Monday, February 4, 2013

100% Whole Wheat Bread

Have you ever wondered how commercially made 100% whole wheat bread gets to be just as soft and fluffy as white bread?  Since I've baked a lot of bread in my lifetime, I have had a lot of experience fiddling around with the texture of whole wheat, and I know it's virtually impossible to get a really soft loaf if you're only using whole wheat.

In my experience, a mix of no more than 40% whole wheat to 60% regular white flour is about the maximum if you're baking for people who are used to commercial bread.  Beyond that ratio, it becomes quite dense.  Personally, I would prefer that texture, but I know it's not for everyone.  Typically, a home baked recipe also includes other ingredients like honey, molasses, sugar, butter, oil  and even milk powder to improve the bread's texture.

Since I don't eat bread any more, it's more of an academic question for me, but I was curious nevertheless to find out how they do it.

Our local Health Unit has the following helpful advice for choosing bread:
Knowing what is actually “whole grain” can sometimes be harder than you think.  Often the grains we choose are not as whole as we are led to believe.  Here are some tips for getting the “whole truth”:
  • Read the Ingredients List on the label: Look for the word “whole” before the grain name.  Words like “pumpernickel”, “organic”, “bran”, “multi-grain”, and “twelve-grain”, may actually contain little or no whole grain.  In fact, “enriched wheat flour” is just a fancy name for white flour.
  • Choose breads that have at least two grams of fibre per slice, and cereals with at least three grams of fibre and less than eight grams of sugar per serving.
I thought this Italian style whole wheat bread scored well by the Health Unit's criteria.  Each 36g slice is made with 100% whole wheat, and provides the requisite 2g of fibre per slice.  Brilliant.

Then I looked at the ingredient list, and I saw something that was very interesting indeed:

The first nine ingredients, before we start getting into the unpronounceable additives:  whole wheat flour, water, sugar/glucose-fructose, yeast, wheat gluten, dehydrated potato flakes, salt, extra virgin olive oil, potato starch.

Get that?  Potato flakes and potato starch.

Something I didn't mention above is that adding mashed potato to bread dough does amazing things to the texture, in much the same way that mashed bananas or grated zucchini add moisture to a sweet loaf.  But whole grain it ain't.

If you've ever bought instant mashed potatoes, you will know they are very light.  Since ingredient lists are ordered by weight, I would be very curious to know where the potato flakes and the potatoe starch have been in the list if they had not been dehydrated, and if they had been added together as one item.

Mashed potatoes pack a high glycemic punch, higher even than white bread.  According to Livestrong:
A baked potato has a glycemic index of 76 relative to glucose and 108 relative to white bread, the institute states. This indicates that the blood glucose increases after eating a baked potato at 76 percent of the amount it would respond when eating the same amount of carbohydrates in pure glucose and 108 percent of the identical amount in white bread...

...Using glucose to representing 100 on the index, boiled white potatoes averaged 50 and baked russet potatoes and instant mashed potatoes averaged 85

I also think it's very interesting that the bread manufacturer can claim in all honesty that the wheat their bread is made of is 100% whole grain, even though another non-grain starch is added to take the place of the white flour that would otherwise be required to keep the loaf nice and springy.

Our Health Unit is correct:  Knowing what is actually “whole grain” can be harder than you think. 

My advice?  Stay well clear of this kind of industrialized processed food if you absolutely need to eat bread.  But there again, who absolutely needs to eat bread?

Edit:  I came across a recipe for a loaf that is described as "life changing".  It has no added yeast or gluten (it does contain oats, which may have traces of gluten).   It is dense and chewy, and high in protein:

If you must eat bread, this is the kind to look out for.  What a difference from mass manufactured store bought bread!

Sunday, February 3, 2013

Causes of Alzheimer's Disease

My mother used to joke that she couldn't retire, because she had far too much work to do.   She would also forget things, and then joke that she had "oldtimers' disease".  

The joke was really on her, because part of the reason for her huge workload, was that even at a fairly young age - probably in her mid to late fifties - her brain was beginning to short circuit.  She would complain that her computer wasn't working, but I could never understand how her computer could be so spectacularly faulty all the time.

