Thursday, April 28, 2011

The Evolution of Economy

When my grandmother married in the early twentieth century, her parents gave her a fairly substantial sum "for herself".  In those days, it was almost unheard of for middle class married women to earn their own living.  The budget was usually tightly controlled by the husband, who would give his wife a weekly allowance to manage the household expenses.

So it was for my grandmother as well.  She accounted for every cent she spent in a little notebook, and even though my grandfather earned a decent living, her allowance was often insufficient to cover all the costs.  Rather than discussing her problem openly, she dipped into her personal wedding gift instead, with the result that she depleted it over the years.

Most other Depression era housewives didn't have the luxury of a personal cash stash.

Either way, economy in the kitchen was something that housewives have striven for over the years, inventing all sorts of recipe substitutions and modifications to enable them to spend less money without sacrificing flavour.  In many cases, the resulting concoctions were delicious, and they have survived the test of time.

I have a theory that many of the recipes we take for granted today evolved over the years with economy in mind.  Grains are often used to replace or augment proteins, but other starches like rice, potatoes, and even pulses, can also be used to reduce the cost of a dish.  Some examples:
Meatballs and meatloaf:  most recipes include breadcrumbs or crushed crackers.  In combination with an egg for binding, the result is a lighter, less dense product, but one that uses less meat.  For more on the different recipes, there is an excellent discussion in CookSmart.

Custards: Desserts like crème brûlée are made by cooking cream or full fat milk with eggs over a low heat until the proteins coagulate.  A more thrifty custard is made with regular milk and bound with custard powder, which is made of flavoured and artificially coloured cornstarch.  Alternatively, the pudding can be thickened with flour.

Cake:  Vinegar cake (also sometimes known as wacky cake) is made with vinegar and baking soda instead of eggs, and dates back to at least WW1.  There are several different theories about the origin of the recipe, and I think I even read somewhere that it originated in the Civil War, but don't quote me on that.  Nowadays, this is a popular way to make vegan cakes.

Sauces and soups:  Heavy cream can be replaced with a mixture of flour and milk to recreate a similar creamy texture.
Whereas our hunter-gatherer ancestors would usually have eaten mainly meat that was prepared by carving it off a freshly roasted animal kill, agriculture allowed humans to develop many clever ways of using carbohydrates to replace increasingly scarce, and therefore more expensive, proteins.  One-dish meals like pilaus (pilav) or biryani are all related and are commonly eaten from Central Asia to India.  The base ingredient is rice, while the flavour is augmented with a combination of vegetables and protein, usually meat.  Often, the amount of meat depends on the relative wealth of the family that is eating it.

In this way, people with less money to spend on food have been able to fill their bellies, though not always with nutritious foods.  In Africa, for example, kwashiorkor is a form of protein malnutrition.  The name is derived from Ghana's Ga language, and means "the sickness the baby gets when the new baby comes" - in other words, the older baby is weaned onto a starch-based diet that is deficient in the amino acids and proteins found in breast milk.

Today, meat and eggs can be purchased much more cheaply than ever before, but many consumers have never learned to cook the way our grandmothers did.  Many of the prepared foods available in grocery stores rely heavily on grains and starches - think of pizza, cakes, pasta dishes, french fries, chips, as well as pasta and potato salads at the deli counter - and provide hefty profits to the corporations that prepare them. 

In this way, we are unwittingly perpetuating carbohydrate-based thrift, even though many of us have more disposable income and better access to high quality protein than ever before.  The difference is that today, the corporations and the middlemen are the beneficiaries, and we are saddled with obesity, heart disease and the various other diseases of modern civilization that result from a diet that is carbohydrate-rich but nutrient poor.

Wednesday, April 27, 2011

As American as apple pie

If you were going to host a foreign family in a typical North American household, in addition to the savoury dishes like hamburgers, pizza and Thanksgiving turkey, you would almost definitely also have to introduce them to a large variety of popular sweet dishes, like apple pie, pumpkin pie, key lime pie, pecan pie, doughnuts, brownies, cheesecake, muffins, banana bread, zucchini bread ... you get the picture.

I don't pretend to know all that much about Asian cuisine.  However, a couple of weeks ago it occurred to me that a major difference between Japanese cuisine and ours is that, as far as I am aware, the Japanese place much less emphasis on sweet goods and desserts than we do. 

Think about eating Japanese food, and what comes to mind?  Sushi, tempura, miso soup, udon noodles, and rice.  There are undoubtedly others, even sweet ones, but Japanese cuisine is known for its savoury umami, rather than its desserts.

This is why I was really intrigued when Dr. Davis pointed out the same thing earlier this week in his blog, together with some impressive health comparisons:
A Japanese male has only 65% of the risk of an American male (despite 40% of Japanese men being smokers), while a Japanese woman has 80% less risk than an American woman. While the U.S. is near the top of the list of nations with highest cardiovascular risk, Japan is the lowest.
No, I'm not suggesting putting grains back into our low carb diet.  Nice try though.

While I definitely recommend that you check out what Dr. Davis has to say, I'd like to spend some more time (yes, I know this is a recurring theme of mine) on our culture of baking here in North America.

We are surrounded by dessert.  Our children eat sugary breakfast cereal, we are socially obliged to offer brownies, biscotti (name your treat) when we have company, we eat ice cream on hot sunday afternoons, coffee and cheesecake after a show... you recognize the picture.

It's extremely hard to say no to sugar, and many people eat it in one form or another in every meal of the day.  One friend of mine had to resort to pretending to have given it up for Lent for people to understand she was serious.

Even many raw foodists and vegans push the sweets, presumably in their (possibly subconscious) efforts to sell the attractiveness of their chosen diet.  Take a look, for example, at the caramel apple pie in the incredibly beautifully presented Raw on $10 a Day (or Less!):

I honestly don't want to sound patronizing about the effort that went into preparing and photographing these beautiful raw dishes.

But I do think it's interesting that while vegan raw foodists aim, by definition, to stay as close to food in its natural state as they can, they still prepare dishes sweetened with agave syrup and substantial quantities of fruit.  This blog is really good about posting the nutritional counts for each of its menus, and they almost invariably add up to more than 200g of sugars every day. 

It's not just this blog, but a number of others that I follow in my reader and on StumbleUpon. The blogosphere is filled with talented amateur cooks and photographers presenting their version of the perfect cupcake, the ultimate kids' party, or the world's best chocolate chip cookie recipe.  They're possibly taking a cue from the cooking shows on TV, bringing a bit of the spotlight into their own kitchens, but it's also reflective of something bigger.

If we're going to tackle our national obesity and diabetes explosion, and the attendant increased risk of cardiovascular disease in a meaningful way, I believe it's vitally important that we start recognizing our societal addiction to sweets and sugar.

And then, let's start saying no. 

We don't have to eat dessert after dinner.
We don't have to serve something sweet when we have friends over for tea or coffee.
We don't have to drink pop at the movies.
We don't have to give our children money for frozen slushies at school on hot days.

Let's learn to enjoy dinner for dinner's sake more often, like the Japanese do.

Tuesday, April 26, 2011

The real reason the Americans want to bring down the Iranian Republic

If you're into conspiracy and intrigue, and you're interested in nutritional science, this is going to be right up your alley.

When you think of LDL, you probably automatically identify it as the bad stuff that causes heart attacks.  When you have your blood lipids checked, LDL is probably one of the main items you're interested in seeing.

But did you know that when you go for a blood test, the lab estimates this number?

First, total cholesterol, HDL and triglycerides are measured.  They are then used to calculate LDL using what is known in the biz as the Friedewald Formula.

It's not at all difficult to do for yourself.  Just plug in your numbers, and you can recalculate your LDL.  I decided to use my latest bloodwork, and I'm happy to report that my numbers agree completely.
LDL = Total - HDL - Tri/2.2
In my case:  6.63 - 2.21 - (0.45/2.2) = 6.63 - 2.21 - 0.205 = 4.22
(This shows that my LDL cholesterol is off the scale high.  The upper limit of the reference range is 3.40.  But more about that in a bit.)

