Saturated Fat and Coronary Heart Disease, Part III: Cognitive Dissonance

"Die wahrheit triumphiert nie, ihre gegner sterben nur aus." -- Max Planck

(Truth never triumphs, its opponents just die out.)

In Part II of this series I wrote that this installment would be about the "best research" those supporting the saturated fat-cholesterol-heart disease link or "causal chain" might use (here's Part I). In the process of doing my homework for that post I came across something I think fits in here because I essentially want you to have some idea of what you'll be up against.

This supplemental entry began when I hit the blog of Dr. A (a reader & commenter here) in the UK: Livable Low Carb. I'll show you a couple of the graphs she posted in a moment, but for now, how about a quote from the British Heart Foundation website on Diet?

It is now universally recognised that a diet which is high in fat, particularly saturated fat, sodium and sugar and which is low in complex carbohydrates, fruit and vegetables increases the risk of chronic diseases – particularly cardiovascular disease (CVD) and cancer. These risks are outlined in the World Health Organization 2003 report Diet, nutrition and the prevention of chronic diseases. The more recent World Health Organization Global strategy on diet, physical activity and health emphasised further the need to improve diets in individuals and populations across the world.

The dietary changes which would help to reduce rates of coronary heart disease (CHD) in the UK population were detailed in the 1994 report of the Government's Committee on the Medical Aspects of Food and Nutrition Policy (COMA). This recommended a reduction in fat intake, particularly saturated fat intake, a reduction in sodium intake and an increase in fruit and vegetable and complex carbohydrate intake. In the 2003 report Salt and Health, the Scientific Advisory Committee on Nutrition (SACN) (which replaced COMA in 2000) repeated COMA’s guidance on salt intake in adults and introduced additional guidance on reducing salt intake in children. In 2005 the Government dietary objectives were reiterated in Choosing a Better Diet: a food and health action plan.

Research from the World Health Organization and others highlight the specific importance of low fruit and vegetable consumption as a cause of CHD. The World Health Report 2002 estimated that around 4% of all disease burden in developed countries was caused by low fruit and vegetable consumption, and that just under 30% of CHD and almost 20% of stroke in developed countries was due to fruit and vegetable consumption levels below 600g/day. The World Health Organization has yet to calculate the precise proportion of the disease burden due to high sodium intake or high saturated fat intake. [emphasis added]

I considered clipping some of that, but it would only serve to dilute what is clearly intended to be a VERY STRONG MESSAGE: reduce fat, especially saturated fat and eat more fruits & vegetables. But why? This is something I'll get into in much more depth in the final entry, but here's just a tidbit. When you really start digging into CVD stats it becomes clear that CVD deaths and CVD incidence are constantly conflated or at best conveniently left ambiguous. If a researcher wants to tell you that reducing saturated fat has been successful, he'll haul out CVD death stats and indeed, there has been a tremendous decrease in death from CVD over the past decades. But they'll rarely tell you in the same breath that the incidence of cardiovascular disease -- i.e., heart attacks and other CVD markers -- is pretty much as high as ever. So, is the reduction of death more likely a function of decreased saturated fat intake or more likely some other factor like improved urgent and emergency care in the face of a heart attack? As usual, a review of Occam's Razor seems appropriate.

So, now, here's a couple of Dr. A's graphs for saturated fat consumption and fruit & vegetable consumption trends since 1975.

saturatedfat
Saturated Fat Consumption
fruitandveg
Fruit & Vegetable Consumption

Oh, did I mention? This data comes from the very same website as the quote, above, the British Heart Foundation. You know what? I'm fairly confident that I could take any kid of normal mental function, explain the parameters including the distinction between CVD incidence and death, ask him or her about association and cause, and get the obvious conclusion: time to look elsewhere.

But kids are naturally honest about such things. For them, it'll be another 20 years before they are "fortunate" enough to get paid for lying and manipulating, which brings us to the second case study in cognitive dissonance. Let's begin with the names, 'cause I always name names.

These names, of course, are prominently displayed in large bold font right after the title of the study: Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines (PDF)

Amit Sachdeva, MD, Christopher P. Cannon, MD, Prakash C. Deedwania, MD, Kenneth A. LaBresh, MD, Sidney C. Smith, Jr, MD, David Dai, MS, Adrian Hernandez, MD, and Gregg C. Fonarow, MD.

Far less prominent, requiring a magnifying glass, are the financial disclosures.

  • Christopher P. Cannon, MD; grants: Accumetrics, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Sanofi- Aventis, Schering Plough
  • Prakash C. Deedwania, MD; consultant of AstraZeneca and Pfizer
  • David Dai, PhD; employee of Duke Clinical Research Institute
  • Gregg C. Fonarow, MD; research from Pfizer and GlaxoSmithKline; consultant and honorarium from Abbott, AstraZeneca, GlaxoSmithKline, Merck, Pfizer, and Schering Plough; and chair of the Get With the Guidelines Steering Committee

No potential conflicts of interest there, eh? I guess that "disclosure" is the name of the game, now, and not the simple fact of the matter. Here's a novel idea: how about simply publishing and paying attention to studies where financial disclosures are unnecessary? Yea, yea, it's impractical and I also don't want to unfairly paint with too broad a brush. Moreover, I'm no Luddite when it comes to the great contributions over time of doctors, researchers, and yes: drug companies. But isn't this getting out of hand?