It wasn't a funny joke at all.  It turned out that she had early onset Alzheimer's Disease.  She is now in her early seventies and lives in an institution where she is well-cared for and happy.  But she doesn't remember anything for longer than about one second.  She used to be able to speak more than five languages and was brilliant at word puzzles and sudoku.  Now, she spends her days sitting in a chair holding an Italian book (sometimes upside down) but not taking in anything.  She can't say much anymore either because she can't remember the second half of a simple sentence she has just begun.  So much for the theory that keeping your mind active and doing word puzzles keeps Alzheimer's at bay.   Clearly it didn't work for my mother.

I suppose the positive side of what happened to her is that she is not unhappy.  Although we feel sorry for her, she appears to be blissfully unaware of the disease that is eating away at her brain.

If you perform a google search on the causes of Alzheimer's Disease, popular media websites will usually return something along the following lines:
We still don't understand exactly how Alzheimer's disease damages the brain. Somehow, cells are damaged and eventually die in different areas of the brain. The damaged areas of the brain contain abnormalities called senile plaquesand neurofibrillary tangles. The death of brain cells leads to dementia, characterized by memory loss, impaired judgment, and behavioural changes.
The article I found this in goes on to claim that:

Possible risk factors include:
  • head injury: Studies show that people who have suffered concussions are more likely to develop Alzheimer's later on.
  • vascular disease: Coexisting small strokes increase the risk and severity of memory problems in Alzheimer's disease.
  • inflammation: People with arthritis are less likely to get Alzheimer's. It is speculated that the medications used to reduce inflammation in arthritis may have a beneficial effect on an inflammatory process in the brain.
  • gender: Women are nearly twice as likely as men to suffer from Alzheimer's.
  • education: Research suggests that better educated people are less prone to Alzheimer's. Those who already have the disease do better if they keep mentally active - an unused brain may deteriorate faster.
  • toxins (e.g., aluminum): A controversial and unproven theory links aluminum in drinking water to senile plaque formation. Earlier studies hinted at a connection, but not according to recent studies that are larger and better-designed.
  • prions: Some scientists speculate that prions, tiny infectious particles made of protein, may be involved in Alzheimer's disease by infecting the brain.
Did you notice that diet wasn't mentioned at all?  Last week I listened to a radio interview with a spokesperson from the local chapter of the Alzheimers Society.  She talked about much of the same stuff, though I do remember her mentioning that it was important to maintain a normal weight, to eat whole foods, plenty of fruits and vegetables, and in particular, to keep fat intake low.

We grew up eating only home-cooked foods, though in retrospect there was a fair amount of refined carbohydrate in our diet:  potatoes, pasta, white rice and store-bought wholewheat bread.  As a teenager in the early eighties, we drank skim milk and ate lean cuts of meat.  We dutifully spread fat-reduced margarine on our bread.  My mother was overweight for much of her adult life, and about 5 years ago, she was diagnosed with type 2 diabetes.

You may find it fascinating that there is peer-reviewed scientific research which differs quite radically from the mainstream media view of what causes Alzheimer's Disease.  Looking at what happened to my mother, I am beginning to uncover papers that provide a more satisfactory explanation as to why my multilingual, brainteaser-loving mother succumbed to this cruel disease.

For example, a 2011 study published in the European Journal of Internal Medicine is titled Nutrition and Alzheimer's disease:  The detrimental role of a high carbohydrate diet:


Alzheimer's disease is a devastating disease whose recent increase in incidence rates has broad implications for rising health care costs. Huge amounts of research money are currently being invested in seeking the underlying cause, with corresponding progress in understanding the disease progression. In this paper, we highlight how an excess of dietary carbohydrates, particularly fructose, alongside a relative deficiency in dietary fats and cholesterol, may lead to the development of Alzheimer's disease.
Did you see that?  Relative deficiency in dietary fats and cholesterol?  The paper goes on to explain that 
The strong influence of Ancel Keys, beginning in the 1960s, has led to dietary avoidance of fats and cholesterol along with over-zealous prescription of cholesterol-reducing medications over the same decades in which there has been a parallel rise in AD prevalence. Although this epidemiological coincidence is not proof, it gives weight to underlying research showing a possible link between cholesterol depletion and neuronal failure.
It has been shown that patients with type-2 diabetes are at two to five times increased risk to AD ... A ketogenic diet has been found to be therapeutic in AD patients.  It involves an extremely high fat diet, with up to 88% of calories derived from fats. This benefit may be likely due in part to the bioavailability of a plentiful supply of fats to repair damaged membranes. 
What I found particularly fascinating, not to say downright disturbing, is that the study claims a correlation between dementia, depression, Parkinson's Disease and low LDL cholesterol.  Aren't we bombarded with advice to lower our so-called "bad" LDL cholesterol?  