If you're an American, you need to use a slightly different formula, since your lipids are measured in mg/dL:
LDL = Total - HDL - Tri/5
For people with very high triglycerides, it has been known for a long time that this formula isn't very accurate.  To get at the right number, the lab would have to measure LDL dirctly.  This is expensive, and so it's not normally done.

More recently, high fat, low carb diets became more popular, and more and more people started showing up with extremely low triglycerides.  Now there is a growing awareness that this formula also gets these people's LDL counts wrong.  We'll never know how many family physicians took one look at their low-carb patients' seemingly high LDL and unnecessarily convinced them to go back to their previous low-fat diet.  But I digress...

Essentially this is because LDL cholesterol consists of both tiny little bad particles (known as VLDL or very low density lipoproteins) and large fluffy ones that are too big to slip through cell membranes and do any harm.  It's the little ones that sneak about causing trouble, but when you have very low triglycerides, there are very few of them around.

The Friedewald formula pretty much assumes all the LDL particles are of a similar size, and because this is very much not the case when the concentration of triglycerides is  either very high or very low, the formulas above give bogus numbers.

It's like using a formula for a linear graph when in fact you should be plotting a curvilinear chart.

Since we already know that HDL and triglycerides are excellent predictors of coronary heart disease risk, my lay-brain finds it hard to understand why we even need to go on to determine an LDL count.

If you're wondering the same thing, you might also enjoy this interview with Gary Taubes, where he explains how the experts manipulated the relative importance of LDL cholesterol back in the 60's and 70's. 

Maybe it's just that the entire western world is indoctrinated into believing LDL is more important than it really is, or perhps it's a fun way to occupy legions of scientists, doctors, labs, and of course, the drugmakers.

Be that as it may, there are alternative formulas designed especially for conspiracy-minded people with time on their hands, and for those who have low triglycerides, like I do.

By now you must really be wondering about the title to this post.  Of course it's tongue in cheek.  But there is an Iranian connection.  You see, you can read a 2008 study reported in the Archives of Iranian Medicine.  The researchers remeasured their test subjects' LDL directly and then performed regression analysis to determine that a more appropriate formula should be:
LDL (mg/dL) = TC/1.19 + Tri/1.9 – HDL/1.1 – 38
You will see this is in the American mg/dL, so if you are a Canadian and your numbers are in mmol/L, you'll have to convert them first.  Luckily this is not hard to do with this handy online tool.

You must be wondering about my apparently dangerously high LDL of 4.22.

The Iranian formula recalculates my LDL at a more respectable 3.1 mmol/L, which means I'm back into the reference range of 2.00 to 3.40.

Doubtless Big Pharma would be delighted to discredit this foreign paper.  Anything to keep sales of cholesterol lowering drugs on the linear trajectory that keeps them wealthy.

Given the political tensions in the Middle East, there must be many Americans, blissfully unaware of Persia's historical role in the development of Medicine, who would fall for this.

But let's say it like it is:  current LDL measurements fail miserably to tell the truth.  Given the sophisticated tools available in our medical system, I find it hard to come up with a logical explanation for the nutritional experts' failure to fix this.

It seriously makes me wonder about the extent of deception, collusion and suppression of the truth in this industry.

It also makes me wonder how many people have unnecessarily been prescribed with statins, some with significant side-effects, just because LDL is arithmetically derived by means of an inadequate formula.

Monday, April 25, 2011


Something I didn't really consider until recently is the relatively high carbohydrate content of onions.   It's kind of obvious when you think about it because it is a root vegetable, after all.  Yet most people wouldn't automatically associate its spicy and watery texture with sugars.

According to Fit Day, one medium onion contains a little over 10g of sugars, of which almost 2g are dietary fibre. 

I know that's not earthshatteringly much, but it isn't trivial either.  Especially if, like me, you automatically start almost every dish with a couple of onions.

In case you are thinking of throwing out all the onions in your kitchen, you should be aware that they are also credited with a host of other nutritional benefits, including a number of sources that claim that onions are excellent for reducing blood sugar.

For example, the Readers Digest tells us:
In one Egyptian study of diabetic rats, onion juice reduced blood sugar levels by an amazing 70 percent. One of few published studies in humans, from India, dates back some 30 years, but it found that people with diabetes who ate 2 ounces (60 g) of onions a day experienced a significant drop in blood sugar levels.
The vagueness of this particular unreferenced quote is a great example of what often passes for fact.

Perhaps onions do have amazing nutritional benefits, though the skeptic in me continues to wonder why diabetics aren't encouraged to reduce their carbohydrate intake in the first place.

Conclusion?  Well, I'm not going to stop cooking with onions, but I'll probably think twice before chopping them up in large quantities.  My eyes certainly won't be complaining.

Sunday, April 24, 2011

Nature's perfect food, not just at Easter

On a day when much of North America has been consuming chocolate covered candies, it occurred to me that this is a good time to spend a couple of minutes reflecting on the other kind of eggs.

The ones that come from chickens.  

They are an excellent source of protein, the essential fatty acids, Omega 3 and 6, and a host of other nutrients, yet with only trace amounts of carbohydrate.

There is sufficient research to put to rest the still widely held notion that the cholesterol in eggs might be harmful.  On the contrary, most people can safely nourish themselves very well on several eggs a day without experiencing any negative effects.

Eggs can be produced without killing or hurting the hen that lays them, making them an excellent animal source of protein for anyone who may be troubled by the idea of killing animals for food.

Free range chickens play an important ecological role when raised in backyards or on farms, where they form a natural pest control team that loves to eat bugs and caterpillars. Kitchen scraps can also be given to hens to root through.  The composted droppings can be used as a high quality fertilizer, helping to continue the cycle of organic food production.

Eggs from free range chickens can be more nutritious than the regular eggs in the stores.  Here in Ontario, Omega 3 eggs come from caged hens, and although there are organically fed cage-free ("free run") chickens, there are no free range eggs available in our grocery stores.

Eggs are also a very versatile ingredient to cook with:  while boiled eggs are highly transportable, they can also be poached, scrambled, fried, deviled or made into the most delicious omelettes or crustless quiches.  That's without even going into the numerous grain and sugar filled baked concoctions we're trying to stay away from!

Lastly, but certainly not least importantly, eggs are normally a very affordable source of nutrition.  In communities with widespread obesity, economics often play a role in people's ability to move away from the carbohydrate loaded diets that are killing them.

We need more people to recognize the nutritional benefits of eggs - prepared and served without grains or sugar, of course.  Eggs are a healthy and affordable way for everyone to eat high quality low carbohydrate food on a regular basis.

If ever there was one perfect low carb food to be stranded on a hypothetical desert island with, it would have to be a supply of fresh eggs.   Admittedly it would be dreadfully boring after a while with no other ingredients, but at least you would stay perfectly healthy while waiting to be rescued.

Saturday, April 23, 2011

From the Journal of Unnecessary Research

Today the BBC is reporting a new study performed by the Mount Sinai School of Medicine, where diabetic mice with kidney disease were fed a diet comprising 87% fat.  After 8 weeks, the disease reversed itself.

Diabetes UK was quoted as considering this diet "questionable" for humans to sustain.

My first reaction was that this was probably the usual Establishment skepticism over any approach to nutrition that isn't "balanced".  After all, plenty of people already sustain themselves very well, and have been doing so over extended periods of time, on very low and zero carb diets.

My second thought was that maybe it was doubtful that people totally addicted to the Standard American Diet could be persuaded to change their way of eating.  My husband regularly gets very frustrated when he turns away overweight patients for elective surgery.  You see, most of them are not willing to consider that their weight will have significant implications on their wound healing ability.  That's an important issue, since about half of his patient population has a BMI in excess of 30.   Usually, the idea of giving up sugar and grains is anathema to them.

But then I realized something else is going on.  What does a diet that gets 87% of its calories from fat even look like?

