Reader Feedback – Doctors and Cholesterol

First up, an email from Robert, who'll become a medical doctor in under a week. He must be completely thrilled, eh?

~~~

Just wanted to say hello. I’ve been a regular reader for several months now and thought I should take a moment to introduce myself. My name is Robert and I will be an MD in about six days. I’ll be starting an internal medicine residency in Reno, NV in July. I am both excited and nervous about starting, nervous largely because my patience with “modern” medicine is in rapid decline and I have three years of attending physicians to deal with. Yes, Richard, all of the doctors I have worked with personally approach health and nutrition in as mindless a manner as you think and often rant about.

~~~

I know, Robert, and isn't it the damnedest thing? Here you spend all that time, money and effort -- all the while enduring an enormous burden in terms of mental and physical stress and fatigue -- and it would certainly be an appropriate reward to be held in the sort of superman high esteem doctors have traditionally and often deservedly been held.

But I think it's safe to say that owing to the Internet, with its legions of people like me who deal in facts, logic and principles -- and not so much in titles, degrees and positions -- that we're in a situation where the gig is up. Doctors have largely squandered the goodwill they've earned over a century of hard, dedicated, lifesaving work. Thankfully, there are a growing number of docs like your very-soon-to-be self who have come to see the light. It's going to be an uphill battle for a long time.

For instance, Tim, another reader, sent me his lipid panel for comment. Though I don't expect you to comment, Robert, I have an idea that you would interpret it far differently from Tim's doctor. So, as frustrating as it is, this is a step in the right direction. There's that.

~~~

February, 2008, 225 lbs, years on the Standard American Diet:

Total 173
Trig 109
HDL 60
LDL (calc) 91
VLDL 22
Ratio 2.9

July, 2008, 160 lbs, through calorie counting, semi starvation, yet semi-low carb:

Total 145
Trig 38
HDL 69
LDL (calc) 68
VLDL 8
Ratio 2.1

Been going Paleo(!) since Sept 08, intermittent fasting, 3 days a week lifting hard efforts, sprints, eating tons of meat! Actually heading down the road for 90 days of meat only (2+ weeks in right now) so I did another panel:

May 1, 2009, 170 lbs, more muscle!

Total 226
Trig 34
HDL 82
LDL (calc) 137
VLDL 7
Ratio 2.8

Should I be concerned of the rise in Total and LDL?  From what I've read on your blog, Dr. Eades, and other sources, I don't think so.  I am more fearful of the 145 total number (cancer! etc) than the 226!  But my doctor is of the opposite opinion.

~~~

His doctor is of the opposite opinion, but why? Has the doctor been reading Eades, Davis, Sears, Briffa, or the many others out there and concluded that they are wrong? I doubt it. Tim's doctor is probably what I now refer to as a "regurgitator," i.e., as applied to the medical profession: someone who is trained to expertly diagnose and treat in accordance with conventional "wisdom," right or wrong. My non-medical opinion is that we ought to be cheering his great success in improving his health in a way that reflects every well done study and observation of this sort of thing I've seen.

For example, his C-reactive protein was .3 (a "BTW" in another part of his email), where "normal" is < 3 mg/l. This is a strong marker for inflammation -- the very thing that small, dense LDL acts upon to cause heart disease. Also, the ratios they have given Tim are of Total/HDL, which remain steady, as his HDL went from 60 to 82 (all the while you hear great cheering amongst the ignorant masses when someone goes from 45-50 and credits oatmeal or Cheerios). Normal for that ratio is 4-6, because grain and sugar eaters have such miserably low HDL. Ideal is 2-3. Mine was 2.1, so was my wife's, thereabouts, so there's three data points on that for Paleo: IDEAL.

The more important ratio by far, in my opinion, is Trigs/HDL. This is one of the biggest associations with cardiovascular disease (CVD). Again, grain and sugar eaters have abysmally low HDL (the thing that carries oxidized LDL out of your arteries and back to the liver for recycling) combined with elevated triglycerides, which is dissolved fat in the blood. Yes, ironic, isn't it? You want low levels of circulating fat in your blood? Replace grain and sugar with fat in your diet and the very first thing that will happen is that your Trigs (fat in your blood) drop precipitously. Guaranteed.

Tim went from a decent level of 109 ("normal" is considered < 150, but that's only because it's based on normal for grain and sugar eaters) to a whopping low of 34. Of course, he did it by replacing crap in his diet (grain and sugar) with real food like animals and their fat. 

Now, in case you're suspicious about the veracity of this Trig/HDL ratio being of prime importance, there's a lot out there. How about this, a 1990 (!) interview with then director of the massive, long-term Framingham Heart Study, Dr. William Castelli.

"There's a subgroup of people who have an HDL under 40 and triglycerides over 150," he explains. "These people have galloping proression of their cholesterol deposits, which will eventually lead to heart disease, and the average physician is not picking it up."

You can read the whole interview.

So, what did Tim's Trig/HDL ratio do while progressing from SAD to Paleo? It went from 1.8, which is on the very low side of ideal (< 2), to .4, which is on the screaming bleeding high side of ideal. Mine is also .4, so is my wife's, thereabouts, so three more data points for ya. Tim achieves a 4.5 magnitude improvement on his Trig/HDL ratio.

I wonder what Cheerios would have done for him.

But that's not all. His LDL is calculated, and rather than rehashing the pitfalls of calculated LDL, I'll just refer you to my 2-part series: What Do You Think You Know About LDL Cholesterol? (part 1; part 2). For another reference, here's how LDL ought to be measured: NMR LippoProfile.

But what can we glean from the information provided? Well, it turns out that the Trig/HDL ratio is a reasonable marker for LDL particle size. Remember, and you can find out more here, but small & dense LDL particles are the real danger. Guess what else? grains and sugar give you a profile where most of your LDL is small and dense, while a high fat (natural, i.e., animal) diet gives you LDL that's large and fluffy, which is inversely associated with CVD, so far as I can tell.

Ratio of Triglycerides to HDL Cholesterol Is an Indicator of LDL Particle Size in Patients With Type 2 Diabetes and Normal HDL Cholesterol Levels

RESULTS — Clinical characteristics, pharmacological therapies, lifestyle, and prevalence of diabetes-related complications were similar in both patient groups. LDL size correlated negatively with plasma triglycerides (TGs) (R2= 0.52) and positively with HDL cholesterol (R2=0.14). However, an inverse correlation between the TG–to–HDL cholesterol molar ratio and LDL size was even stronger (R2= 0.59). The ratio was >1.33 in 90% of the patients with small LDL particles (95% CI 79.3–100) and 16.5% of those with larger LDL particles. A cutoff point of 1.33 for the TG–to–HDL cholesterol ratio distinguishes between patients having small LDL values better than TG cutoff of 1.70 and 1.45 mmol/l.

Let's unpack this, and by the way, while this may look incomprehensible to many of you, do know that a couple of years ago it would have been to me too. I can only encourage you to persevere. You can develop an ability to pretty well understand this stuff. Yes, consult a doctor (hopefully one like new-doc Robert), but go in knowing and understanding what you're talking about. If a doctor is ever offended by your accumulated knowledge and insistence on questions and clear explanations, you need to find a new one.

  • LDL size correlated negatively with plasma triglycerides: higher Trigs = smaller LDL particles (bad)
  • ...and positively with HDL cholesterol: lower HDL = smaller LDL particles (bad)
  • However, an inverse correlation between the TG–to–HDL cholesterol molar ratio and LDL size was even stronger: the ratio is even more important, i.e., the higher the ratio, the smaller (badder) the LDL particles. Stunningly striking: 90% of those with small dense LDL (bad bad bad) had a Trig/HDL ratio greater than 1.33.

So, what's an average Trig/HDL ratio? I don't have time to look up averages and verify sources, but let's just assume an "on the edge" level for both Trigs (150) and HDL (40). 

That's a whopping ratio of 3.75, well above that 1.33 "cutoff"!!! So, if you present to your medical professional with better-than-"normal" triglycerides of 149 and HDLs of 41, he's going to give you a big high 5, and tell you you're on the right track. He's probably not going to even measure your C-reactive protein to determine inflammation markers, nor your Lipoprotein(a), or even homocysteine. And Tim? Before his transformation? Even with a very moderate Trig level by "normal" standards, he had a ratio of 1.8, well over that 1.33 "cutoff" between likely (with 90% confidence) small dense LDL and large fluffy. And now, at .4? Fergettaboutit. He's going to have an NMR per a subsequent email, but I can already tell you what it's going to show.

[Late edit: Note that as commenter below, GoEd, has correctly pointed out, that 1.33 ratio is based on European units for Trigs and cholesterol, i.e., mmol/l instead of mg/dl. That would all be fine and good, but Trigs and cholesterol convert differently. Dumb mistake, as I've made these conversions a number of times. So, at any rate, the ratio for Trigs and cholesterol based upon mg/dl is about 3.0, not 1.33. So, still, our example of a "normal, excellent" profile at a ratio of 3.75 is still well above the cutoff, albeit not quite as dramatically as I first implied.]

Though it is probably achievable to have a a small percentage of small LDL on a standard diet, I'm far more certain that it's going to be far easier accomplishing it on a paleo-like diet.