This was a captivating study to read for the cognitive dissonance, the subject of this entry. Remarkable to me is that I can detect no data manipulation or even evasion of data and facts (until the conclusion, which is an evasion to take your breath away). That's what's so interesting. It's all there. Everything is there to make the same childlike conclusion as we did up above: time to look elsewhere.

Here, let's take a look.

LDL Distribution
LDL Distribution

Now that's almost as perfect of a Bell Curve Distribution as you're ever going to see -- and I'd guess that if LDL levels actually ran to zero in people that you'd see an absolutely perfect distribution. I remind you: these are the LDL levels of 137,000 people admitted to a hospital with coronary artery disease. Let's imagine a scenario, for example, measuring blood alcohol content in people involved in automobile accidents. Would that be a Bell Curve, or, would you naturally expect that the higher the BAC, the more accidents (an ever increasing curve)? Now there you have a definite causal relationship and the data is going to show it unambiguously.

Now let's look at some quotes from the study (PDF).

  • Half the patients hospitalized with CAD had admission LDL <100 mg/dL, and LDL <70 mg/dL was observed in 17.6% of patients.
  • Less than one quarter of patients had an admission LDL >130 mg/dL.
  • There were 54.6% of patients hospitalized with CAD with admission HDL levels <40 mg/dL.
  • HDL ≥60 was observed in just 7.8% of patients.
  • Ideal levels (LDL <70 mg/dL and HDL ≥60 mg/dL) were observed in only 1.4% of patients hospitalized with CAD.
  • Among the 21.1% of patients receiving lipid-lowering medications before admission, LDL levels were modestly lower (94.3 ± 36.4 mg/dL) and HDL levels were similar to those not previously treated with lipid-lowering medications (39.6 ± 2.6 mg/dL).
  • Although high serum concentrations of LDL are a major risk factor for CHD, patients may present with CAD events despite LDL levels, which are not considered elevated and fall well within guideline-recommended targets. In the present study, almost half of patients hospitalized with CAD have admission LDL <100 mg/dL, and 17.6% of patients had LDL <70 mg/dL. Even when only patients without prior history of CHD, other atherosclerotic vascular disease, or diabetes were studied, 72.1% have admission LDL <130 mg/dL and 41.5% had LDL <100 mg/dL. Thus, a substantial proportion of patients present with their first or recurrent CHD events well within the current guideline-recommended targets for LDL.
  • Many of these patients presenting with CAD had HDL levels, which are associated with excess risk. High-density lipoprotein cholesterol is inversely related to the risk of CAD. Even modest increases are associated with lower risk for nonfatal MI or death from CHD. There were 54.6% of patients hospitalized with CAD with admission HDL <40 mg/dL. In addition, fewer than 10% of patients had HDL ≥60 mg/dL. Ideal levels (defined as LDL <70 mg/dL and HDL ≥60 mg/dL) were present in only 1.4% of patients hospitalized with CAD.

How about let's put this final quote in bold.

The present study demonstrates that among patients hospitalized with CAD, the admission lipid levels are below that of the general population.

And, so, what's the OBVIOUS conclusion from all these data points, observation and reasoning?

In a large cohort of patients hospitalized with CAD, almost half have admission LDL <100 mg/dL, whereas less than a quarter have LDL >130 mg/dL. The LDL levels <70 mg/dL are observed in only 17.6% of patients. Admission HDL levels are <40 mg/dL in 54.6% of patients hospitalized with CAD, whereas <10% of patients have admission HDL levels ≥60 mg/dL. Ideal lipid levels (LDL <70 mg/dL with HDL ≥60 mg/dL) are seen in only 1.4% of patients hospitalized with CAD. There were reductions in admission LDL and HDL levels over time. These findings provide insights into the lipid levels encountered in recent clinical practice for patients hospitalized with CAD. These findings may provide further support for recent guideline revisions with even lower LDL goals. They also may suggest a clinical need for developing effective treatments to raise antiatherogenic HDL. [emphasis added]

Shorter version: lower the cholesterol guidelines even more (and, hey, why not throw in a few billions of dollars more of statin Rx?), because heart attack victims already have average cholesterol levels less than the general population. OBVIOUSLY; more lower, please. And, while we're at it, let's come up with a few billion dollars market for meds to raise HDL.

Hey, maybe they could hire me to consult on that last point, since my HDL runs in the 130s and directly measured LDL in the 60s. Of course, that requires no meds, but only a diet of real foods high in natural, healthful saturated fat, plenty of animal protein, some veggies, fruits & nuts -- and occasional bouts with full fat, raw dairy.

So, no chance for me to cash in, I guess. I'll have to content myself with naming names of those who put their livelihoods above your health and are willing to engage in head-spinning cognitive dissonance to hold their lucrative positions of authority.

Naked Feet

Well I don't know about the GW overtones or global Kumbaya, but otherwise a good message. I go barefoot as often as possible, even out in public -- such as last night to the hotel room and back to the in-laws this morning. Coming up on 24 straight hours of barefoot.