We went to and plugged in a theoretical day's menu consisting of 24 oz of steak and 4 oz of butter.  That's pretty extreme by most people's standards, and it's not for me, but it's about average for a fit zero-carber.  This would give you 2,500 calories, a respectable intake, but "only" 68% fat:

So we have a study that shows reversal of kidney disease in mice on a diet that even the most extreme of zero-carb foodists wouldn't normally attain.

So what did the study prove, exactly?

Since many experts believe we have a diabetes time bomb on our hands, I'd like to suggest that we urgently need more practical topics to be researched in the immediate future.  

I know that type 1 and type 2 diabetes are totally different, but I was rather shocked to learn that there are no studies looking at the risks, benefits and effects of very low-carbohydrate diets on blood glucose control in type 1 diabetics.

That would be a good place to start.  ASAP.  I suspect successful treatment of type 1 diabetics with low carbohydrate diets will lead to more Establishment acceptance that low carbohydrate diets are an effective, safe and beneficial approach for the treatment of type 2 diabetics as well.  And pre-diabetics, and the rest of us as well.

And that, in turn, will enable physicians to provide their patients with nutritional counselling that doesn't conform to Canada's Food Guide, without risking censure by their provincial licencing bodies.

Eventually, the dieticians responsible for putting together Canada's Food Guide will even start to accept the shortcomings of their nutritional guidelines.  We need them to change.

Friday, April 22, 2011

Heart Healthy HDL

I was curious to see what General Mills, the manufacturer of Cheerios®, has to say about the impact of their breakfast cereal on HDL cholesterol.  Indeed, the website tells us that
Cheerios® is made with 100% natural whole grain oats. And oats are the only major breakfast cereal grain proven to help lower cholesterol.
Apart from not saying which kind of cholesterol is lowered, technically speaking, the site does not say their cereal will lower your cholesterol.

If oats are proven to lower cholesterol, does that automatically mean a product made with oats as well as additional ingredients known to be bad for heart health (i.e. sugar, modified corn and wheat starch) will also lower cholesterol?  I think not.  I may be splitting hairs, but in my opinion, the site strongly implies that it will, without actually saying so.

This is what the site has to say about LDL and HDL cholesterol:
LDL Cholesterol
Substantial amounts of research have shown that your LDL (“bad”) levels are more predictive of your risk for heart disease than total cholesterol. That’s why physicians take a close look at them. The first approach is to lower LDL cholesterol with a healthy diet and exercise, but sometimes, depending upon other risk factors you might have, physicians will prescribe medication along with diet and exercise. 
HDL Cholesterol
In general, men have lower HDL (“good”) cholesterol than women, but women might see their HDLs drop during menopause. You can help increase HDL levels by not smoking, maintaining a healthy body weight, and being physically active on a regular basis.
It's encouraging to read that LDL is more predictive of heart disease risk than total cholesterol.  But did you notice there is no mention of the fact that HDL is much more effective as a predictor of heart disease?

If you wanted to inform consumers concerned about their heart health in an honest manner, wouldn't you want to mention this too?

Needless to say, I wasn't able to find any information on the website to tell me this popular breakfast cereal is good for HDL cholesterol.  I strongly suspect that's because there aren't any studies to prove that it is.

As it happens, there are several known factors that are known to raise HDL, though none of them include oatmeal.  If, like me, you are intrigued by evidence that a brisk walk and a stiff drink might be more beneficial than a bowl of cereal, please head over to Perfect Health Diet for more information.

If you can find any evidence that I am mistaken, please let me know.  I would be more than happy to post this information.  In spite of the fact that 1 cup packs about 17g of carbohydrates after adjusting for the fibre content, and contains both sugar and wheat, I do like the taste of Cheerios®, and it might be a convenient "sometimes" food if I knew it really was heart healthy.


Writing about sour grapes yesterday reminded me to address fruit in general.  Canada's Food Guide recommends that adults eat 7 to 10 portions of fruit and vegetables a day.  They may be fresh, frozen or canned (to add insult to injury, canned fruit is usually sweetened).   Unfortunately, the Food Guide puts fruits on a par with vegetables, advising that you eat "at least one vegetable or fruit at every meal and as a snack."

It's not that hard to understand the problems caused by refined starches and added sugar.  It's much more difficult to understand why fruit is not as healthy as we are led to believe.

Fruits are natural, right?  Well, as usual, the answer is "not exactly."

The fruits in our stores have been carefully hybridized, selected and, in some cases, even genetically engineered to be juicier, more palatable and sweeter than they normally would have been thousands of years ago.  I'll bet they have even changed in the past 20 years.

Their availability and beautiful presentation in grocery stores, and even their placement  closer to the entrance than vegetables, probably means many consumers purchase, and consume, more fruits than vegetables. 

Juicing and fruit smoothies easily take fruit sugar insulin rushes to a new level.  Dr. Davis tells us he has several patients with diabetes resulting from their daily fruit smoothies.

To put the sugars in fruit into some perspective, I have put together a little table showing the sugar counts for a number of common fruits.  I used the information from Fit Day.

Notice that the portion sizes are either one medium fruit, or 1 cup for fruits that are either much smaller or much bigger than the size of a hand.

Unfortunately Fit Day doesn't separate out the fructose content from the other sugars in these fruits.  Since fructose is just as undesirable from a health point of view as glucose, I think you will find the table useful regardless.  As regards grapes:
A large portion of the soluble solid is sugars. Glucose and fructose are the main sugars in the juice. The sugar content of the juice of ripe grapes varies between 150 to 250 g/L. In unripe berries, glucose is the predominant sugar. At the ripening stage, glucose and fructose are usually present in equal amounts (1:1 ratio). In overripe grapes, the concentration of fructose exceeds that of glucose. In ripe grapes, there is some variation in the glucose to fructose ratio among the grape varieties.

Looking at the whole table, watermelon, strawberries and peaches come out on top, but you need to ask yourself whether you normally eat just one peach, or just one cup of watermelon or strawberries at a time.  Or does their sweet juiciness when they are in season mean you end up consuming three consecutively?

Looking at fruit in relation to sugar cubes as Sugar Stacks does so well, the 590ml bottle of Coke (the one on the left) contains 65g of sugar, or a little more than 16 cubes of 4g each.

You exceed that sugar count when you eat 1 cup of grapes, a banana and an apple.

Just something to think about the next time you reach for nature's candy as recommended by Canada's Food Guide.

Thursday, April 21, 2011

Sour Grapes

When people first hear about successful weight loss through restriction of sugar and starch, their assumption is usually that the dieter must have eaten fewer calories than before.  After all, it's calories in, calories out, right?
(fewer calories in) + (more exercise) = (less fat) 
Well, not exactly.  For one thing, how is it that some people can eat like a horse but they stay lean all their lives, while others don't?   Likewise, when it comes to weight loss, some people struggle to succeed with standard diets while others are more successful.  

All our lives we are told that in order to lose weight, we have to eat less.  If we are hungry in the process, it's a penance for the sin of overeating.  This message is so consistently relayed that it's almost unthinkable that gluttony might not be the whole story.

Fast food, breakfast cereal and soda manufacturers are happy to play along, telling us there's nothing wrong with consuming their sugary, starchy foods in moderation, and we need to exercise more.

So people who are already guilt-ridden about what they have essentially been told was gluttony, now feel obliged to join gyms to work off their extra pounds.

Our societal attitude to food is paradoxical.  On the one hand it fuels (pun intended) a lot of guilt about weight and mental anxiety about body shape.  On the other we have "all you can eat" buffets, eating competitions, and worst of all, a very strong institutional disapproval of carbohydrate restriction.

In the past 10 years or so, as low and zero carbohydrate eating has been becoming better known, more and more of us have been able to break through in the battle of the personal bulge.  Without drugs, weight loss plans, or professional help.  And our health has improved too.

Instead of applauding these successes, we are told it must be all those extra proteins and fats that cause us to eat fewer calories.  Because we all know there's no easy way to do it, right?