By the way, my lipid panels over the last year are here and here, my last with HDLs of 133. Yes: 133.

Afterthought: Tim has VLDL measurements, and the only thing I know is that lower is better. However, I've no idea how they are measured, how reliable they are as a marker, or any relevant studies. If an astute reader can educate me and the rest of us, please do so -- with my sincere gratitude.

Unbridled Reductionism vs. Common Sense

I get lots of interesting questions. For instance, the other day I was in the 40F deg. cold plunge at San Jose Athletic Club -- a mere 5-minute walk from the loft -- and while coming up on the minute mark and my intended time to get out, another guy got in and asked if I hadn't lost quite a bit of weight.

I ended up staying in and chatting for over five minutes about things Primal, Paleo, and "Ev-Revolutionary," not feeling a bit cold.

But the questions were remarkable, in that he could see the transformation in front of his very eyes -- which meant he also had no reason to doubt my performance gains in the gym either (and he could just go ask my trainer, Mike, anyway). But I guess they had to come...

Fasting? Doesn't that "harm your metabolism?"
Answer by question: does it harm the metabolisms of wild animals if they don't always get their kill?...

"Skipping" breakfast? Don't you have to "fuel" the body for the day?
Answer by question: are you saying that I should eat when I'm not hungry, and, do you observe wild animals eating that way?... 

"Only" two meals per day, usually? Don't you need to keep your "nitrogen balance" up so that you don't waste lean tissue?
Answer by question: do wild animals save up their kills and forages in order to divide into six annoying little meals per day?...

No cardio? Don't you have to get your heart rate up into the "fat burning zone?"
Answer by question: do you see wild animals on treadmills or in any way behaving as though they would have the remotest use for one?

Of course, this could go on and on, but hopefully you see the underlying principle at work. Principles save time, folks, because once you see them vindicated over and over, you can gradually raise the bar, over time, such that the burden of proof becomes greater, and you can dismiss out of hand propositions that clearly violate the principle.

I do this a lot, lately. There's so much out there now that is the product of unbridled reductionism in the service of bias confirmation; i.e., The Conventional Wisdom. So, for example, we can easily understand from an almost obvious, self-evident (a priori) point of view that it would be entirely logical for nature to have evolved very complex pathways in many species, including humans, that provide for essential nourishment from the body's own tissues when needed. Everyone talks about "fat burning," but the body can also burn lean tissue (for protein), and even bone (for calcium and perhaps other essential minerals).

But now, since we've been subjected to the conventional "wisdom" for decades that fat is the greatest nutritional evil, everyone is obsessed about "burning fat," "preserving lean tissue," and even, now, preserving bones from leaching minerals. Of course, no one seems to stop to ponder why they aren't afraid of releasing all that arterycloggingsaturatedfat into their bloodstream when they get into the "fat burning range."

So what happens? Reductionism happens, which, on its face is a worthwhile endeavor: "an approach to understand the nature of complex things by reducing them to the interactions of their parts, or to simpler or more fundamental things" (Wikipedia) That's a good method generally, but then there's the unbridled sort of reductionism where a complex, integrated, and logical view of a system is set aside while sweeping cautions are leveled against perfectly normal behavior that we observe in nature all the time, like not getting three squares per day, not eating when hungry, not eating every two - three waking hours, and not running on treadmills or in circles.

Here's an example that's a little different from the above, which focuses primarily on fat burning and an obsessive fear with metabolizing even the slightest gram of lean body mass. I received this very respectful question in email from a reader.

I'd like to preface this by stating that I'm very grateful for the information that people like you and Mark Sisson freely provide to those who are trying to live and eat in a healthy, natural manner.

My question is concerning the fact that Vitamin K2 protects against osteoporosis. You stated that things like animal fats and lean meats are good sources of K2. Since K2 protects against osteoporosis, then it's logical to say that increased meat consumption would preclude bone breakdown; however, I have also read other literature stating that a high protein diet -- such as a diet high in meat content -- would also cause the blood pH to be in a persistent, subclinically acidotic state. The thinking is that this would cause leeching of calcium from the bones, which leads to calciuria and decreased bone mineral density.

I'm thinking that there is a gap in knowledge with respect to the latter point, but can you explain the logical disconnect between the two?

Well I must say that reader Sun hit the nail on the head: logical disconnect. Now, without knowing anything else, does it make any sense that one pathway to good health is also the pathway to decline? I touched on this in my Vitamin K2 entry the other day:

So we're in a sort of bizarre estoppel situation, where they're now finding important nutritional benefits for preventing and reversing heart disease, and these super nutrients are found primarily in the things we've been told will give us heart disease. A perfect storm of modern ignorance.

And digging through the medical literature can become even more confusing, and these are just things I got today, only one of which I explicitly searched for:

Maybe vitamin K increases bone mineral density (BMD) in some people.

Or, maybe it doesn't.

Or, maybe vitamin D is also critical, synergistic.

Or, maybe what's really important is the actual end fracture risk, not bone density, implying the logical, that BD is not the only factor in fractures.

It's enough to make your head spin. Now, here's one I specifically went searching for, but really, only as a means of showing you that the fundamental logic, the Paleo Principle, is sound. Of course, eating meat in abundance is great and essential for your bones, just as one would think from merely looking around and observing nature.

Nutrition plays a major role in the development and maintenance of bone structures resistant to usual mechanical loadings. In addition to calcium in the presence of an adequate vitamin D supply, proteins represent a key nutrient for bone health, and thereby in the prevention of osteoporosis. In sharp opposition to experimental and clinical evidence, it has been alleged that proteins, particularly those from animal sources, might be deleterious for bone health by inducing chronic metabolic acidosis which in turn would be responsible for increased calciuria and accelerated mineral dissolution. This claim is based on an hypothesis that artificially assembles various notions, including in vitro observations on the physical-chemical property of apatite crystal, short term human studies on the calciuric response to increased protein intakes, as well as retrospective inter-ethnic comparisons on the prevalence of hip fractures. The main purpose of this review is to analyze the evidence that refutes a relation of causality between the elements of this putative patho-physiological "cascade" that purports that animal proteins are causally associated with an increased incidence of osteoporotic fractures. In contrast, many experimental and clinical published data concur to indicate that low protein intake negatively affects bone health. Thus, selective deficiency in dietary proteins causes marked deterioration in bone mass, micro architecture and strength, the hallmark of osteoporosis. In the elderly, low protein intakes are often observed in patients with hip fracture. In these patients intervention study after orthopedic management demonstrates that protein supplementation as given in the form of casein, attenuates post-fracture bone loss, increases muscles strength, reduces medical complications and hospital stay. In agreement with both experimental and clinical intervention studies, large prospective epidemiologic observations indicate that relatively high protein intakes, including those from animal sources are associated with increased bone mineral mass and reduced incidence of osteoporotic fractures. As to the increased calciuria that can be observed in response to an augmentation in either animal or vegetal proteins it can be explained by a stimulation of the intestinal calcium absorption. Dietary proteins also enhance IGF-1, a factor that exerts positive activity on skeletal development and bone formation. Consequently, dietary proteins are as essential as calcium and vitamin D for bone health and osteoporosis prevention. Furthermore, there is no consistent evidence for superiority of vegetal over animal proteins on calcium metabolism, bone loss prevention and risk reduction of fragility fractures.

Now, did you catch the unbridled reductionism in the above? "This claim is based on an hypothesis that artificially assembles various notions, including in vitro observations on the physical-chemical property of apatite crystal, short term human studies on the calciuric response to increased protein intakes, as well as retrospective inter-ethnic comparisons on the prevalence of hip fractures."

It's all so unnecessary.

“WTF”: Read the Label

I've become a real label reader lately, and I almost never like what I find. There are exceptions, such as when I got to Whole Foods and get a few tubs of Alexander Valley Fresh Sauerkraut, where the ingredients are: cabbage, filtered water, sea salt, and... there is no "and." That's it. That's what the label of a Real Food product reads like. It even works for dogs, where I regularly get the dried chicken breasts, duck breasts, venison and buffalo livers, and even lamb's lung. In each case, the ingredient label has only one word: chicken; duck...you get the idea.

The biggest shocker is the way HFCS or High Fructose Corn Syrup has made its way into virtually everything. I recall looking at a bottle of BBQ sauce a while back, and, you guessed it: HFCS was ingredient number one. Same with catsup. Virtually all of them have HFCS as the first, second or third ingredient.

OK, so now what? We'll, how about a "healthy alternative" sweetened with, let's say, "agave nectar?" Sounds exotic; healthy even. But at 80-90% fructose, it's not only a health fraud but is actually far worse than corn syrup.

Here's why: Not All Sugars are Equal. Stephan blogged that study too, and here's what he said:

...In one group, the drinks were sweetened with glucose, while in the other group they were sweetened with fructose.

After ten weeks, both groups had gained about three pounds. But they didn't gain it in the same place. The fructose group gained a disproportionate amount of visceral fat, which increased by 14%! Visceral fat is the most dangerous type; it's associated with and contributes to chronic disease, particularly metabolic syndrome, the quintessential modern metabolic disorder (see the end of the post for more information and references). You can bet their livers were fattening up too.