Sous-Vide Supreme Maiden Voyage: Chicken

It might strike you as odd that with all the various beef and other fancy dishes I do -- putting such care into my sauces and such -- that after laying down $400 for a kitchen appliance I would choose chicken breasts as the first dish.

How often do I do chicken of any kind? Not very. And it's not that I don't like chicken -- I do -- it's just that I usually have something better in mind.

Back when I attended the Doctors Eades' presentation in San Francisco, Mike told me to pay particular attention to the chicken. I did, and here's what I wrote about it.

I must say that the chicken was probably the best in terms of improvement over any other cooking method. Mike had warned me about this before we even got started, and he was sure right. It's really difficult to describe, but it's tender, moist, and has a flavor as though it has been infused with a particularly concentrated chicken stock. And while the skin wasn't exactly crispy, it and the nice layer of fat were just delicious. I believe I'd buy a SousVide Supreme solely for the way it does chicken.

Well, now I can definitely say that it wasn't because it was prepared by Chef Blumenthal. You can do this at home with a Sous-Vide Supreme.

Vacuum Packed Chicken
Vacuum Packed Chicken

Very simple. A pinch of sea salt & slice of butter in each bag. I had a bit of difficulty getting the pump to get going sucking out the bag but by the third time had figured out the trick of moistening the rubber seal and things went easier.

Then it's into the water bath.

In the Sous Vide
In the Sous-Vide

One nice thing is how quickly the water heats up. Of course I began with hot tap water which certainly helps, but I think it was only at around 110 or so and it took only a few minutes to get to 146. And, as advertised, the unit keeps the temperature within 1/3 of one degree F. An hour is all it took to get done, though it's fine if you leave it in longer. That's another advantage, you can't overcook.

Conventional cooking is all about overcooking the outside just enough to get the inside done the way you want it, risking having the inside overdone (dry & stringy) or underdone (crunchy chicken). Here, all you need to do is make sure you leave it in for a minimum amount of time and it's perfectly moist, tender & delicious.

Sous Vide Chicken
Sous-Vide Chicken

What I did here was to brush the skin with the butter and drippings from the bags and fire them under the broiler for a few minutes. Incidentally, there was only a small amount of moisture other than butter; i.e., the moisture was still inside the meat where it should be.

SANY0023
 

The funny thing is, that probably doesn't look particularly different or better than any nicely prepared chicken breast. In terms of moisture, texture and taste, however, it is totally superior to any chicken I've ever had. In fact, I've had chicken -- and turkey -- that looked fine but was so dry that it made me cough.

Yes, of course I did a sauce. I reduced a quart of quality organic chicken stock to about 1 cup, with 1/2 cube of butter, just a pinch or so of tarragon (less is more with that herb), a bay leaf, and about 3 tbsp of heavy cream. But, I served the sauce on the side so the chicken could be sampled all on its own.

There were four of us and everyone raved. Robert was demonstrating the tenderness by cutting his chicken with a spoon. Bea, uncharacteristically, brought up the sous-vide subject a couple of times today and is anxious for more. Julie did a wonderful salad with bacon bits. I'll put that up in a separate post over the weekend

I'll likely be blogging regularly about this cooking method. I want to try pork chops very soon. Scrambled eggs, too, and I'm looking forward to seeing if I can have perfect soft boiled eggs waiting for me in the morning. While I'm looking forward to doing steaks soon, what really excites me about this is doing other kinds of meat & fish -- far less expensive than grassfed beef -- and attaining a level of satisfaction that rivals your BBQ steak.

The four of us agreed last night that this dish rivaled the pleasure of a perfect medium rare steak. So if I start doing a lot more of this and a bit less grassfed beef I'll pay for the cost of it in no time.

Paleo Pussies

Well that was fun. And you know what? Life is just too fuckin' short to be a paleo pussy, a wimp...an intellectual masturbator in all of this.

No prisoners. No refuge. No quarter.

See, we're dealing with murderers, maimers and their accomplices in academia, research, the medical profession, the big food and drug industry, and of course the total fucking clueless morons in the news media, for whom I reserve special wrath because if they were doing their dammed jobs rather than deep throating big advertiser food & drug cock as much as they possibly can, I wouldn't have to be doing this shit essentially for free -- and as well, a lot of other people could be out Groking on and enjoying life instead of worrying whether they're hearts are going to explode because they didn't buy "cholesterol lowering" fucking Cheerios for Christ's sake.

...Yes, yes, I understand there are other bloggers and commenters out there who want to sit and have tea & crumpets and discuss it all nice and kind like. "Let's not be too threatening. We want to persuade them all."

Yea? Well, FUCK 'EM ALL!

That's what I say. You've got your approach, I've got mine. And as far as I'm concerned, yours has failed utterly and completely. Now it's time to name names, drag those names through the mud, ridicule those names, embarrass family members with the same name...all while having solid reasoning and evidence behind you. Reasoning like: given our evolution, it's highly unlikely that a fucking box of Cheerios is better for you than a steak, asshole. So, just go right on ahead, Mr. Research Fuckhead and keep "associating" meat & its natural fat with bad things. Just keep it up; and I'll keep it up.