The last thing manufacturers with deep pockets and political influence want is for the public to stop buying food that has been processed in any way.  There's no money in it for them when we revert to foods which can be bought direct from farmers or grown in our backyards.  Drug manufacturers feel similarly - there's little in it for them when people are healthier and require fewer drugs.  Why should they help provide research funding to investigate why low or zero carbohydrate eating is working miracles?  Rather keep talking about moderation and exercise, and cast subtle doubt on those "nutty paleo people". 

If it works for them, the thinking goes, there must be a catch somewhere.  One of the easiest explanations is that they must be consuming fewer calories. 

In a way, I do think they have a point.  Two years ago, if there were a half eaten dish of rice pudding on the kitchen counter before I went to bed, I might have finished it off.  Why not?  It was delicious, and it cleared the kitchen.  Today, there's no struggle in my mind any more, and I don't feel tempted to dig into it.

Likewise, there are no more hypoglycemic periods where I need to grab something - anything - to eat.  I can go for more hours without snacking, and it has become comfortable to have an empty stomach:  it feels empty, but I'm not hungry.  Does that constitute eating less?  If it does, why is that a bad thing? 

Carbohydrate restriction requires no restriction of fat or protein.  You eat as much as you want, even if that means a huge steak slathered in butter or a bowl of whipped cream garnished with some berries (strangely, I don't really desire the latter and although I like a good steak, I can only eat so much of it).  There is no need for calorie counting, because with carbohydrates out of the way, the body is able to regulate very well how much it needs.   Without a surplus of carbohydrates (I do still eat quite a few), the metabolism corrects itself.  Naturally, and without drugs or prescription medications.

You would think that would be hailed as a wonderful breakthrough, not as a dangerous fad. There are many intelligent, informed people who say we need to be looking more closely at sugar and starch as the root of our metabolic and health problems.  In a world that is apparently ruled by science, it's stunning how unscientifically the Establishment dismisses the now firmly entrenched belief that fatty red meat might not be the root cause of heart disease.  

There is far too much evidence for me to believe that gluttony is the underlying cause of our problems, and successful weight loss is often far more complex than across the board calorie restriction. I just don't understand why some people can't see the effects of low carb eating as a good thing.  It's for them that I titled this post sour grapes.

Tuesday, April 19, 2011

Stockholm Syndrome

Stockholm Syndrome describes a paradoxical psychological phenomenon wherein hostages express empathy and have positive feelings towards their captors. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors as an act of kindness.
You're probably wondering how is this related to this blog.  Let me explain.

The Mayo Clinic isn't alone when it warns that:
The weight loss may or may not continue long term, depending on your commitment to following the eating plan. If you abandon the low-carb diet and return to your former eating habits, you may regain any lost weight.
This is commonly cited by those who oppose the low-carbohydrate approach to nutrition.

But doesn't that logic hold in exactly the same way for any other lifestyle change that you might take on, and later abandon, including stopping smoking or recreational drug use, and even any weightloss program? 

In my opinion, the Mayo Clinic misses the point completely.  This is not about following a diet for a set amount of time and then reverting to the original way of eating that got you into trouble in the first place.

It's about recognizing that there is something structurally wrong in the way our modern society eats.  The evidence is in the cardio-vascular disease statistics.

Stroke and heart disease are two of the top three causes of death.  As for diabetes, this CNN article tells us it is:
The fifth-leading killer of Americans, according to the American Diabetes Association. A sobering two out of three people with type I or type II diabetes will die from a heart attack or stroke -- the combined leading causes of death among diabetics.
This is why I have been writing so much about triglycerides and cholesterol lately.  It isn't really about losing weight in and of itself.  If there were no health risks associated with obesity and diabetes, I would feel very differently about weight.

The Standard American Diet is responsible for worsening people's blood lipids.  Once your bloodwork is under control, you have lessened your risk of heart and stroke.

What most people of all persuasions can agree on is the excessive consumption of highly refined starches and sugary drinks.  While saturated fats are still the biggest sticking point, even the low-fat camp are becoming grudgingly supportive of calls to reduce or eliminate sugar and even carbohydrates. 

It makes no sense at all to take a temporary break from eating carbohydrates and sugars, especially when you look and feel so much better, and particularly when the most potent predictors of heart disease are pointing in the right direction.  Why would you sabotage your health?

Of course this doesn't mean you can never touch a piece of bread or an ice cream again.  But it does mean that this is mainly about a long term lifestyle change that will improve your health.

This is why if you are thinking about low carb eating as a temporary phenomenon, I am suggesting you may be suffering from Stockholm Syndrome, and the carbohydrate-driven Standard American Diet is your captor.

Monday, April 18, 2011

Agave Syrup

I recently wrote about the problems with fructose, and why replacing high glycemic foods with others that have higher concentrations of fructose does your body no favours.

According to the Organic Raw Blue Agave Nectar website, it is "perfect for everyone, including raw-food enthusiasts! This amber nectar has a distinct and delicious flavor that genuinely enhances foods' natural sweetness.  It is certified Organic and GMO-Free, and appropriate for vegan and plant-based diets."

If you're interested in reading more about agave syrup, which is often touted as a healthier alternative to sugar, I found something you are bound to find very informative:
Once upon a time, I picked up a jar of “Organic Raw Blue Agave Nectar” at my grocery store. It was the first time I’d ever seen the stuff in real life, and the label looked promising. After all, words like “organic,” “raw,” and “all natural” should mean something. Sadly, agave nectar is neither truly raw, nor is it all natural.

Based on the labeling, I could picture native peoples creating their own agave nectar from the wild agave plants. Surely, this was a traditional food, eaten for thousands of years. Sadly, it is not.
It concludes:
Agave nectar is bad for you. It’s not traditional, not natural, highly refined, and contains more concentrated fructose than high fructose corn syrup.

But don't just take it from me.  Please check out the whole article.   For even more reading there is also this 2009 article from the LA Times, which comes to similar conclusions.

Low Carbohydrate Study in Canadian Diabetes Literature

I was planning to write about fasting glucose and minimum carbohydrate levels today, but when I came across this little gem of a study reported in the Canadian Journal of Diabetes in 2006, I just couldn't resist the opportunity to comment.  What first caught my attention was this sentence on page 270:
Low-carbohydrate diets that result in higher intakes in saturated fat may aggravate levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), major risk factors for [coronary heart disease].
I don't have a problem with the first part of the sentence, but I find the term "major risk factors" totally disingenuous when it's coming from the so-called experts.

I wrote about this earlier this monthLow HDL and high triglycerides are known to be the most effective predictors of vascular disease, not total cholesterol and LDLThis is not controversial.  

It is backed up by a recent 33 year Danish study reported in the Annals of Neurology which found that non-fasting triglyceride levels are a better predictor of stroke risk than cholesterol, especially in women.

It's no wonder the public is confused, when the people who know better continue to reference total cholesterol and LDL.

The story continues.  On page 273 we read:
With low-carbohydrate diets, TC, LDL-C and triglyceride (TG) decreased, and HDL-C increased  ... these lipid concentrations increased after 6 and 12 months...

It was concluded that the adverse effect of a greater saturated fat intake associated with the low-carbohydrate diet may have been offset by the greater weight loss in that group.

At 12 months, reductions in serum TG [triglyceride] and increases in HDL-C were seen only with the low-carbohydrate diet.
Notwithstanding the positive findings, high saturated fat intakes, which are often characteristic of low-carbohydrate diets and come mainly from animal protein, have been demonstrated throughout the literature to raise TC and LDL-C.
What is the adverse effect of a greater saturated fat intake?

Bearing in mind that the second sentence suggests no possibility in the writers' minds that saturated fat consumption might actually be beneficial, let me paraphrase the rest - the sarcasm is all mine:  When study participants ate unlimited saturated fat and limited their carbohydrates, their blood work showed improvements in both of the most important measures of coronary heart disease at 6 and 12 months.  This finding is consistent with other studies, but we'll continue to look at the measures that are known to be marginal predictors, at best.  There is no way we could possibly consider a causal relationship between the greater saturated fat intake (combined with lower carbohydrate intake) and these improvements.