The good news doesn't end there. The fructose group saw a worsening of blood glucose control and insulin sensitivity. They also saw an increase in small, dense LDL particles and oxidized LDL, both factors that associate strongly with the risk of heart attack and may in fact contribute to it. Liver synthesis of fat after meals increased by 75%. If you look at table 4, it's clear that the fructose group experienced a major metabolic shift, and the glucose group didn't. Practically every parameter they measured in the fructose group changed significantly over the course of the 9 weeks. It's incredible.

And now I come to the inspiration for today's post, which is Mark Sisson's post for today: WTF?... Where's The Fat?! where he takes you on a label reading roller coaster that ought to make you sick to your stomach. And, for those who want to see Mark at his sarcastic best, this is the post for you.

...What manner of culinary wizardry can make a delicious, creamy version of ranch dressing without all that artery-clogging fat? They must be doing something right, because they almost outnumber their full-fat counterparts on the shelves. And the people I see frequenting the aisles are always trim, slim, and full of vitality. Plus, what with the nationwide rates of diabetes, obesity, and heart disease plummeting to all-time lows just as the fat-free movement finally seems to be picking up steam, I think we can thank the good folks of Kraft, Best Foods, and Lean Cuisine for their commitment to public health.

And so I set out to peruse the aisles of the local supermarket for evidence of these shining beacons of health and chemical ingenuity. I hoped to discover the secrets so that I might recreate the delectable food products at home and avoid messing up my kitchen with “recipes” and “raw meat” and “food.”

Mark takes you on quote a photo tour through supermarket isles, and in the end, comes away as most of us would and do, now.

My trip to the inner aisles of the grocery store left me in a state of disbelief. I knew what I was in for, but I still came out amazed. I’m amazed that people can continue to deceive themselves into thinking what they’re eating is actually food, let alone healthy food, and I’m amazed at the cunning of food marketing that plays off this deceit...

Vitamin K1 vs. Vitamin K2

I've written a healthy bit on the enormous benefits of vitamin K2 (MK-4) Menatetrenone. To access those posts, click here.

Via Dr. Eades' excellent Twitter feed, I just got wind of this study on K1 (Phylloquinone) and its ability to modestly slow the progression of coronary artery calcium ("CAC" - 6% less progression than the control).

Conclusions: Phylloquinone supplementation slows the progression of CAC in healthy older adults with preexisting CAC, independent of its effect on total MGP concentrations.

There's also a media writeup on the affair. Let's probe.

Speaking to NutraIngredients.com at the recent Vitafoods show in Geneva, vitamin K expert Professor Cees Vermeer from VitaK at the University of Maastricht explained that matrix Gla protein (MGP) in the vessel walls is a hot topic.

“It is the most powerful inhibitor of soft tissue calcification presently known, and it definitely needs the vitamin K to be active in that way. So, vessel walls have only MGP to defend themselves against calcification,” he said.

So, what's "MGP," or, matrix gla protein? Lets close the loop, and Wikipedia will do just fine.

Matrix gla protein (MGP) is a protein found in numerous body tissues that requires vitamin K for its optimum function. It is present in bone (together with the related vitamin K-dependent protein osteocalcin), as well as in heart, kidney and lung. In bone, its production is increased by vitamin D.

Ah, vitamin D, again, eh (click here for my many posts)? So, what, all the experts be dammed, and get your unblocked sunshine and eat plenty of leafy green vegetables? Uh, no problem, but it's not my approach -- although I eat plenty of leafy greens. Let's continue with the article.

Overall, no significant differences in the groups were observed. However, in people with pre-existing CAC who took at least 85 per cent of the assigned supplements experienced a retardation of CAC progression of 6 per cent, compared to the control group. Such decreases occurred independently of changes in serum MGP, said Booth and her co-workers.

“Vitamin K supplementation reduced the progression of existing CAC in asymptomatic older men and women when taken with recommended amounts of calcium and vitamin D. The mechanisms by which vitamin K conferred a protective role are still uncertain,” wrote the researchers.

So, is it really the K1, the vitamin D, or could it perhaps be that just an added bit of K helped the K and D work in better sync (something that happens naturally on a paleo diet with plenty of sunshine, BTW)?

But so now let me get to the far bigger news, something I've blogged on before. Though there are no studies in humans I'm aware of, yet, it is well known that in rats, high-dose K2 (MK-4 - Menatetrenone) doesn't just slow the progression of CAC, it actually reverses it and does so significantly. Stephan at Whole Health Source tracked that down some time ago. This is a must read post, folks. A couple of things to highlight.

In the group fed high K1 but no warfarin, there was about three times more K2 MK-4 in the aortas than K1, suggesting that they had converted it effectively and that vascular tissue selectively accumulates K2 MK-4. A high K1 intake was required for this effect, however, since the normal K1 diet did not reverse calcification. The rats fed high K2 MK-4 had only K2 MK-4 in their aortas, as expected.

[emphasis added]

I just had a brief email exchange with Stephan about this and speculated that emphasized bit before even looking up his posts (that's not to say he agrees, but he may post on this too, and we'll know). Essentially, since we're so bad at converting K1 to K2, perhaps a big enough dose of K1 helps.

But why not just go for the K2, as that's where the benefit really is? Well, then, instead of recommending people eat leafy greens, you've got to recommend they eat things like bone marrow, liver, meat, animal fat, eggs, fish eggs, foie gras and such. Can't do that, because those things clog arteries; uh, right? So we're in a sort of bizarre estoppel situation, where they're now finding important nutritional benefits for preventing and reversing heart disease, and these super nutrients are found primarily in the things we've been told will give us heart disease. A perfect storm of modern ignorance.

Now, stop and consider that for a second. Everything ads up, here. The Japanese have been hot on the trail of K2 and its ability to halt and reverse osteoporosis for years. Then there's the vitamin D. Huh, pretty paleo: sunshine, meat, animal fat, & eggs. Sound a lot like what primitive people experienced and ate for eons. Here's Stephan from the same post, again.

K2 MK-4 (and perhaps other menaquinones like MK-7) may turn out to be an effective treatment for arterial calcification and cardiovascular disease in general. It's extremely effective at preventing osteoporosis-related fractures in humans. That's a highly significant fact. Osteoporosis and arterial calcification often come hand-in-hand. Thus, they are not a result of insufficient or excessive calcium, but of a failure to use the available calcium effectively. In the warfarin-treated rats described above, the serum (blood) calcium concentration was the same in all groups. Osteoporosis and arterial calcification are two sides of the same coin, and the fact that one can be addressed with K2 MK-4 means that the other may be as well. 

In the end, it's gratifying to see daily confirmation of stuff I've blogged over the last couple of years. For me, it's pretty easy and straightforward: follow the paleo principle.

The burden of proof is on the others, and more and more, it's becoming very clear that we have been duped by government, big agra, and big pharma -- all bedfellows in a money-making scheme that has already maimed and killed millions unnecessarily.

Later: Uh, that last characteristically inflammatory bit may be a little overstated. While there's no doubt to me that the state, big agra and big pharma constitute a perfect storm of harm, whereby nutritional and health problems that didn't exist have been created, with the same villains rushing in to "solve" them, for a price (both individually and societally), it is nonetheless a fact that billions of people -- individuals -- exist because of agriculture. Wishing that away would be to wish away all those lives, and I can't do that. Equally, the pharmaceutical industry has presided over miracles.

A Great Email (FTA tops Zone; Medical Professionals)

As I muddle around, trying to get back in sync from the long weekend -- of which I took every advantage -- here's an email from Eileen that came in last Friday that I was really pleased to receive.

~~~

I just wanted to let you know that you are certainly changing (saving?) lives with your blog.  I forget how I found Free The Animal, but it was shortly after I started my New Year's resolution to drop the 20 lbs I'd gained in the past 18 months.  I had the idea that I was going to Zone because it had helped me lose weight in the past, although I remember quitting because it was a hassle to weigh and measure every bite of food (and quite frankly, I was starving on 12 blocks/day).  Anyway, finding your blog coincided nicely with my Zone procrastination so I decided to follow your recommendations instead.  January 1st, I weighed 145 lbs and a week ago, 125 lbs.  The best part of that is that much of the weight lost was this big spare tire of fat around my waist and no starving.

Also thanks to you/your blog, I began to supplement Vit D heavily. I should mention here that I'm an RN, and since it was cold & flu season the topic came up with some of my coworkers regarding Vitamin D supplementation.  One of the older nurses was telling the younger girls how important it was to take "the recommended 400 IU per day".  If I didn't read your blog, I wouldn't have known that 400 IU isn't likely to do much for people with D deficiency.  I kept taking 6000 IU (and kept my mouth shut - can't argue with some of those old battleaxes and win).  D Action sent my test results in April and my level is 76.

My annual "physical" is coming up in a few weeks, and I am curious to see if my physician will check my cholesterol.  Last year my HDL was a pathetic 38. I'm hoping that after 5 months of healthy eating, there is an improvement.

So thank you, Richard.  Because of your drive to educate the rest of us, you have helped me make truly positive changes in my life and health.  Keep up the great work!