In a nutshell, the authors hypothesize that a diet high in processed carbohydrates results in elevated blood glucose levels which, over time, impair serum proteins, which in turn results in the appearance of advanced glycation end-products, commonly known as AGEs.  AGEs cause damage to LDL, which in a roundabout way causes the neurons in the brain to become cholesterol and fat depleted and stressed.

This is complex stuff and I certainly don't have the background or expertise to critique the authors' hypothesis in an educated way.  However, I do find that it makes more sense than any explanation I have ever read in the mainstream media.  

It also makes me very curious to read how proponents of low fat vegan diets like Dr. Neal Barnard, whom I wrote about yesterday, would respond to this paper.  It would make for an incredibly interesting academic discussion.

To wrap it all up, the paper concludes with the following rather simple recommendation:
Simple dietary modification, towards fewer highly-processed carbohydrates and relatively more fats and cholesterol, is likely a protective measure against Alzheimer's disease.
I do realize it's not necessarily the only factor in the development of my mother's disease, but it's advice I'm taking seriously, just in case I inherited a genetic predisposition to Alzheimer's Disease from her.  

And while it's too late to do anything about it now, I do harbor a painful feeling of regret that my children may have lost out on knowing their grandmother, in large part because she was taken in by the prevailing dietary advice to eat more grain and less fat.

Edit:  here is a picture of her that was taken at the beginning of 2015.  I know it isn't very flattering, but at her stage of disease progress, nothing is flattering any more.  She needs a wheelchair to get around, and no longer feeds herself.  I noticed her lunch is exactly the kind of food I never touch, but at her stage of disease progression, I imagine it doesn't really matter.

Saturday, February 2, 2013

Neal Barnard's Take

You probably know about Dr. Neal Barnard.  He is one of the leading proponents of a vegan approach to reversing diabetes and heart disease.  It doesn't hurt that he looks spectacularly healthy himself.  In this TED talk, he explains his case:

It certainly does sound appealing.  Much of Dr. Barnard's 18 minute talk essentially convinces me that humans are biologically suited to a paleolithic diet and that the industrialized food that is served all around us and which seems to fill upwards of 80% of most grocery store shelves is of no use to anybody except the pharmaceutical companies that make money off the drugs they claim will counteract the harmful effects of the poor food that is eaten.

He compares the inside of a mouth of a cat to a human mouth.  Quite clearly, we don't have teeth that are adapted to tearing into prey and ripping it apart in the same way that cats do (it does bring up the question of the logic of people who feed their cats only vegan food, though that is outside the scope of what I am writing about today).  I would tend to agree with him that we are better suited to not hunting fast moving animals in the same way as cats.

Where I disagree with Dr. Barnard, is that humans are not adapted to hunting animals at all.  He doesn't, for example, discuss the fact that humans have long been pretty adept at catching a number of other non vegan food sources.  For example, the fact that humans have historically mostly lived on or near waterways, is probably because fish and seafood have generally been an important source of protein.  Furthermore, reptiles, insects and eggs have also been a major source of sustenance to hunter-gatherers, especially those living in more land-locked areas.  In order to catch these forms of animal protein, it isn't necessary to have the attributes of a cat.

His talk discusses the role of fat, sugars and insulin at the cellular level.  I really wish he would have spent a little more time on this.  Essentially his view is that dietary fats stop insulin and glucose functioning properly at the cellular level. The low carb understanding is that sugars stop fats and insulin functioning properly at the cellular level.  Both views agree that this malfunctioning causes plaque build-up in the arteries.  My understanding of biological science is very limited, so I really am not in a position to comment on which explanation is more scientifically valid.  It is worth pointing out that Dr. Barnard is not a nutritional scientist either, which might explain why he spent relatively little time explaining his theory.  It would be helpful to non-experts like me, to find a real expert to weigh in on the facts.