I'm glad a guy like Dr. James Carlson isn't a pussy. How could he be, with a book title like this: Genocide: How Your Doctor's Dietary Ignorance Will Kill You!!!!. Do you think Dr. Jim is interested in sitting around for a mutual "stroke" with his enemies, the people killing the patients he has to fix?

Then there's Dr. Malcolm Kendrick. While not quite as rough, I can tell he wants to be. Here's some excerpts from the introduction to The Great Cholesterol Con. Notice the word "con." He's calling them criminals, which they are.

It has reached the point where I feel like shouting, 'Listen guys, I know you need to 'publish or perish,' and the more publicity you can achieve the bigger the next research budget. but you're scaring people half to death. No one knows what to do or what to believe any more. And by the way, your study was RUBBISH! Now go away, grow your beard, and do some proper boring research that no one can understand.'

But they won't. For it's so much more fun to appear on a news programme, talking earnestly about your discovery of the latest possible cause of heart attacks - a danger that the public absolutely, positively, must be warned about. Afterwards, you will probably be invited to lucrative speaking engagements at international cardiology conferences. Does a professorship beckon? 'Who, me? I really don't deserve it, but if you must...'

It's a shame. In a rational society, those sorts of people would be driven away, or, you know very well what... When you add in the element of state subsidy and laws that shield them from both liability and competition, you have insult on top of injury.

They're killing you, slapping you in the face, and laughing all the way to the bank. Continuing with Kendrick.

...And boy, is the cholesterol hypothesis wrong. To adapt a quote from Blackadder, 'It is wronger than a very wrong thing.' Yet it has mesmerised scientists, doctors and the general public for years, exuding a siren song that none can resist, dragging us all to our doom on the sharp rocks of illogicality.

And at whose expense and whose profit?

Yet I think we have been sold a pup. A rather large pup - more of a full-grown blue whale, in fact. But how can I convince you, my fellow jurors, of the truth? You have heard so much, read so much, listened to experts promoting the wonders of statins and ever-greater cholesterol lowering. Adverts bombard us every day with some new fabulous yoghurt, probiotic, margarine or milk drink assuring us that these things lower cholesterol, thus protecting your heart.

On the basis of this never-ending information, many of you will be convinced that you should take statins for the rest of your natural lifespan. Firstly, of course, you will be frightened into action by a blood test demonstrating that you - you sinner - have a raised cholesterol level ('Have you been eating hamburgers again? Have you?'). Everywhere you look, everybody is in agreement about the need to lower your cholesterol level. How can almost everybody be wrong?

In fact, almost everybody being wrong has been a quite normal phenomenon throughout human existence. So the fact that there are only a few dissenting voices out there shouldn't bother you unduly. And medical scientists (an oxymoron if ever there was one), have a long and distinguished history of grabbing entirely the wrong end of the stick, closing their eyes tightly shut, holding on grimly and refusing to listen to anybody else. Another leech anybody, or perhaps a radical mastectomy, or a tonsillectomy, or a removal of toxic colon? What about that old chestnut 'no bacteria can live in the human stomach'? And 'strict bed rest following a heart attack' - how many millions did that kill? [emphasis added]

I really don't think the calm, quiet, deliberate, polite approach accomplishes fuckall but perhaps a decent pension someday for an otherwise mundane life. And even if it did, I still wouldn't respect it. I respect maverick & bravado, risk, in-your-face determination. And besides, I smell a rat in these admonitions for calm deliberation. They're just 'fraidy cats that they're wrong, or they're afraid of offending, or they're afraid of one thing or another. There's a theme there: fear. So they're fuckin' sissies and too afraid to admit it. And it's so unnecessary because it's so irrational. We're RIGHT! No, not in every detail or nuance, but we have the principle foundation set in a Stone Age, and we're fuckin' right goddammit! And you know what I'm going to do about that? I'm going to ridicule the white coats who are wrong, and I'm going to do it with delight. And I'm going to keep doing it relentlessly, ruthlessly.

As I recently wrote in a comment, I won’t be satisfied until they start charging admission to take a piss on Keys’ grave.

More Kendrick.

I am not alone in my beliefs. There are many hundreds of doctors and researchers who agree that the cholesterol hypothesis is bunk. Many keep their counsel, others have been stomped into silence, but a few have had the guts to speak out. However, their voices, unlike those of the implacable medical 'statinators' are not supported by multibillion-dollar pharmaceutical budgets.

In a world dominated by PR-controlled spin, critics of the cholesterol hypothesis get very little airtime. If they did, this world would change, and I hope this book starts the process of change. Because, despite my apparent joviality, I am deadly serious in my belief that the misguided war against cholesterol, using statins, represents something very close to a crime against humanity. So close that you may not be able to spot the difference. [emphasis added]

So, yea, just go right on ahead trying to convince them with showers of daisies. You know what? I don't want 'em even if they can be convinced. I want the whole lot of 'em swept away, viciously, disgraced and left to starve on the streets with rotting sores.

Perhaps that'll illustrate for future generations that this is crucially important work calling for the utmost in honesty and integrity, and by utmost, I mean far in excess of normal or average.

11/24/09 Update: Shorter Brett Mattingly: "My pussy hurts!" From his Twitter feed, in reverse order.