~~~

Pretty amazing, eh? The Zone, a working life amongst medical professionals, and all it really takes is some decent common sense to eat real food, plenty of natural fat, and the rest takes care of itself.

Hearty congratulations to Eileen.

Great Comments: Experience, Knowledge, Encouragement and Inspiration

Wow do we have some great readers who are willing to share all that in the title and more. A couple of days ago I posted this plea, from someone trying to get things together in terms of diet, exercise, health.

The community really responded. There are many great comments there, and I encourage you to read them all, but I also want to re-post a couple as recognition for some really good help.

~~~

First, from David:

Obviously you got into your current condition through a combination of what you eat, how much you eat and what you do (or don't) for exercise. Here's the obvious. Keep doing the same and you'll continue down the same path, at least as fast. if you figure you're 60-80 lbs overweight now, you'll be another 60-80 lbs heavier in 10 years. So here's something obvious ... change what you eat, change how much you eat, change your exercise. Now, we all know that is easier said than done. After all we eat the amount that we do because we're hungry. Overweight people have a hard time exercising, because they're overweight. I think the place to start is with WHAT you eat.

Start with the easy changes. Dump all fructose that is not in fruit. That means dump soda. Dump almost every breakfast cereal. READ the ingredients of stuff you buy. If it includes sugar, high fructose corn syrop, corn solids et cetera ... DO NOT buy it. Google on how the body metabolizes fructose, how it goes straight to abdominal fat, how it does not give you any sense of fullness, and what abdominal fat does to your body and your liver in particular. That should motivate you.

Dump anything made with any kind of fat or oil identified as hydrogenated or modified.

If you do that it will make a huge difference.

Next consider dumping grains. It took me about 5 years to admit that it was worth trying. I have never looked back. It was hard to do, but like quitting smoking, it is fantastic afterwards.

Learn about how to reset your hormones, such as insulin and leptin. They are way out of balance now. I know this because you are overweight.

Once the weight is coming off and once you purge the crap out of your diet, you will feel more energy and will be able to exercise.

Cut fructose and work on your hormones and you'll start feeling full after eating.

These are all simple things but they are up to you. YOU have to make a change. Right now just about any change would be better than carrying on with your current path. Good luck and keep writing here for support. Richard has collected some good people here.

~~~

Patrik:

Who's right? Is the AHA, Cleveland Clinic, Cholesterol Fascists, etc? Or is it the people such as Weston Price, Sally Fallon, Mary Enig, Udo Erasmus, and Ussi Rasnikov and their beliefs on what is the determining factor(s) in heart-disease?

It is easy for anyone to say: I am right. Here is why. Also, humans have a tendency to try and split the difference as in "I don't know who is right, let's just agree that both parties are 50% right".

This, I think, in evaluating fitness/health/life philosophy is incorrect.

Here is what I use to evaluate Paleo versus Conventional Medicine/Fitness. Use at your own risk.

1) What is the underlying framework that any specific advice rests on?

Modern medicine/fitness almost completely ignores evolution. I think this is wrong as "Nothing in Biology Makes Sense Except in the Light of Evolution."

2) Cui bono?

Modern medicine and pharma. Don't get me wrong, I am for Free Markets and I do think that pharma has done a lot -- but in some cases, the incentives are not aligned correctly.

3) So-called studies and "science"

Again, don't get the wrong impression. I use reason and logic to arrive at my conclusions about Paleo BUT I'd advise reading this post when it comes to evaluating "studies"

There is increasing concern that in modern research, false findings may be the majority or even the vast majority of published research claims. However, this should not be surprising. It can be proven that most claimed research findings are false.

BTW cui bono is also relevant when it comes to "science". Do you think that "scientists" aren't subject to confirmation bias?

4) Very important. A healthy amount of both empiricism and skepticism. Is Paleo working for you?

My experience: it has changed my life. I wish I been raised this way.

Aside from the empirical aspects of Paleo -- there is much conjecture. We don't know what the Paleolithic was like.

For example, the debate over sat fat in the Paleo community. (Personally, I don't think it is harmful and suspect it is healthful. But Loren Cordain could certainly be right and I could be dead wrong.)

Are we, right at this very point, getting some things 100% wrong? We sure as hell are.

But so is Western Medicine. Again, don't get me wrong. If I am in a car accident, get me to a emergency room, use all of western medicine, pharma incuded, and fix me up stat!

I don't know if that helps -- but this is how I view epistemological questions of who is right and why they are.

My recommendation: Get off your ass, suck it up and try it. Stop pussyfooting.

If it doesn't work after an honest effort, 3 months or so, nothing is stopping you from going back to the ostensible healthy Standard Government Recommended Diet.

~~~

Erik:

You got it right with "unwilling," but not "unable." It's up to you, man. And you've been keeping up with paleo/Weston Price literature since age 18? Man. What's stopping you?

I first happened upon paleo when I rescued a flat-coat retriever puppy from a trailer park in Escondido. The guy was undernourished and I, of course, rushed to the nearest Petco for a bag of Nutro-Max. Lamb flavor, I believe. "Flavor" shoulda tipped me off. Anyway, he didn't react well. Loose stool, runny nose, sluggish temperament. Something was wrong, and I figured it just might be diet. I was just an English major in school, but I knew the basics of evolution - and I just kinda figured "Hey, this dog is, for all intents and purposes, a wolf. Wolves don't cook and process their meals. Why the hell is he eating all these polysyllabic ingredients?"

I did a bit of digging around online and found that entire communities had sprung up around raw, ancestral feeding. Raw meat, bones, organs. It made perfect sense, and Charlie (my pup) agreed. Shiny coat, boundless energy, white teeth - it worked to perfection.

I got to thinking that maybe the same sorta dietary concept could be applied to all animals. Maybe even, or especially, humans. I'd been putting on a fair amount of weight, having ballooned up to 235 lbs at age 25 (with a fair amount of muscle underneath, but still...), and I figured something new (or ancient) might work.

It did. I dropped the grains, the legumes, and most of the starches, upped the fats and protein, and started paying attention to everything I ate. I also dropped the body fat. Thanks to blogs like Richard's and Mark Sisson's and Stephan's, I got into Weston Price and all the fat soluble vitamin stuff. Cod liver oil, activator X, raw dairy. This way of eating / living / behaving / works so flawlessly it feels like magic. The way vitamins D, A, and K2 work in concert to heal cavities and regulate calcification? Absolutely insane. Such elegant simplicity. Such beauty. Nature wins again.

How can you see the evidence, read the testimonials, acknowledge the millennia of real world case studies that support it - and still reject the paleo way? I can understand if you were ignorant of this stuff, but you've been reading about it for decades! C'mon! I'll echo a previous commenter and say, "Give it three months."

Three months of fatty steaks, coconut milk curries, and handfuls of macadamia nuts. Heaping salads with feta and olive oil dressing. Roasted chicken, crispy skin, organs, and all. The odd fast. A few days of intense workouts every week, no more than forty five minutes per session. Dust the cobwebs off those old football muscles! Go for a hike every once in awhile. Play with your kid (once she's walking). Hell, I sometimes use my (now full-grown) retriever as a mobile, asymmetrical weight. You could do the same with your kid if cautious (I'm no parent, so perhaps I suggest heresy). No weights or gym membership? Check craigslist for a cheap set or buy sandbags from the hardware store. Bodyweight is good enough, too; when I was heavy, one of the advantages was built in resistance training.

While I don't appreciate the clunky foot cocoons they peddle, Nike had it right with "Just do it." So, yeah: do it, man. Good luck (though you won't really need it... it's all just so easy).

~~~

And those were just three out of a dozen of helpful comments. Feel welcome to read 'em all.

Oh, by the way, this is really the norm here, now. Just last week another reader in need of help got an outpouring.

Thanks you commenters, for such willingness to share and help.

The Thing With Grains

Another reader question today.

Why is grain so dangerous to health? can you send me a listing of those grains that are not to be eaten and why?

Well, fortunately, there's a lot of good info out there and so rather than rehash it, let's just call attention to it here, particularly for the benefit of newer readers. I just checked the number of RSS subscriptions to Free the Animal and it's now over 1,000, which would represent regular, daily readers. Just a couple of months ago, last I checked, it was less than half that. Growing all the time, so thanks for the support I get from readers.

Let's begin with Mark Sisson and his Definitive Guide to Grains. First, let's look at the principle behinds the thing, which I call The Paleo Principle. Here's Mark:

Those of you who have been with us a while now know the evolutionary backdrop I mean here. We humans had the pleasure and occasional scourge of evolving within a hunter gatherer existence. We’re talking some 150,000 plus years of hunting and foraging. On the daily scavenge menu: meats, nuts, leafy greens, regional veggies, some tubers and roots, the occasional berries or seasonal fruits and seeds that other animals hadn’t decimated. (Ever seen a dog at an apple picking?) We ate what nature (in our respective locales) served up. The more filling, the better. And then around 10,000 years ago, the tide turned. Our forefathers and mothers were on the brink of ye olde Agricultural Revolution. And, over time, grains became king. But, as countless archaeological findings suggest, people became smaller and frailer as a result of this new agrarian, grain-fed existence.