Does this sound feasible to you?  Why is it simply not possible for these people to consider that saturated fat might not be the enemy, and that it is the carbohydrates which need to be limited instead?

A little further down on the same page, I also found this comment:
To our knowledge, no study has assessed the risks, benefits and effects of very low-carbohydrate diets on BG control in type 1 diabetes.
Honestly?  I just cannot believe that nobody has studied what happens when you restrict the very nutrient that, in the absence of insulin injections, kills people whose system cannot control it.

Because it is my understanding that 19th and early 20th century physicians did plenty of experimentation, including carb and calorie restriction, on their type 1 diabetic patients in the hopes of figuring out what was going on.

Could they mean there are no current studies?  With all the research and publishing going on today, I am totally flabbergasted that this has not been thoroughly researched.

Sunday, April 17, 2011

Vegan Cannibals?

At one extreme of the dietary spectrum there are are zero carbers, who eat meat, fat from animal sources and maybe some fish. Somewhat less extreme, but still quite radical when compared with people eating the Standard American Diet, are the Paleo crowd, who derive their nutrients from leafy green vegetables and animal proteins and fats.

At the other extreme, there are the vegans, who won't touch anything produced by an animal. At both extremes of the extremes, there are raw foodists. Raw animal products (no veg) on the one hand, and raw vegetables (no animal products) on the other.   Meat vs. veg.

My impression is that the vegan camp is dominated by females, the meat camp is dominated by males.  I personally know several youngish vegans, as well as people of my age who are ex-vegans, but I don't know any older vegans.  My impression is that the majority don't maintain their veganism longer than several years.

There's no love lost between hardcore vegans and paleo people.  Mars and Venus, anyone?

Yet they have a surprising amount in common, which perhaps has something to do with why they dislike each other so much.

For one thing, people from both sides, after they have followed their diet fairly strictly for some time, are seldom overweight.  Both groups believe in eating food that has little or no processing.  Many paleos (not all) and all vegans eat vegetables.  Vegan raw foodists don't eat many, if any, grains, because they generally need to be cooked to become edible, so they have that in common with paleos too. Most dairy products don't feature high on the paleo menu, because they often contain a fair amount of carbohydrate, and because most paleos try to select the majority of their diet from foods that were available before man turned to agriculture and domestication of animals.

The big difference between these two camps is in the source of their protein. Both vegans and paleos derive at least some of their proteins, or to be more specific, amino acids, from animal sources.  You're wondering if that is a typo, right?  Well read on.

Contrary to what many non-vegetarians believe, there is no shortage of vegetable sources of protein.  The issue is that, unlike meat, not all the building blocks of protein are available in vegetables.  As the Vegetarian Resource Group explains it:
Protein is made up of amino acids, often described as its building blocks. We actually have a biological requirement for amino acids, not for protein. Humans cannot make nine of the twenty common amino acids, so these amino acids are considered to be essential. In other words, we must get these amino acids from our diets. We need all nine of these amino acids for our body to make protein.
I was intrigued to see that That Paleo Guy describes the exact same thing from a paleo perspective as follows:
In the absence of animal-derived fat and protein from your diet, you[r] body can turn to its own human-animal sources.  That is right - don't eat the fat and protein, and you will invariably begin to reduce your own levels at an accelerated rate.  ...

... they are 'self-digesting' their own protein from lean body mass sources, and running quite nicely on the saturated animal fat being burned from their muffin top.  This is a point so often missed by nutritionists, dietitians, doctors, researchers, etc... when people burn their own fat through their metabolic machinery, they are 'consuming' a high saturated fat 'diet', regardless of how low-fat a diet these professionals think they are prescribing. 
So whereas from the vegan perspective, they manufacture many of their own amino acids to supplement with those found in vegetables, the paleo camp derives theirs from meat sources alone.  They think vegans are crazy to be doing it the hard way, since vegans essentially cannibalize themselves by breaking down their own stores to find the essential amino acids they are lacking.

Personally, I think it's rather neat that there are two completely opposite ways of arriving at the same point.

Whereas vegans would see that as a justification for not killing animals to sustain themselves, this is not a view I'm totally sold on.  The fact that there seem to be so few long term vegans around makes me suspect that total veganism probably isn't the answer for optimal nutrition, and certainly not for me.  It lends credibility to the paleo assertion that vegans eventually deplete their available stores of essential amino acids.  This can cause health problems that can only be resolved by consuming some form of animal product, whether it be meat or dairy products, both of which contain all the essential amino acids.

I wonder if there is a third way.  Could an acceptable variant for people who can't stomach meat be a largely vegetable-based diet that is supplemented by free range eggs instead?

The answer to that depends on the amount of carbohydrate being eaten with those vegetables, and the effect on insulin levels.  Habitual insulin spikes in response to sugars in the system underlies all the diseases of modern civilization, to which vegetarians, by and large (admittedly a disparate group) have not been statistically less susceptible.  This is why the paleo approach minimizes the consumption of carbohydrates.

I would be very interested to compare the levels of insulin resistance of people like Dr. Neal Barnard, a major proponent of a low fat calorie-restricted vegetarian diet, with those of paleo proponents like Gary Taubes and Mark Sisson.  Maybe then we would find out if the two approaches can be reconciled in any way.

Saturday, April 16, 2011

Spot the contradiction

It's late, and I am keeping this post extremely short with a little quote about strawberries that I came across this evening:
They can slow the rate of digestion of starchy foods.  This helps control the rise in blood sugar that follows a starchy meal. This is a key benefit for those with adult-onset (Type 2) diabetes.
I don't know if this is a real benefit of strawberries, though I have seen it referenced in several places.

What I really wonder is whether the authors of this piece, Dr. Leo Galland, M.D, and Jonathan Galland, are actually serious about that paragraph.

Diabetes and starchy meal.  They don't belong together in an article written by people with M.D. after their name.  They don't belong together in any article on improving one's nutrition.

Friday, April 15, 2011

Advice to Sugarholics - from the 1950's

Jack Lalanne passed away at the beginning of this year, aged 97.  According to Wikipedia, he was
an American fitness, exercise, and nutritional expert and motivational speaker who is sometimes called "the godfather of fitness" and the "first fitness superhero." He described himself as being a "sugarholic" and a "junk food junkie” until he was 15. ... During his career, he came to believe that the country's overall health depended on the health of its population, writing that "physical culture and nutrition — is the salvation of America."
There are also some relatively recent pictures of him on Michael Eades' site.

Thursday, April 14, 2011

The impact of a meat diet on triglycerides and cholesterol

I had my bloodwork done yesterday, and was excited to get the results back.  The last time had been almost exactly 6 months ago, in October 2010.  I decided to stop eating grains and sugar in August 2010, but eased my way into it a little bit - I had no trouble staying away from sugar, but I did, from time to time, eat some pulses or small quantities of quinoa.  The last month or two, I have been more consciously eating more meat, mainly ground beef, prime rib and lamb.  Whereas I used to prefer lean cuts if I wasn't eating vegetarian meals, I have been intrigued by the low-carbers' assertion that animal fat is perfectly ok.

So I would eat a bit of bacon here and there, and didn't bother pouring off the grease when cooking ground beef.  Whereas I used to use skim milk before, I've been pouring 2% milk in my coffee, and sometimes cream (I do prefer milk though), as well as eating as many eggs as I felt like.  Oh, and I drank quite a bit of coconut milk too.

The dieticians of Canada would be mortified to learn what I did.  One of the few things we do both agree on was staying away from trans-fats, but I've stayed clear of them since the early nineties, when I first found out about their potential dangers.

The dieticians would expect me to have elevated cholesterol and triglycerides because of all the meat, eggs and the additional fat.

They wouldn't have been disappointed, and I can just hear their disapproving tut-tutting over my solo meat and egg experiment.  This is what my bloodwork shows:
  • Cholesterol up 38% to 6.63.
  • This is quite a bit above the upper limit of the reference range (5.2)
  • My LDL cholesterol is up 41% to 4.22, which is also above the upper limit of the reference range (3.4).
If my BMI hadn't come down from a little over 25 to a fraction over 23 in that period, it would have been cholesterol lowering drugs for me, no excuses accepted.