@rnikoley But I know I'm wasting my breath. You keep your 'entertainment' and I'll keep informing.

@rnikoley feel the need to use 'fuck' repeatedly to get your point across, you've proven how childish you are.

@rnikoley Nutritionists, 'dieticians', etc, are idiots and murderers, but once you refer to people with similar views as 'pussies' and ...

@rnikoley Really, you abhor the values of other paleo bloggers who don't share your methodology? I don't disagree that conventional doctors

@rnikoley Respect for those less-informed or with differing views than yourself, for starters.

And, ladies & gents, @rnikoley has just lost my readership. Not that he cares, o'course. It's all about respect if you want progress, Rich.

See, here's the deal. Nobody has to read my blog or like it...though I am always reminded of the bit in Howard Stern's movie Private Parts where some radio network guy is talking to another about Stern's controversial show and it goes something like this, though I don't recall the specific details:

"Those who love him listen for an average of an hour a day."

"And those who hate him?"

"Two hours."

Apparently, Mattingly thinks I'm singling out him and others who advocate a more persuasive approach. Actually, I'm not, and this isn't the first time he's called me out. ...I couldn't give a flying fuck who Brett Mattingly is, what he does, how he approaches paleo or how he represents it to others. And I'd have never cared even if I had known who he was.

I would have never gone to his blog or called him out in a comment or forum elsewhere to say, "man, quit being a pussy." Moreover, I never call out or criticize other paleo / low-carb individuals or bloggers specifically by name on this blog. And in fact, I have pointed and do point to a lot of bloggers who don't share my style and will continue to do so.

But I also note that none of them come around here criticizing me or pathetically lying, implying that there's nothing BUT that. This blog has almost 2,500 posts, the vast majority rather calmly making some argument or observation. And many of them are specifically to assist people on the path.

If anyone doesn't like or can't tolerate my style, that is perfectly fine. but if you want to come around here or pollute my twitter feed with lies and implication that I am only a loose cannon, or "childish," or can't make a real argument with real data, then you can simply GO FUCK YOURSELF ALL THE DAY LONG AND INTO THE HOLIDAY, for all I care.

Tri-Tip & Kohlrabi

Just some quick Sunday morning Food Porn.

Tri Tip Kohlrabi
Tri-Tip & Kohlrabi Mash

I did the roast low & slow in the oven at 225, up to an internal temp of 125. Then a couple minutes per side under the broiler with butter rubbed on the outside. The sauce was 1 1/2 quarts of store bought beef stock with a half stick of butter, some sage, onion and celery, reduced to about 1 cup over a couple of hours.

My mom made the kohlrabi mash in the same manner you'd do potatoes. An excellent alternative.

Wanna Metal?

I'm up at the cabin in Arnold, CA, where Bea & I met my parents late yesterday afternoon after the easiest Friday afternoon drive out of the Bay Area I've had in years. Get this: usually it takes nearly 3:30 to get up here with rush traffic and I made it in 2:40.

My dad just posted this to Facebook. Yep, a touch of wettish snow last night, mostly gone now.

cabin
The Cabin

Anyway, I'm eating my mom's chicken pate with celery, drinking whiskey & soda, and Food, Inc. is downloaded to the Apple TV for viewing after dinner -- which will be low & slow tri-tip, a sauce reduction, kohlrabi and salad. Maybe I'll snap some pictures.

But this post is about entertainment; when I began streaming my iTunes to the Bose earlier, first song up just made me want to share. I'm not much of a metal enthusiast, and this song isn't really metal, but the band is.

Here's Metallica, Nothing Else Matters. Oh, and excuse the advert in the video. But, it was the best version.

Laf Laf Laf Laf Laf

Oh, this is just too delicious not to put up here (via Mike Eades' Twitter feed).

Climate sceptics claim leaked emails are evidence of collusion among scientists - Hundreds of emails and documents exchanged between world's leading climate scientists stolen by hackers and leaked online.

Yes, I've always been a "global warming denier," at least in the sense of it being anthropogenic (man made). I've always thought it the height of being Fooled by Randomness.

...That, and now, good evidence that grant whores and other self-serving lying criminal deadbeats willing to sacrifice their fellow man for their personal advancement really do exist.

A couple of choice quotes.

In one email, dated November 1999, one scientist wrote: "I've just completed Mike's Nature [the science journal] trick of adding in the real temps to each series for the last 20 years (ie, from 1981 onwards) and from 1961 for Keith's to hide the decline."

Of course, everyone "declines to comment." Well, Michael "Hockey Stick" Mann does, and he's really concerned about the truth.

Professor Michael Mann, director of Pennsylvania State University's Earth System Science Centre and a regular contributor to the popular climate science blog Real Climate, features in many of the email exchanges. He said: "I'm not going to comment on the content of illegally obtained emails. However, I will say this: both their theft and, I believe, any reproduction of the emails that were obtained on public websites, etc, constitutes serious criminal activity. I'm hoping the perpetrators and their facilitators will be tracked down and prosecuted to the fullest extent the law allows."

What this demonstrates, to me, is not wide conspiracy but a reflection of what happens when whole livelihoods are staked on a particular hypothesis being correct, something we see all the time in the Cholesterol Con.