And actually, the 150,000 years is just for Homo Sapiens and could be upwards of 200,000 years. but, before that, more primitive ancestors of humans go back at least 2.5 million years. Grains never played any significant role in diet.

Why? It's certainly not that people would have considered them unhealthy. In fact, had they been eaten for all those years, we would certainly be well adapted to them by now -- just as people worldwide have become increasingly adapted to lactose in milk beyond weaning age, owing to a genetic mutation about 8,000 years ago that left the lactase producing gene on, and that mutation has been spreading far and wide ever since. Unfortunately, we know of no such stark mutation for grains, and it's important to remember that we were already genetically adapted to milk. The mutation merely allowed us to continue to drink it into adulthood.

But the principle reason ancestors didn't take grains into the diet is because it's too much work for the reward. Think about how much work it would take you to locate and pick wild grains, just to get a handful -- a few hundred calories at best. Now, compare that with the effort required to take an animal and the thousands of calories you get from that.

So, somewhere along the line someone realized that it's better to lay around most of the time, hunt occasionally, bag the meat, and enjoy life. The life of a gorilla, for example, is pretty dismal. They literally have to eat all the time, the nutrient density of the food they eat is so low. Moreover, look at the size of the gut needed to break down and digest all that fibrous plant matter.

Continuing with Mark (be sure to read his whole entry, as I'm just excerpting):

Among my many beefs with grain, the first and foremost is the havoc it plays with insulin and other hormonal responses in the body. For the full picture, visit the previous Definitive Guide to Insulin from some months ago. Guess what? The same principles still hold. We developed the insulin response to help store excess nutrients and to take surplus (and potentially toxic) glucose out of the bloodstream. This was an adaptive trait. But it didn’t evolve to handle the massive amounts of carbs we throw at it now. And, yes, we’re talking mostly about grains. Unless you have a compulsive penchant for turnips, the average American’s majority of carb intake comes from grains.

That's one, but there's more.

And as for the nutritional value of grains? First off, they aren’t the complete nutritional sources they’re made out to be. Quite the contrary, grains have been associated with minerals deficiencies, perhaps because of high phytate levels. A diet high in grains may also reduce the body’s ability to process vitamin D.

Why not get the same nutrients from sources that don’t come back and bite you in the backside? If you have the choice between getting, say, B-vitamins from chicken or some “whole wheat” pasta, I’m going to say go with the chicken every time. Is pasta cheaper? Yes. Is it healthier? No. The B6 in chicken is more bioavailable, for one. The fact is, you pay too high a physiological price for the pasta source. Let’s get this point on the dinner table as well: whatever nutrients you can get from whole grains you can get in equal to greater amounts in other food. In terms of nutrient density, grains can’t hold a candle to a diverse diet of veggies and meats. (And if the label says otherwise, look closely because the product is fortified. Save your money and buy a good supplement instead.

This is a big one that, frankly, pisses me off. Even not considering the problems with grains in terms of insulin, gluten, and other lectins, they are not very nutritious. Listen, everyone, and listen closely: if you eat grains as a significant part of your diet, you are getting CRAP nutrition as compared to a paleo-like diet. It's simply a fact, the "healthy-whole" fraud notwithstanding. You are feeding your children an inferior diet, and considering the phytic acid in grains, you are sacrificing their ability to absorb minerals, potentially setting them up for arterial calcification later in life (contributed to by the vitamin D deficiency that goes hand-in-hand with a high grain diet).

Want proof that a diet with any significant grain content is nutritionally inferior, and woefully so? See here, and here (really, take a moment). In fact, for most micronutrients, a Paleo diet outstrips a standard, grain-based diet by 100-300% in terms of nutritional content.

Grains are junk and garbage that barely pass for "food," and yet this is what the "authorities" advise that you eat as your primary source of "nutrition." Why? Wish I knew, definitively. Much is a result of the huge subsidies paid to producers, much is modern ignorance, and the rest is simple inertia. Anyway, the nutritional deficit from grains pushing out far more nutritious and bioavailable foods like meat and veggies (you can only eat so much, so what's it gonna be?) is the prime reason why they ought to be avoided in any important quantity.

But, wait, there’s more. Enter the lurker substances in grains that cause a lot of people a whole lot of obvious problems (and probably all of us some kind of damage over time). Grains, new evolutionarily-speaking, are frankly hard on the digestive system. (You say fiber, I say unnecessary roughage, but that’s only the half of it.) Enter gluten and lectins, both initiators of digestive mayhem, you might say. Gluten, the large, water-soluble protein that creates the sludge, err, elasticity in dough, is found in most common grains like wheat, rye and barley (and it’s the primary glue in wallpaper paste). Researchers now believe that a third of us are likely gluten intolerant/sensitive. That third of us (and I would suspect many more on some level) “react” to gluten with a perceptible inflammatory response. Over time, those who are gluten intolerant can develop a dismal array of medical conditions: dermatitis, joint pain, reproductive problems, acid reflux and other digestive conditions, autoimmune disorders, and Celiac disease. And that still doesn’t mean that the rest of us aren’t experiencing some milder negative effect that simply doesn’t manifest itself so obviously.

Now for lectins. Lectins are mild, natural toxins that aren’t limited to just grains but seem to be found in especially high levels in most common grain varieties. They serve as one more reason grains just aren’t worth all the trouble that comes with them. Lectins, researchers have found, inhibit the natural repair system of the GI tract, potentially leaving the rest of the body open to the impact of errant, wandering (i.e. unwanted) material from the digestive system, especially when these lectins “unlock” barriers to entry and allow larger undigested protein molecules into the bloodstream. This breach can initiate all kinds of immune-related havoc and is thought to be related to the development of autoimmune disorders. Some people are more sensitive to the damage of lectins than others, as in the case with gluten. Nonetheless, I’d say, over time we all pay the piper.

So, there you have the most of it. However, I urge anyone who's interested to read Mark's entire entry.

For even more, check out Life Spotlight's post just today: The Real Truth About Those "Healthy Whole Grains." Also, Scott linked up Stephan who has a three part series that I probably already linked at some point, but let's do it again.

Leptin and Lectins

Leptin and Lectins: Part II

Leptin and Lectins: Part III

The punch line, from Stephan the biologist as pulled together by Scott from those three posts:

For this model to be relevant to us, we'd expect that humans with metabolic syndrome should be leptin-resistant. Well what do you know, administering leptin to obese people doesn't cause satiety like it does in thin people. Furthermore, elevated leptin predicts the onset of obesity and metabolic syndrome. It also predicts insulin resistance. Yes, you read that right, leptin resistance comes before insulin resistance.

Many plants use lectins as a defense against hungry animals. Thus, an animal that is not adapted to the lectins in the plant it’s eating may suffer damage or death. … Grains and legumes (beans, soy, peas, peanuts) are rich in some particularly nasty lectins. Especially wheat. Some can degrade the intestinal lining. Some have the ability to pass through the intestinal lining and show up in the bloodstream. Once in the bloodstream, they may bind all sorts of carbohydrate-containing proteins in the body, including the insulin receptor. They could theoretically bind the leptin receptor, which also contains carbohydrate (= it’s glycosylated), potentially desensitizing it. This remains to be tested, and to my knowledge is pure speculation at this point. What is not so speculative is that once you’re leptin-resistant, you become obese and insulin resistant, and at that point you are intolerant to any type of carbohydrate.

One of the molecules they use to probe the function of the leptin receptor is our good friend wheat germ agglutinin (WGA), a lectin found in wheat, barley and rye. They used WGA to specifically block leptin binding at the receptor.

This fits in very nicely with the hypothesis that grain lectins cause leptin resistance. If WGA gets into the bloodstream, which it appears to, it has the ability to bind leptin receptors and block leptin binding. It doesn’t take much imagination to see how this could cause leptin resistance.

As to the last part of the question, what grains would be OK, I'd have to pass. I'm so over grains, don't think about 'em and don't miss 'em. I'm just sticking to Real Food.

A Reader Question

Here's one that I think applies to a whole lot of folks. They know, but practice is tough.

I stumbled across your web-site a few months back and must say that I find it thoroughly entertaining and thought-provoking.

I am 43 yrd old married father of a nine month old-daughter who is frightened to death of dying prematurely of heart disease and yet I am still unwilling or unable to make lasting changes in my lifestyle to lessen the chance of this occurring. Being 5' 7.5" tall and weighing 242 is not healthy w/a cholesterol level of 302 with a BMI over 35 is a far cry from my days of being athletic while playing football.

The ironic twist to this sad tale is that I have been an avid reader of nutrition & Exercise related materials since I was 15 yrs old, I am very knowledgeable but even I am completely confused as to what to eat!! Who else reads the Paleolithic Prescription at 18 for fun and went to school to be a nutritionist!! Who's right? Is the AHA, Cleveland Clinic, Cholesterol Fascists, etc? Or is it the people such as Weston Price, Sally Fallon, Mary Enig, Udo Erasmus, and Ussi Rasnikov and their beliefs on what is the determining factor(s) in heart-disease?

