounds or simply because they find it unappetizing.  But when the attempt is made to confirm this personal bias by finding scientific data to support their case, they run into a lot of trouble.  Especially when they do as poor a job as Campbell did with his opus.

So if this kind of thing interests you and you really want to see someone demonstrate how even a respected scientist can stack the deck in his favor and draw a dishonest conclusion, do yourself a favor and read Minger’s thorough takedown.  If you are a vegan or vegetarian and are interested in the faults of Campbell’s ‘research’, I highly recommend reading Minger’s piece as well.

The China Study: Fact or Fallacy- by Denise Minger

All further weak comments from brainwashed vegan trolls will be deleted. All cogent, substantive comments still welcome.

One ingredient that I still see popping up all the time in supposedly ‘healthy’ or ‘natural’ or ‘vegan’ recipes is agave nectar and syrup.  The idea behind using agave as an alternative sweetener is that it is natural, comes from a cactus, has a low glycemic index (more on that below) which is supposedly good for those controlling blood sugar, and some has some healthful properties such as being anti-inflammatory and anti-oxidant.

It turns that virtually all of those claims are false.  The first myth we need to dispose of is that because something is ‘natural’, it is necessarily healthy.  Snake venom and poison ivy are all natural too.  But that turns out to be irrelevant anyway because the actual agave products that are used as sweeteners are not natural at all.  They are actually highly processed and a far cry from the aguamiel juice that drips out of the real agave cactus.  In making agave sweeteners, the plant starch is harvested from the cacti and is subject  to an enzymatic  and chemical process that converts the starch into a fructose-rich syrup—anywhere from 70-90 percent fructose according to nutritional information on various brands of agave sweeteners.   These processing steps greatly alter the natural aguamiel and inulin (fiber) components of the agave plant, largely destroying any health promoting properties and greatly increasing the fructose content of the syrup.  So much for being natural.  [Interestingly, native desert people have a rich history of consuming the agave cactus in a more natural form- either by despining it and eating it whole, or by boiling it into a tea or juice, with pulp included.  If you really wanted the health benefits of the plant, this would be the way to consume it.]

Next, let’s look at the glycemic index (GI) of agave and its alarming fructose content.  First, some basic misconceptions about GI itself should be addressed.  Glycemic index is a measure of how quickly a food’s glucose is absorbed into the bloodstream- the idea being that slower digesting sugars are healthier for blood glucose levels and will be used more efficiently, not stored as fat.  This is especially important for diabetics and pre-diabetics who need to monitor their blood sugar levels and keep them in a safe range, as well as dieters who are limiting sugar intake to control weight.  However, when looking at the original research used to establish GI numbers many problems arise making this measurement only minimally useful.  First, GI measurements are only valid for foods that are eaten alone in a fasted state- that is, not combined with fat or proteins and eaten only on an empty stomach.  We know in real life that we often eat sugars like grains, starches, fruits, and sweeteners with other foods and not on an empty stomach.  Combining sugars with fats and protein greatly slows their digestion as does more food already being in the digestive tract.  So unless the sugar is eaten alone in a fasted state, you can basically throw the GI number out the window.  In addition, recent research has shown that presumed blood sugar levels do not always correlate with GI numbers and that blood glucose clearance is an important factor not taken into account.  For more on that, see this excellent article by Alan Aragon.  So those factors greatly explode the myth that low-GI foods are necessarily healthier or even helpful in managing blood sugar levels and obesity.

Now let’s look at agave’s GI index and its fructose content.  Although, we’ve already debunked a lot of assumptions about GI, even if GI was helpful we can see that agave’s supposedly low GI number is misleading anyway.  Agave has a GI of 32 (and a glycemic load (GL) of 5.12- this takes dosage into account and is a per serving measurement), which is lower than most other caloric sweeteners.  However, GI is a measurement of glucose absorption and agave gets a low GI score because it has such an exorbitantly high fructose content.  As mentioned earlier, agave nectar contains 70-90 percent fructose!  For some scale here: sucrose, which is table sugar is 50% glucose, 50% fructose and even the hated high-fructose corn syrup is 55% fructose, 45% glucose.  So agave contains much higher fructose than even HFCS and consuming excess fructose is a very bad thing.  Fructose is a simple sugar that is quickly absorbed into the bloodstream after a meal and is routed to the liver where it is preferentially stored as glycogen (sugar storage).  When glycogen stores are full, excess fructose will be converted to fat, sent into the bloodstream as triglycerides, and stored in our fat cells- hence the problem with high fructose sweeteners.  Another problem with fructose is that it circumvents many of the body’s satiety signaling mechanisms, and becomes easier to over-consume.  When we eat fructose in fruit, it is accompanied by a fibrous matrix that slows its digestion (and increases satiety), along with lots of water and phytonutrients that are beneficial for health.  Agave nectar has had the fiber processed out of it along with any nutrients so you are basically getting a direct hit of concentrated fructose.  So much for helping your blood sugar!

the bottom line

In summary, if you like the taste of agave, using a small amount occasionally as a sweetener is not going to do much harm.  But don’t delude yourself into thinking it’s any healthier than table sugar or high-fructose corn syrup.  In fact, since its fructose content is so high and it is so highly processed, agave is probably worse than its counterparts.

We also established that glycemic index is a largely misleading measurement of blood sugar absorption. GI numbers are affected when a food is eaten with other foods, especially fat and protein, greatly slowing digestion.  GI does not correlate with blood glucose clearance, an important factor in blood sugar control.  GI also does not account for fructose content, which in the case of agave, makes it a largely irrelevant number.

**I do want to point out that there is nothing inherently evil about fructose, in fact a moderate amount can be used as energy and has been shown to help glucose processing.   The fructose we ingest in whole fruits and vegetables is accompanied by healthful fiber, water, and micronutrients.  Even eating a small amount of junk fructose from time to time is not going to harm most people.  The problem comes from over-consumption of fructose in a hypercaloric diet, which is a fast road to obesity and a host of other health problems.   The myth of a ‘natural sweetener’ like agave that is actually a highly processed, high-fructose syrup, needs to be exposed for what it is.