But wait, there's more!

As it happens, I was keeping the good news for last.

Remember I wrote the other day about low HDL being by far the best predictor of heart disease?  And that triglycerides are the other measure to look at?  Are you curious?

Well, take a look at this to round off my bloodwork analysis:
  • HDL is up a whopping 43% at 2.21, which is at the upper end of the reference range (2.40)
  • triglycerides are down an almost unheard of 25% to a reading of 0.45
  • This is also 25% below the lowest reading in the reference range (0.6)
This is what the cardiologist, Dr. Davis has to say about triglycerides:
When fasting triglycerides are 60 mg/dl or less, most ... people will show little to no small LDL particles.
What this means is that when triglycerides are low, LDL, and by extension, total cholesterol become irrelevant.  LDL particles come in different sizes, and it's the smallest ones that are dangerous.  There are also big fluffy LDL particles, which are actually quite benign.   Our Canadian blood tests don't fractionate LDL, so the best we can do is look at HDL when considering cholesterol levels and heart disease risk.

I think you will agree that my HDL and triglycerides, in addition to my weight loss, the best predictors of heart disease, show absolutely no reason to be worried.

The dieticians of Canada warn that:
Many people find it difficult to stay on low-carb diets for long periods of time because food choices are so limited. They soon find themselves returning to their old eating habits.
Are they kidding me?  What planet are these dieticians on?  Do they have any inkling how encouraging it is to get such healthy bloodwork back?

Would you be tempted to return to a diet that includes bread, pasta and rice if you could be eating steak and salad every day, never feeling uncomfortable, bloated or unpleasantly hungry, and becoming healthier in the process?

Why would I want to choose a life of cycling between feeling stuffed and shaky-hungry?  And as for a lack of variety - I say that's complete nonsense.  The variety in your diet has nothing to do with carbohydrates, and everything to do with your creativity and imagination.

The environmental impact of low carb eating

We often read about how costly meat production is for the environment, and this is an issue which needs to be taken into consideration when discussing how we need to be eating as a society.

In our family, we have been trying to source most of our food locally for some time.  I'm not convinced our low carb eating is necessarily that bad in terms of its environmental impact.

In fact, in spite of us eating more meat, it might be that our diet is, on balance, somewhat better for the environment than the Standard American Diet.

Let's start by summarizing the main components of our diet:  meat (mainly beef), eggs, dairy products and vegetables, some seasonal fruits.  Admittedly we also use condiments and spices that might come from far away, but they are used fairly sparingly, so we can ignore them for the purposes of this discussion.  I also buy bulk nuts from time to time, mainly almonds, which come from California.

The great news is that we are making far fewer trips to the grocery store, since we no longer need wheat based staples like cereal, pasta and bread.  Since we don't live in a wheat growing region, we are saving significant food miles there, as well as packaging.

Sugar and tropical fruits come from far away, so we are definitely saving on those food miles.

We have raised beds about 10 feet from our kitchen door and we are active members in a local CSA.  For 9 months of the year, we take care of most of our vegetable needs ourselves.

We also get our free-range eggs from nearby.  I'm a big believer in eggs, since they are a cost-effective and sustainable way of eating high quality protein, especially when they come from free range chickens.  I really wish backyard chickens for egg production were encouraged by our local authorities, but that's an issue for another day.

Dairy products, fish and chicken are three main foods that are not locally produced in any great numbers, but our way of eating these protein foods isn't really any different than before.  It's fairly difficult to obtain local farm raised chicken at all where we live.  Even before we started eating this way, we made a decision to buy local chicken only, and since it's not that easy to get hold of, our consumption has gone down.  But that is independent of our decision to cut out grains and sugar.

Beef is something we're definitely eating more of these days.  Luckily we have some great farmers not too far away, where we are able to purchase naturally raised meat at reasonable prices in bulk quantities.   I'm not too concerned about all the inputs that go into the raising of cows, because water and grass (hay) are plentiful where we live.  And the cows' output is turned back into the earth as manure because our farmers have family farms, and not massive CAFO operations.

We never ate take-out or prepared foods very much, so all the plastic and cardboard that they are packaged in isn't really much of an issue for us.  However, I can see this would be a noticeable change for some families.

On balance, it seems to me that a low carbohydrate diet can work quite well in an environmentally responsible framework.  Where meat production is arguably less sustainable than grain-based agriculture, we more than make up for it by trucking in fewer packaged staples and sugary tropical fruits, and by sourcing a larger percentage of our diet from the area.  And we most definitely drive to the grocery store less often.

Wednesday, April 13, 2011

The underlying cause of obesity

Sometimes I think advocates of the two sides of the nutritional camps (let's call them the 'low carb' side and the 'balanced diet' side) are each so convinced that they are right that it's confusing to those of us trying to make sense of what's good and what's bad.

Here is an example:  If you are overweight, the balanced diet side say you're eating too much.  You need to eliminate fatty, sugary and refined foods from your diet, eat more whole grains, reduce your calorie intake, and you will lose weight in a gradual manner.  This solution works for some people, but many more feel guilty for lacking what they perceive as the willpower to stick to it.

The low carb side has an equally straightforward response, but they point to a different cause:  They say your diet has too much carbohydrate, which (1) caused the glucose to bind with the excessive fats you ate, forming triglycerides which are now firmly ensconced in your derriere, and (2) set you up in a vicious cycle that makes you hungrier than you'd like to be, and which makes it virtually impossible to control your appetite even when you know you've had enough to eat.

The low carbers go right to the source of the problem: focus primarily on carbohydrate reduction.  This means eliminating sugar and starches.  While the initial withdrawal can be uncomfortable, after the first couple of days, it becomes really manageable.

In the absence of a carbohydrate overload, fats are unable to form glycerol phosphate, which is needed to form triglycerides.  Essentially, this disarms the fats you eat.  Instead of banishing them to your fat deposits, your body burns them as energy instead.

Lower sugar levels allow your insulin to work much less than before, so now your body stops cycling through the ups and downs that make you crave a snack at certain times of the day.

There are three main sources of energy that fuel the body:  carbohydrates, fats and proteins.  Carbohydrates are the only ones that offer little nutritional value in and of themselves, and there is no physical need to consume any minimum quantity.  Of all the fuels, they are usually the cheapest and most easily digested.  Because sugars are also highly addictive, it's psychologically hard to let go of the idea of radically reducing your carbohydrate load.

On the other hand, once you've made that decision, it's usually quite easy to stick to this way of eating. 

Many people realize, often for the first time in their life, that it is possible to break free from their appetite, and this is a liberating feeling.

The big hurdle is overcoming the initial psychological resistance, and the public health bodies don't make it any easier with their dire sounding warnings.  There are many degrees of low carb eating, the least radical being as simple as replacing sugar and starch with high quality protein and plenty of leafy green vegetables.  Usually, this approach also restricts fat consumption to some extent.

It's hard to work out why this is so threatening to the public health bodies, who, you would think, should be supportive of an effective diet that ensures its adherents stay away from processed food, sugar and refined carbohydrates.  Especially when there are growing numbers of doctors who have looked at the science and believe this is the way to go.

Of course the whole grains are still a sticking point.  But as long as our hospitals and other public institutions continue to serve processed grains with the approval of registered dieticians and their controlling bodies, I firmly believe real whole grain foods are not going to be a reality for the vast majority of North Americans, at least not in our lifetimes.

The reality, today, is that diabetic and morbidly obese patients in our local hospital get food trays with high glycemic foods like potatoes, crackers, bread, rice, juice and jello.  They even get fries.

Call me cynical, but in my opinion, the 'balanced diet' approach is broken when looked at from a public health point of view.

There should at least be more recognition that low carb eating plans are worth considering.  Instead of dismissing low carb diets out of hand, the authorities and foundations that are concerned with nutritional standards need to be more honest about the real underlying cause of obesity.