I guess I am reaching out to you, do in part, because you come across as a sincere, intelligent, honest man trying to provide quality information whom I am seeking advice from. Any information that you may have in taking that 1st step in the right direction, what to focus on, where people are making the biggest mistakes and what further reading would you suggest would be extremely helpful.

Wow.

There's a lot of ways I could tackle this, but I'm going to do so from the perspective of my own experience. But, first, the who's right question: nature and human evolution are right. Most simply: to accept that dietary saturated fat from animals higher than 10% of calories causes high cholesterol causes heart disease, stroke, death is to ignore and reject the whole logic of the evolution of species. It is arrogant and ignorant at the same time, with predictable results: people die early.

This is how arrogant these killers are, and I mean that: we are now several decades into them offering advice that is literally killing and debilitating people and I am never going to shy away from that. It is the very prescriptions they have offered to cut healthful, natural fats, preplacing them with fats created from what used to be industrial waste, all wrapped up in refined sugar and "healthywholegrains," that has created this obesity, diabetes, heart disease epidemic, now progressing even to children.

Paleo or modified Paleo is a principle. This should never be forgotten, downplayed, nor should an opportunity be missed to contrast it with all other diet prescriptions. The Paleo principle begins with an observation: animals, in the wild. What do you see? Provided their environment is suitable to their biological requirments, they thrive in pristine health. They are simply living in accordance with their natures. "Man is the only animal that can sink below his own nature" -- Ayn Rand. And while modern civilization provides us many means and choice to produce and create for ourselves environments to sustain us when a natural one is lacking (bridges, dams, homes, skyscrapers, airplanes, gardens, etc., unlike wild animals), it also provides us the means and choice to ignore or reject our natures. Unfortunately, the choice we lack is whether or not we'll have to live the consequences.

So, for that part, I suspect you know plenty enough to have confidence in a natural, paleo, primal, evfit -- or even a low-carb or WAPF lifestyle.

So what's stopping you? You are. Nobody but yourself. While the fear of early death is a powerful force, let's face it: most people don't actually die young, even those who abuse their bodies. So, it's not like overweight people in their 40s are dropping like flies all around you and you're just gonna ignore it.

It's probably more like my own experience. Life just catches up with you.

I began seeing the weight creep in the early 90s and I knew all about Atkins. I even knew it worked, and I have never in my life worried about eating animals or whatever fat happens to come with them. I grew up on good home cooking, by far and large real food. I tried Atkins at least a half-dozen times over the years, and probably six weeks and 15 pounds was the best I ever got out of it, and in months I'd have gained it all back, with interest.

What changed? I wish I new. I just finally got fed up one day, went to the gym, signed up with a trainer and started pushing weight around twice per week for 30 minutes each. That was May 2007, two years ago this month. I mildly watched what I ate, but I was of the mistaken belief that I could do it mostly by exercise with a little attention to diet, while it's the reverse that's true. But, I kept with the workouts, felt better, looked better, clothes fit better. I was losing a pound per month and getting stronger. It was about 4-5 months later that I really began to tighten up eating and my fat loss doubled. Then, a couple of months later I incorporated intermittent fasting. That was the single thing that made me connect all the dots and really understand human beings as animals.

You might have to do some fasting to see what I mean, so I'll just say that it's in our natures to be hungry fairly often, and the paleo way of eating ensures that this hunger is natural and invigorating rather than nauseous and debilitating when one exists off processed foods and refined sugars.

So, I suppose that my advice would be to pick one of the three aspects and get going: workouts, food, or fasting. When you see good results with the first, add another.

As to confusion over what to eat, here's a good rule of thumb: could you eat it raw if you had to? If the answer to that is yes, then you're a go. If the answer is no (grains, sugar cane, industrial waste chemically processed into "food?"), then keep away.

For reading, there's a few important links on my Overview page. I actually just updated that yesterday to add Mark Sisson's Primal Blueprint 101 page, which is a tremendous resource.

Does anyone else have any comments, advice, experience or inspiration to offer this reader?

Vitamin D and Soap

I've had this one hanging around for days and since I'm on a roll just now, and just got a question about D, here goes. I'm not going to dig up the many past posts, but you can find most of them here, or simply search vitamin d to the right.

The short version is that vitamin D is crucial for a host of processes and modern life has come to the point of shielding humans from receiving the vitamin as nature and evolution intended. The things we already know about are clothing, shelter, working indoors and sunscreen that keep us from the D we need. But here's another: soap. Yep, all you clean freaks: you're washing your vitamin D off before it gets absorbed.

It was an interesting discovery for me, as it has been a very long time since I've put soap to anything but hair, face, armpits and groin. I never use lotions or creams and I have wonderfully soft skin. Maybe that's one reason for my high levels of D, along with supplementation, of course (now 4k IU per day instead of 6, since I get sun about 4 times per week).

So, here's Dr. Mercola to explain, with a video and a write up.

I must say that I disagree with his hierarchy of the most preferred way to get D. I think you need to get tested and that your 25-hydroxy vitamin D levels ought to be above 60 ng/ml. Unless you're living at a low latitude, I don't see how you're going to get that from sun exposure, at least year round. Tanning panels or beds are very expensive, and they strike me as rather like the treadmill in terms of eventual boring drudgery and something that ends up sitting in your house just taking up space. Supplementation is inexpensive, takes no time, is safe, and in the gelcap form is proven to get levels of D where they ought to be.

MovNat at Wildfitness

I've mentioned MovNat before: here, here and here, but here's a new MoveNat video done at Wildfitness that really demonstrates the beauty, fun and playfulness of this sort of movement. Be sure and click the HQ button once the video begins for the high quality version.

Thinking Through It

It began yesterday, when I was thrust into yet another battle with "conventional wisdom," only somewhat against myself. For the first time in quite a wile, I ended up last Friday with a sciatic nerve flare up. How did that happen? Well, it's probably related to the much heavier dead lifts and squats I'm doing. But I can say there was no specific lift or event that gave the slightest clue.

Anyway, it was pretty uncomfortable over the weekend and I took it easy. Sitting in any position but a contorted one with my right big toe touching my left ear was painful. Monday came around, and I moved my workout to Tuesday afternoon (the 'yesterday' from above). I took a long walk in the morning and noticed something. Whereas, I could hardly move my right leg forward without a lot of pain upon getting out of bed, once I was three minutes into the walk I had total relief. Then, when I got back I sat at my stand-up computer bench on a barstool. Pain returned. I stood the rest of the day and felt good. But, pain was still there various times. The relationship was pretty clear: the more activity, the less pain. Sitting and even laying in bed was more painful.

So: should I work out, or not? I recalled that in a number of cases where my back was a bit tired or sore -- and other muscles or joints as well -- a workout was exactly what I needed.

So, while the conventional wisdom is take drugs, take it easy, lay in bed, I decided to move around, but in a sensible way.

So I went to the gym.

I told my trainer what I wanted to do and he agreed. We went back to an old-style mostly isolation routine, full body. First I did chest flys on a machine, then lat pull downs, some push ups, dips (triceps) machine, more pushups, some curls and a shoulder exercise I can't describe. Funny thing is this: back when we began doing the high volume compound stuff (linked above) my trainer said it would be instructive to go back and do the isolation periodically as a measure of progress.

Well, I had told my trainer of the nerve issue and said I wanted to do a light & easy workout, mainly for the activity. It turns out, however, that light and easy was actually more weight in every exercise than I was doing intensely just a couple of months ago. It was so easy, in fact, that I barely broke a sweat.

For legs, we did some extensions and then did the incline leg press with only about 160 on it, and I did a bunch of very, very slow reps with a wide, high stance in order to get into a very deep squat. This was basically a weighted stretching exercise and it felt good.

My sciatic is far better today, and I think I'm on the road to a near-term recovery. If anyone has experience with this or knows anything about it from a training and conditioning perspective, I'd love to hear your comments.

Simple Salmon

A commenter asked on another post about ideas for salmon. I pointed him to this past preparation of mine, but then got hungry for salmon, so here was dinner last night coming off a 1-day fast.

Simple salmon

I just salted & peppered the fish, put it on a rack under the high broiler for about 2 minutes on one side and 3 or so on the other, until golden. In the meantime I wok fried asparagus in coconut oil and in a saucepan, melted a couple tbsps of ghee, to which I added just a tiny bit of minced garlic, making sure not to toast it to much. Then I added in the juice from half a lemon (for two servings) and let the juice boil off.

This ghee, garlic & lemon oil went over the salmon and mixed very well with the coconut oil fried asparagus. Very satisfying.

Noodless Lasagna Recipe

Yesterday I posted about the noodless lasagna I made over the weekend. In this post I'll take you through the procedure. That way, you can try my recipe, vary it, or use your own. This is a variation on my grandmother's old recipe.