I'm closing comments on this one. It's an aside and the last thing we need is a huge comment thread arguing AGW. I'm well aware that many in the paleo and evfit community clearly see what's driving bad dietary advice but seemingly don't see the same principles and dynamics at work elsewhere in the various "disasters" and "epidemics" engineered to scare the crap out of the general populace.

Saturated Fat and Coronary Heart Disease, Part II: The Paleo Principle

In Part I of this series I introduced you to Professor Rod Jackson, who has quite a strong view of the dangers of saturated fat from animal sources in the human diet. This series of posts is intended to examine his claims and, yes, ultimately call them into serious question if not discredit.

In this installment it is my intention to establish a foundation from which we can build. I find it particularly odd that so many of the studies I look at appear to have been done in a vacuum, with no reference to guiding principles; like, human evolution. When epidemiological associations suggest that some variable may be at the root of causing some problem, we ought to be highly suspicious of such associations when they contradict what we would infer from our evolutionary past. While that past is certainly not fully known and we'll probably be gaining knowledge about it for many decades, even centuries or millennia to come, what has been established is sufficient to constitute solid, established knowledge about how we evolved and what we ate that drove our evolution forward.

Against All Odds

Before we proceed, let's keep something in mind, which is this: we are talking about a species of hominid -- Homo sapiens -- that is the last and sole survivor of a long line of bi-pedal hominids going back six million years. As early as 50,000 years ago, there were still three species of humans (erectus, neanderthalensis, sapiens), living concurrently on Earth. Yet, we alone survived, and we did so without a shred of our modern medicine and conveniences. It was the logic of natural selection, chance, environmental upheavals such as floods, droughts, fires, ice ages and perhaps even predation that drove us forward -- that from three angles of varying degrees of niche exploitation (and many before that; evolutionary dead ends) to more generalist, one species came out on top in spite of huge odds against it.

Genetic analysis has now established that at one point the entire world population of our species was only 600 individuals. That is to say, the entire human genome comes from no more than 600 individuals, and this was after the great migration out of Africa, so at one point there must have been many thousands of H. sapiens. And yet, against all those odds, here we are, numbering in the billions.

And given all that, saturated fat -- the fat that makes up a large percentage of our own body fat and that of the animals -- the sort of fat your body will manufacture from excess carbohydrate in your body -- is, in the words of Dr. Jackson, "pure, natural poison?" Does that make any sense? Would that not be about the most surprising thing ever if it were even questionably true?

Imagining The Ridiculous

Suppose some zoologist were to claim that the natural, wild diet of some species of animal is killing them off early. Imagine an omnivorous animal like a bear, for instance. What if some researcher claimed that the super high-fat diet of salmon bellies and fatty skin was detrimental to their health?

What would you think about that? If you have any sense, you'd have to think it absurd. Catching those salmon that run upstream annually in the fall is how bears survive & thrive, packing on the mass they need for winter hibernation. They evolved as the prime animal to exploit that food resource.

But let's stop and think about animals in zoos, where they may be fed some combination of natural food and specially designed chow or other concoction. If you Google for "zoo diets," "animal nutrition," or similar terms, you quickly come to the realization that it's highly varied; lots goes into it and, guess what?

Every Species is Different

And just how do they know this? Well, obviously they have some knowledge about what these animals eat in the wild -- what they evolved to eat -- from observing them. It's not hard. Moreover, they observe their animals in captivity for signs that they're not thriving. And when they don't thrive, what's the first thing you think they'd consider? Would the zookeeper wonder if that saturated fat in the rump steak he's feeding the lions is the culprit, or, would he more likely think something essential was missing from the diet or in the captive environment? As we know, predators typically go for the rich, nutritionally dense organs first, then the meat -- probably the fattiest meat.

Is this difficult? Do you read about zoo animal epidemiology? How about long-term intervention studies employing diets of differing lion chow macro-nutrient composition to compare differences in thriving, disease, mortality? Would you expect to find zoos seeking grants and attempting to study the implications of the meat and fat consumption of a bengal tiger's sustenance and to affirm that the tiger's dry chow is heart healthy over his natural diet in his natural environment? No?

Lifespan! Lifespan!

But wait: zoo animals typically live far longer than their wild counterparts. A male lion in the wild only lives to about 10, but can exceed 20 years of age in a zoo. Perhaps wild ones aren't living long enough to die from all that meat & fat? Does that sound familiar? Well, it should, because that's one of the chief counter-arguments I see against an evolutionary or paleo human diet, even where there is agreement on dietary composition. What they're claiming is that paleolithic hunter-gatherers didn't live long enough to encounter those collection of diseases we tend to call "diseases of civilization."

It's a difficult argument to deal with because there is at least some surface logic to it; and, because it's true that H-Gs and animals in the wild live average shorter lives than those in the zoo of civilization or the zoos we erect for non-human animals. But in the end, we understand that when you remove most of the risks of living in the wild -- like newborn mortality, injury accidents, pathogens, predation, and so on -- that you increase greatly the chances of survival to ripe old ages. Zoos -- for both human and non-human animals -- have been very successful in that. They have been successful in increasing average lifespans. This is not the same as increasing absolute lifespans, and there exists plenty of documentation that hunter-gatherers lucky enough to escape all that brutal nature throws at them, when able to obtain adequate nutrition from a natural diet, are able to rival the advanced ages we find in the human and animal zoos.