Rather than putting the blame on excessive consumption of fat-laden refined food, they need to tell people that our carbohydrate culture is the underlying cause of obesity, diabetes and cardiovascular disease.

Sugar is the worst offender, and they need to openly tell people to stop eating it.  But the other starches aren't much better.

We need more honesty.  We need direct language that cuts to the chase.  And we need more public discussion on the true cause of obesity.

Tuesday, April 12, 2011

Cholesterol in eggs

Last weekend I was speaking to somebody who told me he doesn't eat many eggs because he has high cholesterol.  I didn't say anything, since I don't know him very well, but it did prompt me to dig up some research on the effects of egg consumption on blood cholesterol.

I wrote yesterday about how HDL is by far the best predictor of cardiovascular disease, so by extension, all we should need to investigate is how egg consumption affects HDL.

The Journal of Internal medicine reported a study in 2009 that measured exactly that.  

This 6 week study looked at 24 healthy adults, who were instructed to eat 2 boiled eggs daily.   The result:
HDL cholesterol increased by 10% (P < 0.05) and total cholesterol increased 4% (P < 0.05), whereas the ratio total cholesterol/HDL cholesterol did not change significantly. Serum triglycerides and LDL cholesterol were also unchanged.
Another study, this one reported in Journal of Nutrition in 2008, put a group of overweight males on a carbohydrate reduced diet over a 12 week period and instructed them to eat 3 eggs every day.   Compared to the control group, whose carbohydrate was similarly restricted, the egg eaters' HDL improved by almost 20%:
The plasma LDL-C concentration, as well as the LDL-C:HDL-C ratio, did not change during the intervention. In contrast, plasma HDL-C concentration increased in the EGG group from 1.23 ± 0.39 to 1.47 ± 0.38 mmol/L (P < 0.01), whereas HDL-C did not change in the SUB group. .... Eighteen subjects were classified as having the metabolic syndrome (MetS) at the beginning of the study, whereas 3 subjects had that classification at the end. These results suggest that including eggs in a CRD results in increased HDL-C while decreasing the risk factors associated with MetS.
This is great news, and if anything, suggests we should be eating more eggs in a reduced carbohydrate diet to improve our heart health.

If you're interested in reading more, do take a look at this Health in Motion article, which looks at some of the other great nutrients found in eggs.

A blueprint for fitness and health

Take a look at Mark Sisson's explanation of how to live healthily, by ditching grains.  Sisson is the author of the book, The Primal Blueprint, and he also has a website named Mark's Daily Apple.  Mark says:
Saturated fat is our friend as long as we keep insulin low, and we do that by reducing carbohydrates.

Monday, April 11, 2011

High HDL is good for you!

Public health bodies are adamant that low fat foods are healthier, and that we should be eating plenty of whole grain carbohydrates in order to avoid a whole host of problems, heart disease being one of the main ones.

You've probably heard this all your life, and it's difficult to imagine it not being true.  However, it is the exact opposite of what many low-carb proponents maintain.  They say we should be minimizing our carbohydrate consumption, favouring quality protein foods like meats instead, and that they don't have to be lean to be good for us.

Let's look at something that is not controversial:  HDL or high density cholesterol, otherwise known as "good" cholesterol.  Most of us are now aware that it's not so much our total cholesterol that is important, but the ratio of the total to "good" cholesterol.  In other words, we want HDL to be as high as possible, and the ratio to be as low as possible.

Furthermore, it is widely recognized that low HDL is a potent predictor of coronary heart disease, even more so in women than in men.  This is an even better predictor than the ratio of total to HDL.

For example, this is from the Jewish Hospital of Cincinnati:
There is considerable evidence that low levels of high-density cholesterol (HDL-C) are a contributory factor in the development of atherosclerosis and coronary heart disease (CHD). Low HDL-C is one of the most common lipid disorders in patients with premature coronary artery disease. In the Framingham study, for example, low HDL-C values were associated with increases in risk for CHD of approximately 70% in men and of more than 100% in women.  (my emphasis)
Edit (2014):  This link is no longer working.  Here is another link to the same quote.

High triglyceride levels are the other uncontroversial measurement:  the higher your triglycerides, the higher your risk for cardiovascular disease.

You would think this would be an easy nut to crack.    Focus on increasing HDL and lowering triglycerides, and you'll have your health under control.  For some people this is genetic, and sometimes there is an underlying medical condition, but for most of us, it's determined by our diet.

So how to go about increasing HDL cholesterol and reducing triglycerides?

This is what the New England Journal of Medicine has to say:
When fat is replaced isocalorically by carbohydrate, high-density lipoprotein (HDL) cholesterol decreases in a predictable fashion.
Going back to the Jewish Hospital of Cincinnati website quoted above, we read that:
Triglyceride-rich particles derived from dietary fat, chylomicrons, are not themselves associated with CHD
It goes on to list the following 6 most common causes of high triglycerides:
excessive alcohol intake, exogenous estrogens or estrogen agonists, poorly controlled diabetes, beta blocker drugs, corticosteroids, and uremia.
The most common causes of low HDL:
Patients with hypertriglyceridemia usually have lower HDL cholesterol and a higher risk of heart attack and stroke. Beta blockers, poorly controlled diabetes, uremia, anabolic steroids, corticosteroids, male sex hormones (testosterone), excessive zinc intake, and severe physical inactivity lower HDL cholesterol levels. 
I don't see dietary fat anywhere in that list, do you?  Never mind, let's continue....

The textbook, High Density Lipoproteins, Dyslipidemia, and Coronary Heart Disease, edited by Ernst J. Schaefer also has this to say:

So now we know that poorly controlled diabetes is a factor in high triglycerides and lower HDL.  We also know that  diabetes is a disease that results from the body's inability to properly manage carbohydrates.  And we have also learned that low fat, high carbohydrate diets lower HDL.

This might leave you wondering why we are encouraged to replace fats in our diet with carbohydrate.

It's not clear to me either.  I can tell you one thing for sure:  while there are plenty of  studies that show that people who eat lots of fat have more coronary heart disease, it's unclear how much carbohydrate they eat.  Put another way, how do we know it isn't the carbs, rather than the fat, that caused their heart disease?

How many people do you know with heart disease or low HDL but who don't eat plenty of grains and sugars?

Sunday, April 10, 2011

Extreme diet or paleolithic re-enactment?

I used to get really irritated when people mentioned hunter-gatherers in relation to some aspect of our modern lifestyle.

When I first learned about the increasingly popular Paleo diet, I felt a similar irritation, particularly when people talked about eating a food that clearly wasn't available in pre-agricultural times, like coffee or chocolate.  Whey powder is another strange one.

But as I thought about it more, I realized it's meant more figuratively than literally, and since I tend to think more literally, I came to the conclusion that I simply needed to lighten up a little.

There is a serious group of people online, whose goal is to achieve a diet that is as close to zero carbs as they can get.   They do this by subsisting on a diet that is mainly meat-based, the premise being that meat has all the nutrients one needs to stay healthy.

Many of the adherents are healthcare practitioners, and they are certainly not ignorant about nutritional science.  I suppose they follow the ultimate "hunter" diet, and it's not that far off from the way the Inuit historically stayed completely healthy and disease-free before they started to take on western dietary habits.

I find it interesting that these zero-carbers, as they are known, seem to be mainly male.

Of course there is no public body that will recommend or give a stamp of approval to such an extreme diet.  It's also not for me.  For one thing,  as I mentioned before, I do have vegetarian tendencies, and eating mainly meat isn't that appealing to me.  I also have a hard time believing more than 6 billion people could possibly be fed on meat alone without some dire environmental consequences.

I also like a varied diet.

Lack of variety is one of the frequent criticisms I've seen of a low-carbohydrate way of living.  While I would be the first to agree that this would be so if all one ate was meat, I strongly disagree that my way of eating is boring.

By removing sugars, grains and the starchiest of vegetables, one is actually left with more scope for dietary variety.  Salads and leafy green vegetables provide plenty of colour and interest.  Add eggs, milk, nuts, fish and meat to the culinary pot, and contrary to what the detractors would like you to believe, there is no end to what you can do to make delicious and appealing meals.