Ingredients

- Meat Sauce

  • 1 pound ground beef, veal, or venison (I used venison this time)
  • 1 medium onion, chopped
  • 3 large stalks celery, chopped
  • 1 cup (more is fine) finely chopped mushrooms
  • 3 cloves of garlic, crushed & chopped
  • 1 large can (28oz) crushed tomatoes 
  • 2 small cans tomato sauce 
  • 1 small can tomato paste 
  • 1 tbsp Italian seasoning
  • 2 tsp marjoram 
  • 1/2 cup fresh parsley, chopped 
  • 1/2 cup fresh basil, chopped 
  • 1/2 cup fresh oregano, chopped
  • 1 tbsp sea salt (or as desired) 
  • 1 tsp finely ground black pepper (or as desired)
  • 1/2 cup water, or as needed -- less is better, but enough so you can simmer without scorching 

- Meat & Cheese Filling

  • 1 pound sweet Italian sausage
  • 1/2 small to medium onion, chopped 
  • 1-2 clove of garlic, crushed & chopped 
  • 1/2 tsp fennel seeds
  • 1/2 cup chopped fresh basil 
  • 1-2 tsp sea salt 
  • 1/4 tsp black pepper 
  • 2 packages (salad size) of baby spinach or loose equivalent (it's a lot, but cooks down to nothing)
  • 3/4 cup pine nuts 
  • 2 eggs, beat 
  • 1 16oz container of ricotta cheese 

- Layer Materials

  • 3 small eggplants (more consistent coverage)
  • 3/4 pound mozzarella 
  • 1 cup grated parmesian

This recipe is neither simple, nor quick. You can probably do it in about 3 hours if you coordinate things very well. I didn't, making it most of an enjoyable Sunday from 10am to about 3pm for the prep, then another hour later, after pool time for the cooking.

One option would be to do the sauce a day or so before. Also, here's a prior post on the sauce itself. The only significant difference is that I used chunkier tomatoes, had green bell pepper in it, and used beef, which is fine. I still have some ground venison left, so I used that and it makes an amazing spaghetti sauce. Basically just fry up your ground meat at a low setting and then combine all the ingredients in a pot, bring to a boil, then cover and simmer very low for a couple of hours minimum.

Click on all images for the full size version.

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Next I make the cheesy filling. In some recipes, all the meat goes into the "pasta" sauce, but I like to split the meat, half & half. So, first fry up the sausage on low heat and put in the fennel seeds, basil & onion. I had a small bit of mushroom left over that didn't go in the sauce, so I tossed that in too. Keep it flexible.

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Once it's cooked, fold in your spinach, one package at a time. It's going to make a big pile, but just be gentle and keep folding it under the meat and it will reduce down. Here it is after both salad-pack sized portions have been added.

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Next add in the pine nuts and set aside to cool. Once cool, add in the eggs and ricotta cheese and mix it all up.

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Now you're ready for the noodless part, i.e., the eggplant. You can also use zucchini squash. First, cut off the ends and then slice lengthwise into 1/2 inch wide slices. Make sure to get them wide enough. Don't peel the eggplant; the skin will become soft but will help hold things together. Once sliced, salt them down liberally on both sides and set them in you baking dish for 30 minutes. Unbelievable amounts of moisture will be released and this is very important, or, you'll end up with a big casserole of mush. This was only a few minutes in. After 30 minutes there was a good 1/2 cup of liquid.

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Rinse them off, dry them, and then fry them both sides until brown. You'll notice that they are now about 1/4" thick.

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Now for the assembly. First goes two cups of your sauce on the bottom, maybe a bit more -- whatever you need to cover. Place your eggplant on top. I believe that next time I will try to overlap them, as they do cook down to about 1/8" in thickness.

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On top of that goes 1/2 of our sausage & cheese mixture.

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I don't have a photo for it, but at this point you use 1/3 of your mozzarella cheese and the same for your parmesan. Then, repeat the whole process -- 2 cups + of the sauce (I have a couple of cups left over), another layer of eggplant (I ended up with about 2 slices left over), the remainder of the filling, the remaining 2/3 of both your mozzarella and parmesan.

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And here it is after the bake, which was at 350 for one hour. Make sure to let it rest for at least 30 minutes before cutting into it. You need to be very mindful of water content. This had about 1/2 cup excess moisture, I'd estimate. I think next time I'll do a very thick tomato & meat sauce and just bake in the oven so I can do it with minimal moisture.

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And once again. You can click on the image to see the full size version.

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“Noodless” Lasagna

I'll go through my own recipe and procedure in another post, probably tomorrow. But this should work with any lasagna recipe, of which there are hundreds. Now, that's step one. Step two is to go out an look up moussaka recipes and find out how to do the eggplant layers. Combine the two and you've got a lasagna that will come out pretty amazing. Update: Here's the detailed recipe.

Lasagna

Saturday Cooking

I'm just about to get going on assembling stuff to make lasagna, tonight. But of course, it's going to be noodle-less, based instead on something I've had in mind for quite a while. Also, it will have a very unique meat ingredient.

In the meantime, here's last Saturday's fair for friends & family. It was braised short ribs again, but different from my last go-round. Here's stage one.

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That's most of the stuff. In this case, I actually began with a recipe and made some changes. First, I used 4.5 pounds of meat and so reduced quantities accordingly. I also further cut down the amount of tomato to the one 14 oz can. In addition, I cut back on the wine and increased the amount of beef broth somewhat, using my own broth, of course. I also added in about a handful of blueberries and, as well as pine nuts.

In terms of procedure, I did this in the oven, about 4 hours at 300F and I only put the carrots and pearl onion in for the last hour.

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Alongside is a stir fry of finely chopped cauliflower, done in lots of butter and some almond meal. You should be able to click on the one below for the full size version.

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Later on, our friend robert made up this nice dessert plate for the four of us who were playing cards. The chocolate was 70% cacao.

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Help For a Fellow Traveller?

If I had a paid subscription, here's where I'd have you pay (in comments with your own experiences). From a comment to a previous post:

I have a question. I am married to a vegetarian, so low carb per se is not possible. Even if it wasn't in India it is quite a bit more difficult to do.

I am trying to reduce my Wheat consumption. Now down to 8 rotis (indian flat bread) per week. It is whole grain.

I am thinking of replacing a few of them with fermented flat breads (aka naan) soon.

I have also increased my butter and ghee (aka butter oil) consumption. I have also increased my meat and egg consumption.

The problem I am facing is that over the weekend when I try to go low carb, for a full day, next morning I have vertigo (not the messy one just head spinning). I guess my brain is going bonkers with no glucose. Is there any solution.

I cannot go completely low carb. And it seems that the liver will not start producing glucose just because I have not had carbs for a day. I have heard that some people need to go at it for a couple of weeks to get their liver to respond.

I could try two days of the weekend tops with low carb diet, but not anymore. Its not practical.

Do you think it is going to be beneficial to try to get into low carb, for this small duration, because I just feel dizzy, and nothing else is happening. Is it possible to get your liver to respond, without going to the long induction period. How long was your induction period?

So, any help, from your own experiences?

Here's my input.

First, I had no idea that naan was fermented. That's good, as a great garlic naan is second to none, and I might cheat with one a few times per year -- with a good butter chicken or lamb curry.

As to the low carb, my chief concern is that if your health is normal, zero carb (or low) for a human being is a natural (as differentiated from normal or routine) state of affairs.

in other words, my own natural tendency is to think that, rather than there being something fundamentally wrong with low or zero carb, there's something wrong with me when, in principle, every ancestral person not living in the tropics faced that state of affairs regularly.

The ability is within us.

So, without knowing anything about the individual (his ultimate responsibility), my own personality and drive is such that I would go to the principle: this is programmed within me, and it's only the bugs that exist that are stopping me.

I'd want to conquer it. I'd just simply push through, and a fast might be the best way. If you deprive all nutrition, your body might be more amenable to kicking in gluconeogenesis to get the glucose your brain needs. have you tried a serious water-only fast for 30 hours?

Alternatively, the Atkins induction is a decent way to begin the whole ordeal. It's neither Paleo nor a long term lifestyle, but it will get most people over the hump.

Here's another suggestion from a friend of mine who began this whole thing in dire straights: stay in bed for three days. Seriously. How does one define sickness? If you can't exist without carbs for a few days, aren't you sick? If so, there's no shame in just calling it what it is and bedding down for the 2-3 days needed.

To sun it up, I don't think low or zero carb is in any way a necessary long-term lifestyle unless you're in a metabolic condition (e.g., type 2) that dictates it indefinitely. I'm not necessarily low carb by Atkins standards. Some days are near zero carb, and others, between 100-200. I enjoy mixing things up, but always under the principle of Real Food (naan & rice don't count -- those are rare exceptions for me). That said, I could only be slack on the carbs knowing that I could go zero indefinitely.

Obviously, this isn't advice or prescription. It's me, and I hope others take a moment or two to give you (and all the other beginners who'll read this) their perspectives.

“…we eat too much because we’re too dammed hungry.”

We don’t eat too much because we’re more gluttonous than our grandparents. We eat too much because in the 1970s because the McGovern committee convinced us we need to live primarily on low-fat grains and other starches. We eat too much because our insulin levels are too high. We eat too much because we’re storing too many calories as fat.

Tom Naughton.

Yep, as I have said, it's all about hunger. It's been a different world for me for a long time, now, and it's the primary reason I know it's for life. If you eat lots of "whole grains," even fair amounts of sugar, and load up even moderately on other forms of carbohydrate, it's very likely that you and I don't mean the same thing when we talk of hunger.