Turning to more practical matters, Dr. Barnard talks about a 2006 study that he led, which studied 99 people with diabetes who were put on a 22 week vegan diet, with 50 control subjects who were assigned a standard diabetic diet.
RESULTS—Forty-three percent (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group participants reduced diabetes medications. Including all participants, HbA1c (A1C) decreased 0.96 percentage points in the vegan group and 0.56 points in the ADA group (P = 0.089). Excluding those who changed medications, A1C fell 1.23 points in the vegan group compared with 0.38 points in the ADA group (P = 0.01). Body weight decreased 6.5 kg in the vegan group and 3.1 kg in the ADA group (P < 0.001). Body weight change correlated with A1C change (r = 0.51, n = 57, P < 0.0001). Among those who did not change lipid-lowering medications, LDL cholesterol fell 21.2% in the vegan group and 10.7% in the ADA group (P = 0.02). After adjustment for baseline values, urinary albumin reductions were greater in the vegan group (15.9 mg/24h) than in the ADA group (10.9 mg/24 h) (P = 0.013).
Tucked away at the end of the body of the study, are the only references to HDL and total cholesterol:
Changes in HDL cholesterol were −0.16 mmol/l (−6.0 mg/dl, −11.0%) for the vegan group and −0.07 mmol/l (−2.8 mg/dl, −5.7%) for the ADA group (P = 0.14). The total-to-HDL cholesterol ratio fell for both groups, as did triglyceride concentrations. 

It is unfortunate that the control group in this study followed a standard diabetic diet.  It would have been much more helpful if a third group of test subjects had followed a low carbohydrate, high fat diet.  Then we could have discovered more objectively which approach is better.

While the results definitely do show statistically valid improvements in the vegan group, it bears pointing out that Dr. Barnard's study focuses more on LDL than HDL.  As I have mentioned before in this blog, an LDL count is not only likely to be inaccurate, but it also isn't really predictive of anything much at all.   

My major concern against purely plant-based diets lies in the fact that dietary fats contain a wealth of  nutritional benefits that are not commonly talked about by the people who push them.  They often conveniently (perhaps unknowingly) claim that their plant-based diet provides them with all the nutrients they need, while this might not be strictly true for long term health.

For example, vitamin K2 is fairly easily obtained by eating liver and egg yolks, and helps the body to ensure dietary calcium ends up in the bones instead of lining the arteries as plaque.  Nothing major will happen to you in the short term if you don't get enough vitamin K2, so any deficiency is likely to go unnoticed.   The only known vegan source of vitamin K2, natto, happens to be an excellent one but it is relatively obscure outside Japan.  I would be interested to know how many people who find purely plant-based eating compelling are sufficiently committed to it to either make their own, or import, these foul smelling fermented soybeans. 

Perhaps hard-core vegans like Dr. Barnard eat natto regularly, but I have seldom seen vitamin K mentioned in a popular vegetarian publication, other than in the context of the other vitamin K that comes from the chlorophyll in green leafy vegetables.  For more reading on vitamin K (and the differences between the two kinds), I recommend Kate Rheaume-Bleue's excellent book Vitamin K2 and the Cacium Paradox: How a little-known vitamin could save your life.

Another food I have been researching quite intensively lately is bone broth.  Again, something that is not available to those on a plant based diet, the theory is that regular infusions of the micronutrients and proteins inside slow cooked animal bones are essential to long term human health.   A teaser for a future post I'll be writing soon:  we have been experimenting with regular broths in our house in the last couple of months.   Curious about Ray Peat's conviction that gelatin aids sleep, I have been on a chicken foot quest that ended at one of our local Asian stores yesterday.  After a half-cup of rich chicken foot broth last night, I didn't wake up until 7.30 am this morning, something that hasn't happened in months.  Coincidence?  I don't know, but suffice it to say at this point that chicken foot broth is not available to Dr. Barnard's vegan followers.

I do find it heartening that Dr Barnard talks about our paleolithic ancestors, and I firmly believe that any diet that rejects industrialized food is a great step forward.  While he might be horrified to hear me say it, I do think there are some major commonalities between his approach and the meat-based paleolithic one.   There are not enough commonalities to convince me that a purely plant-based diet is the right one for me, but it seems to work for him and many of his patients. What I am convinced about is that we have a lot more to learn about the food we need to maintain optimum health and longevity, and I will continue to explore this fascinating subject while keeping my skeptical mind as open as I can.