This also leaves you with a diet that still provides carbohydrates, just not as many.  This makes me wonder if, in hunter-gatherer terms, there might be a difference between the sexes.

Perhaps meat eating tends to appeal more to men, who, historically, needed to be lean in order to be successful hunters.

And perhaps the women, being the bearers of children and their primary caretakers, tended to stay closer to home.  This would make them the gatherers, and in doing so, they probably consumed more carbohydrates, which are found in greater abundance in plants and vegetables.  A little more fat around the hips, thighs and buttocks would be useful to mothers in order to breastfeed their babies and to stay alive longer in times of famine, and possibly explains why some studies suggest that a little more fat might actually be heart-protective in women.

Saturday, April 9, 2011

Study linking sugar consumption to CVD

It can take a bit of detective work to find authoritative information linking sugar consumption to heart disease and strokes.  However, this is neatly packaged in a study reported in the Journal of the American Medical Association (JAMA).  Specifically, we read that:
Consuming a higher amount of added sugars in processed or prepared foods is associated with lower levels of high-density lipoprotein cholesterol (HDL-C, the "good cholesterol") and higher levels of triglycerides, which are important risk factors for cardiovascular disease.

"Monitoring trends in consumption and understanding the effect added sugars have on risk of cardiovascular and other diseases is critically important, because added sugars are a potentially modifiable source of calories," the authors write. "Added sugars are food additives that can be recognized by consumers and have been proposed for specific labeling on food and beverage packaging."
The website,, picked up the story too, adding some further commentary:
The dyslipidemia findings echo those from the Framingham Heart Study three years ago that associated elevated TG and low HDL-C, among other markers of the metabolic syndrome, with consumption of at least one sweetened soft drink daily  ...

[This] is also consistent with a body of literature linking high-carbohydrate diets with elevated risk of stroke and heart-disease events, prospective short-term studies suggesting that increased sugar consumption promotes dyslipidemia, and the well-recognized worsening effects of greater carbohydrate intake on TG and HDL-C levels...
Of all the food on our plates, sugar is probably the least nutritive.  Many experts argue that it is actively harmful, and it's a view that is supported by this study.

Objectively speaking, sugar should be the first food to eliminate, if you knew you needed to make some improvements to your diet.

But a sugar-habit can be difficult to break, both because it is so addictive, and because we live in a culture of baking.  I have to wonder if this is why the Canadian Diabetes Association is strangely reluctant to tell people to avoid sugar, advising instead:
Sugars can be included in a healthy diet as a part of a carefully planned meal plan. Carbohydrates, including sugars, should be spread evenly over the day, as part of slowly digested meals.
Having grown up in a dentist's family, where our sugar consumption was fiercely restricted to prevent us from getting cavities, I used to fantasize about buying all the sweets and pop I wanted when I grew up.  Thankfully, when I did grow up, I didn't have much of a sweet tooth, so my own parenting style has much in common with my mother's.

She would be delighted to know that she turned out to be right, though perhaps not for all the right reasons.  I grew up without any cavities, for which I am thankful.  In addition, she led my brothers and me along a nutritional path that makes it easier to say "no thanks" when a plate of sweet stuff is passed around.

If organizations like the Diabetes Association were more like my mother used to be, they would take a stronger stand and advise everyone to say "no thanks" more often to sugar.

It might wake people up to the fact that sugar is a lot more harmful than they think.  I did a quick informal survey among my friends, and they had no idea that sugar could cause heart disease.

Given the epidemic of obesity and Type 2 Diabetes, lowering our collective consumption of sugar would go a long way towards reducing the occurrence of cardiovascular disease that is looming for many of us.  But we need more people and organizations to stand up and start saying it like it is:  Sugar can give you heart disease.  Period.

Friday, April 8, 2011

Killing ourselves with sweetness?


Take a look at this list of some of the common foods North Americans might eat every day, that commonly contain added sugar:

  • coffee or tea with added sugar
  • muffins
  • cold cereal
  • cooked cereal like oatmeal, with syrup
  • pancakes or french toast with syrup
  • toast with jam or honey
  • ketchup 
  • sweet pickles
  • granola bars, crackers or cookies
  • juice and pop
  • ice cream, cake or other dessert
  • flavoured yogurt
  • flavoured milk
  • hamburger & hotdog buns, commercial bread
  • candies
  • apple pie

It's not an exhaustive list, and it's unlikely that you eat each of these items every day, but it's easy to understand how most people do consume a significant amount of sugar, mainly without realizing it.  Kids,  teenagers and those on a limited budget are the ones who are especially likely to regularly eat from this list.

There are many people who "eat healthily" along the lines recommended by the nutritional powers that be.

Maybe they have decided to eat organic food only, or they might have celiac disease.  Or maybe they are simply following the nutritional guidelines.  Even so, it's still really easy to ingest a fair amount of sugar on a daily basis.  Perhaps not on the same scale, but my point is that when you eat muffins baked with agave, brown rice syrup or even evaporated cane juice instead of high fructose corn syrup or refined sugar, it's still a sugar.

There is a lot of online discussion currently about the Paleo Diet, which aims to replicate the kind of foods eaten before the days of agriculture.  The thinking is that Man lived for hundreds of thousands of years on a simple hunter-gatherer diet.  Our bodies have not yet evolved sufficiently to adapt to our modern grain-based diet, according to this way of thinking.

However you might think about paleolithic eating, it's clear that the addition of large quantities of sugar takes us into a realm our bodies have not seen for longer than a couple of hundred years, at most.  Human beings used to eat mainly savoury foods, supplementing them with seasonal fruits when they were available.

Since evolution takes place over thousands of years, could it be that we are killing ourselves with sweetness?

Thursday, April 7, 2011


Oats, which are naturally gluten-free*, are often touted as the ideal food for people on low carb eating plans.  The cardiologist, Dr. William Davis, and author of The Heart Scan Blog, begs to disagree.

When he tested his own response to a bowl of oatmeal he discovered that his blood glucose shot sky-high.  He says:
If you are not diabetic and have a fasting blood sugar in the "normal" range (<100 mg/dl), you will typically have a 1-hour blood glucose of 150-180 mg/dl--very high. If you have mildly increased fasting blood sugars between 100 and 126 mg/dl, postprandial (after-eating) blood sugars will easily exceed 180 mg/dl. If you have diabetes, hold onto your hat because, even if you take medications, blood sugar one hour after oatmeal will usually be between 200 and 300 mg/dl.

This is because oatmeal is converted rapidly to sugar, and a lot of it. Even if you were to repeat the experiment with no dried or fresh fruit, you will still witness high blood sugars in these ranges. Do like some people and pile on the raisins, dried cranberries, or brown sugar, and you will see blood sugars go even higher.

Blood sugars this high, experienced repetitively, will damage the delicate insulin-producing beta cells of your pancreas (glucose toxicity). It also glycates proteins of the eyes and vascular walls. The blood glucose effects of oatmeal really don't differ much from a large Snickers bar or bowl of jelly beans. 
On the other hand, Gary Zeolla, the author of Fitness for One and All, also tested his response to oats, and his results aren't anywhere near as dramatic:
The steel cut oats and quick oats both produced low glycemic responses, spiking the blood sugar into the 90s then dropping it to the mid-70s. But the old-fashioned oats only spike the blood sugar into the mid-80s, and then it also drops into the mid-70s. So of the three, old-fashioned oats gives the lowest response. So that is my oatmeal of choice.

I also tried some "Irish Style Oats." Like quick oats, they take two minutes to cook in the microwave, and the response was about the same as for quick oats.
So who is correct?  It appears that different people can obtain significantly different results.

If you have blood glucose testing strips, the best thing is probably to test your own body's response before making up your mind.   Perhaps oats really are not as good for you as the cereal corporations would like you to believe.

* Oats are normally gluten free, but some gluten may be found in the packaging when they come from a facility where other gluten-containing products are processed.