But I think I know what you might mean. For, I remember a day when hunger was nauseating. It was debilitating. It was: eat something now, and all attention turned to that. It's one reason I talk less about fasting to beginners at this. One day I realized that I had been eating pretty decent Paleo for 3-4 months before I did my first fast, I had been eating somewhat "clean" for months before that.

So, now, I recommend that people go until they realize hunger isn't the same anymore ("I could eat, or, I could wait -- even a long time... and hey, I kinda enjoy this feeling.") and then try their hand at a fast. Fasting gives you, as I have said, high resolution into your own hunger.

That resolution is the key to making this a style for the rest of your life, and you'll never look back.

Back to Tom's good post linked above.

...emphasis should be shifted toward encouraging people to drastically reduce their consumption of carbohydrates; do that, and the “eating less” will take care of itself.

Ouch! More Low LDL Cholesterol to “Die For”

Here's one you probably won't find reported far & wide:

Low admission LDL-cholesterol is associated with increased 3-year all-cause mortality in patients with non ST segment elevation myocardial infarction.

After 3 years, patients with admission LDL <= 105 mg/dL had higher all-cause mortality rate compared to patients with LDL > 105 mg/dL (14.8% vs. 7.1%, p = 0.005). The higher all-cause mortality persisted (OR 1.8, 95% CI 1.0-3.5, p = 0.05) even after adjustment for confounding variables. CONCLUSIONS: In our cohort, lower LDL-cholesterol at admission was associated with decreased 3-year survival in patients with NSTEMI. Whether this was a result of current therapy or a marker for worse baseline characteristics needs to be studied further.

The bottom line? The body count for 517 patients with heart problems over three years was twice for the low LDL cholesterol as the for "high" LDL cholesterol people.

Peter the UK veterinarian has observations.

My take home message is that having a low LDL cholesterol, as guesstimated by your cardiologist using the Friedwald equation, is very bad news if you have just had a heart attack.

This is really just a quick hit to call attention to Peter's analysis, so go have a close look.

More reading:

Low Cholesterol to "Die For"

What Do You Think You Know About LDL Cholesterol? (Part One)

What Do You Think You Know About LDL Cholesterol? (Pt 2 of 2)

Crystallized Cottonseed Oil (“Crisco”)

Tom Naughton is going to be placing some of his additional Fat Head footage up on YouTube. Here's the first installment, which features Sally Fallon of the Weston A Price Foundation, biochemist Mary Enig, PhD, and Dr. Michael Eades, MD. Listen as they expose the Big Corporation lies Proctor & Gamble and others engaged in in the early 1900s to demonize relatively expensive but healthful natural fats like lard, butter, and coconut oil in favor of "frankenfats" -- chemically extracted, then deodorized, hydrogenated, interesterified, and so on.

Crisco, for example, is a consequence of electrification and light bulbs. For, you see, Crisco was originally intended to replace the expensive animals fats used to make...candles. From Wikipedia:

When William Procter and James Gamble started the company Procter & Gamble, they hired chemist Edwin C. Kayser and developed the process to hydrogenate cottonseed oil, which ensures the shortening remains solid at normal storage temperatures. The initial purpose was to create a cheaper substance to make candles than the expensive animal fats in use at the time. Electricity began to diminish the candle market, and since the product looked like lard, they began selling it as a food. This product became known as Crisco, with the name deriving from the initial sounds of the expression "crystallized cottonseed oil".

I suppose the "logic" must have gone something like this: "well, since we can use food (animal fat) to make candles, let's just feed people candles!"

Then, they marketed the hell out of it by giving away free cookbooks, every recipe calling for Crisco. They also dishonestly, manipulatively, murderously demonized natural, real food, scaring people away from it in order to replace it with a money-making killer. While other factors and variables surly contribute, it's just too much of a coincidence that cardiovascular disease really took off with the advent of frankenoil, Crisco being among them. [Added later: see this from Stephan.]

Here's a 1915 Crisco Advertisement in the Saturday Evening Post (click the image to enlarge).

1915 Crisco Shortening Ad

There's a lot of talk of "Tea Parties," these days, in which I have not the slightest interest. I might could get interested in Pee Parties, however -- wherein certain graves are urinated upon by righteous crowds seeing to some justice, if only in symbolic form.

Might I suggest beginning with William Procter and James Gamble?

How To Raise Your Cholesterol

Huh? Why would you want to do that?

Well, the short answer is that it very well might lengthen your life. Let's have a go at Dr. Malcolm Kendrick, MD.

When I went to medical school I was told that the very high rate of heart disease in Scotland was caused by a diet containing far too much saturated fat. This raised our Scottish cholesterol levels. The excess cholesterol was, in turn, deposited in the artery walls, thus narrowing them to the point where they blocked up - causing angina, heart attacks and death.

The answer, therefore, to preventing heart disease was to eat less saturated fat, thus lowering cholesterol levels. Or, if you couldn't get people to eat less fat, then simply lower cholesterol level with drugs. It all seemed very simple and exceedingly straightfoward. Why look anywhere else, when the answer was clear.

Uh, OK, so why raise cholesterol? He continues.

For years I did not question this orthodoxy. Then, one day, I was on holiday in France. Whilst chewing on a fatty steak, dripping in butter, it suddenly struck me that the French ate rather a lot of saturated fat. As I peered through the smoke filled restaurant I also recognised that they smoked quite a bit too. However, their rate of heart disease was one tenth that of Scotland (age and sex-matched).

I then looked at the other classic ‘risk factors' for heart disease in France e.g. blood pressure, HDL ‘good cholesterol' levels, body mass index (BMI), amount of exercise taken. I found that, in comparison to the Scots, the French ate significantly more saturated fat, had the same cholesterol levels, the same blood pressure and the same HDL ‘good cholesterol' levels. They also had the same average BMI and took slightly less exercise (on average). They smoked considerably more. In short, much worse classical ‘risk factors,' one tenth the rate of heart disease.

This became the basis of the "French Paradox." I lived, worked, and ate in France for two years in the early 90s and can surely attest to the good eats, by which I mean: fat, fat, and more fat. People tend to think the French are famous for their bread and wine, which they are, but they consume much less of it than most people think. As I showed here, the proportion of bread to cheese is the reverse of what it is here and elsewhere. Rather than spreading a little cheese on a lot of bread, you place a huge gob of cheese (and butter too) on a small piece of crust. About the only time I saw the French eat quite a bit of bread was petit dejeuner (breakfast). Back to Kendrick.

So, the soon to be Professor, Hugh Tunstall-Pedoe looked at the French, and their diet, and came to the conclusion that the French were protected against heart disease by their high consumption of garlic, red-wine and lightly cooked vegetables (full of anti-oxidants, don't you know). Very soon after this, it became a ‘fact' that these three factors were protective against heart disease.

One slight problem is that there never was, and still is not, the slightest evidence that any of these three factors provides any protection. I write this in the certain knowledge that many of you are absolutely convinced that garlic, red-wine and anti-oxidants truly are protective, and that many studies have proved it. To which I would say..... ‘show me the studies'.

And now comes the punch line. What do the studies actually show?

To give another example of facts that aren't true. Namely, that saturated fat intake raises cholesterol levels. The Framingham study, the longest lasting, most respected study into the causes of heart disease (started in 1948) reported that ‘In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people's serum cholesterol.' Dr William Castelli - director of the Framingham study at the time - 1992.

That's bad, you see. You don't want your cholestrol levels decreasing (as they typically do with age). You want to keep them "elevated." Here's why.

For example, here is another quote from the Framingham study on the impact of cholesterol levels themselves. There is a direct association between falling cholesterol levels over the first 14 years of the study and mortality over the following 18 years. 11% overall and 14% CVD death rate increase per 1mg/dl per year drop in cholesterol levels.

In short, once your cholesterol level starts to fall, you are much more likely to die from heart disease. A 150% increase in relative risk for every 10 % fall, approximately. Add this to another very big study of the elderly, published in the Lancet: Our data accord with previous findings of increased mortality in elderly people with low serum cholesterol levels, and show that long term persistence of low cholesterol concentration actually increases the risk of death. Thus, the earlier that patients start to have lower cholesterol concentrations the greater the risk of death.

It's only a matter of time.

It is a slight comfort to know that in fifty years (hopefully many fewer than this), people will look back at cholesterol lowering and say ‘You did WHAT?' Were you MAD? Don't you know that cholesterol is absolutely vital for human health? Didn't you realise that blocking cholesterol synthesis would directly lead to nerve cell damage, muscle destruction, liver obliteration and cancer?

So, how do you raise your cholesterol to adequate, healthful levels, for which I believe -- as shown in these graphs based on data from four governmental databases worldwide -- is 200-220?

Eat healthful fats, and lots of them: butter, ghee, coconut oil, coconut milk, cream (preferably from pastured cows), quality real cheeses, and of course all the animal fat you can get your hands on, along with the meat. Yep, especially the chicken skin.

For more information on Dr. Malcolm Kendrick's views on cholesterol, see The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It. Here is a great primer by the doctor that's a must read: The Great Cholesterol Myth.

I blogged about that article more than a year ago.