Meat & Fat in the Diet

When you run the numbers, there's no other way we could have evolved our huge brains and small guts without a significant quantity of meat & fat in the evolutionary diet. Kleiber's Law dictates that virtually all animals possess a metabolic rate that scales to the ¾ power of the animal's mass. What this means is that animals of different species that weigh the same have the same overall metabolic rate.

You have the same metabolic rate as a chimpanzee that weighs the same as you. Moreover, your heart, lungs, liver, kidneys and so on (major energy expensive tissue) will have comparable metabolic rates. But, your brain will have 4-5 times the metabolic rate of the chimp, and his gut will have 4-5 times the metabolic rate as yours. There's the difference. Why?

Conclusions

There are really only two necessary.

  1. We evolved from primates.
  2. Accomplishing (1) required at first the scavenging of animal-derived protein and fat, which in-turn allowed the shrinking of guts and expanding of brains over six million years.

And, so, the battlefield lines have been drawn. Dr. Jackson asserts that saturated fat is a poison and the chief culprit that underlies heart disease, "the single biggest killer in the western world."

I'm saying that a food so critical and essential to our very unlikely evolution -- against all odds and against all other hominids -- is logically most likely to be extremely healthful. And even if it were not particularly healthful in relation to other nutrition -- no more and no less -- it would be quite illogically odd if it were actually bad for us a priori, which is to say on its face, in any context, even a natural diet of real whole foods.

In Part III I want to attempt to look at what Dr. Jackson and people like him might regard as the best evidence and science out there implicating saturated fat in the diet. If anyone can steer me to some studies they believe are thusly touted by the authorities, I would greatly appreciate it.

11/20/09 Addendum: Prior to publishing this post I was able to have a draft copy reviewed by Dr. Monica Hughes and Dr. Stephan Guyenet, both PhD biologists. Monica helped correct a few errors in my descriptions of our ancestors and Stephan signaled a quibble with the shrinking gut hypothesis, described as follows.

It doesn't specifically imply that we ate more animal foods, but simply that we ate more easily digestible, calorie-dense foods. That could also include cooked starchy tubers. In my opinion, increased animal foods, cooking and starchy tubers probably all contributed to the gut shrinkage. The degree to which each contributed is debatable.

Yes, I'd agree with that, though we would have had to be cooking first, as meat, marrow, brain and other fat can be consumed raw while starchy tubers cannot. And, as it turns out there is some controversy just now over when the advent of cooking actually happened. At any rate, even if you use the advent of H. erectus 1.8 million years ago, you'd still have to conclude that we got near that point through raw animal food for several million years, and which was sufficient to get us large enough brains to invent cooking.

A Fine Day In The Echo Chamber

The morning started off just right. Sunrise on the patio, a cup of coffee, then skipped the morning hour long walk because Bea was off in the morning and wanted to do it.

To top it off, a comment from reader Ian.

Richard, your blog is great and the effort you put into photographing your paleo lifestyle including recipes and cooking techniques is invaluable, as are your regular updates containing links to articles with new relevant information for those pursuing or curious about pursuing this lifestyle.

I’ve been reading it pretty frequently, sometimes multiple times per day just to flip through the old posts and drool over your delicious looking creations and soak up your thoughtful advice.

However, when it comes to your advocacy for the paleo diet, you’re doing yourself and others who are interested in it, and are ignorant of it, a great disservice. Arguing from a position of unchallengeable authority, or even just arrogance peppered with accusations and attempts at mockery is not only unpersuasive but totally alienating to anyone who doesn’t already share your point of view.

In other words, you sound like a shithead. Based on the rest of your blog, i think it’s pretty unlikely you actually are one, but at first glance at one of your forum posts, who would know?

Getting as close as possible to the truth on any subject that falls under scientific scrutiny is difficult, it requires dispassionately analyzing the evidence available and trying to come to the best objective conclusion, then sharing your analysis of the evidence and having it sanity-checked by others.

It’s not a rap battle or a comedy central roast. Calling a guy who has spent a decent portion of his life trying to educate people on nutrition and bring them away from processed foods and to whole natural foods a liar (”inconsistent, bordering on dishonest”) because he hasn’t been persuaded to your point of view on meats and fats yet is pretty uncalled for.

People who believe differently from you are not your enemy to be destroyed, but your ally to be persuaded, this is the only way meaningful knowledge can advance. Making an argument to someone requires having a sensitivity to their point of view, ie understanding what it is and how they established it if possible, and then building on it with a combination of persuasive rhetoric and dispassionate presentations of the evidence you feel supports your position.

Quips like “do the math” and “the religion of plant based dieting” do not serve this cause well. It also sets the tone for the participants and readers of your blog, the first comment was someone making a point about the perceived ecological impact of the meat industry to which someone responded just to call them a “lower case troll”. What the hell is a lower case troll? We’re really going to attack peoples conversational internet grammar because they have an environmental concern? That’s where unnecessary vitriol inevitably leads.

But don’t take my word for it, here’s an excellent and highly amusing video of Neil Tyson making a similar argument to Richard Dawkins.

Though my response didn't mention this (I thought about it later), Ian makes one point I have a certain sensitivity to: "It also sets the tone for the participants and readers of your blog." Yep, that's the risk and I must say that I generally don't like commenters slinging shit (either direction). That's my job. Call it inconsistent, or whatever, but the post is designed to -- as I've often said -- hit & run or slash & burn, then let's hammer it out in comments. Anyway, that's my goal: to use the posting to draw in the traffic, then let's have a decent discussion. And, yes, I don't always live up to that ideal myself.

Anyway, the day gets better. I headed off to the gym shortly after the above & had a really great workout. And then I get back from the gym and, low-&-behold, I've got another comment, this time from John.

Ian, you are absolutely correct about Richard. Having read this blog since before Richard started bowing to Art DeVany, I have noted that Richard’s personality at its core is that of a know-all asshole whose primary mission is to win a fight/argument, not necessarily find or promote truth. In other words, whatever Richard believes today is the Truth. The point of the blog is to satisfy Richard’s congenital need to express his rectitude. He is always “immovable”.

Like a blind pig, Richard’ has latched onto the Paleo thing. For the most part, I find his writing entertaining and often informative (I focus primarily on his cooking explorations), but always subject to scrutiny.

His and Jimmy Moore’s ilk consistently react to criticism the same way their targets do: name-calling and instant dismissal, with a dash of unsubstantiated counter-claim. The echo chamber is an easy/comfortable box in which to live. But that is part of the entertainment of the blog. It can be helpful to read things that often annoy me and keep me questioning and investigating, such as Richard’s comically authoritative perspective. It requires more than what Richard’s intellect possesses to argue his perspective dispassionately.

If you prefer more consistently moderate and accurate reading, read Art. Art’s writing reflects a deep and long-running interest in what makes for healthful living. Art also is an actual prototype for long-term health (as opposed to Richard’s born-again evangelism). Art’s ego is satisfied with considered thoughts and a focus on his own health and on sharing his experiences and observations without shrill ridicule.

If you primarily want entertainment, read Richard. But don’t expect any less lyprocrisy or hyperbole from him than from the people he ridicules.

So, there you have it. Right out in the open. Just taking one in the chin for Team Echo-Chamber.

I've always said -- ask my wife -- that I enjoy being loved & hated just about equally. It's far, far better than indifference, so I've got to give a warm thanks out to both Ian and John for helping to make it a great & effective day.

I think I'm right on track. For those who care to wonder why I engage in the style I do, it's really the only way I could. Entertainment? Yep, that's primarily it, for me -- the lifestyle has its own rewards and I don't need to be doing this to get all the rewards such lifestyle offers. Part of that entertainment is the inputs, i.e., the posts, all of the posts. The other part is the results we get to read about and the help other readers are more than willing to give.

It takes what it takes. But I'm sure both Ian and John spend far more time and effort promoting paleo in their own ways than I do, and I'm sure they've convinced a lot more people than I that a paleo path is a good one. Possibly -- I'd have to look -- but perhaps Ian & John are really the ones responsible for this.

Free the Animal Stats
Free the Animal Stats

We're on a rate to exceed 70,000 visits and 120,000 page views in November.

Thanks Ian & John for all the hard work.

Primal Chicken Pot Pie with Cauliflower Crust

The other day I happened to hit Kat's place, and then her blog, where I saw that she did a chicken pot pie, although she used standard pastry. I was thinking how much I always loved pot pies, and wouldn't it be great to make one. Then it dawned on me: cauliflower crust, just like for pizza. Click on the image to enlarge.

Primal Chicken Pot Pie
Primal Chicken Pot Pie

So, I used the original crust recipe almost exactly. However, now I have a food processor and so was able to really make the cauliflower into a mush. To the cup of cauliflower, cup of mozzarella cheese and an egg, I added about a tbsp each of almond meal and coconut flour.

As for the filling, I followed Kat's recipe with the following modifications:

  • Skinless boneless thighs instead of breasts
  • About a cup of organic free range chicken broth which I reduced to almost nothing
  • Organic heavy cream instead of whole milk
  • No flour for thickening (because of the cream)
The Pie Filling
The Pie Filling

So, as with the pizza crust where you have to cook it first, I greased the pie tins  with butter and then coated the insides with dough and popped 'em in the oven at 350. Oops. Within a few minutes, all the "dough" was sitting at the bottom of the tins. Cranked up the oven to 400 and let them cook a bit more to release moisture. Next time, I'm going to roll up my cauliflower mash in paper towels to get rid of moisture. Also, more almond meal, coconut flour and maybe some butter or lard will help. Another thing I could do is stack another tin on top to keep the dough in place while it sets up.

At any rate, I took them out after a few more minutes, the dough was still pliable, and so I added a few dashes of coconut flour and was able to get the dough to adhere to the sides of the tins using a fork. Then I added the filling and covered with the remaining raw dough, and then into the oven again at 350, probably 10 minutes or so.

Remove, melt butter on top, and fire under the broiler until well browned.

Chicken Pot Pie
Chicken Pot Pie

This was very exceedingly delicious. Definitely something I will do again and attempt to improve.

Do The Math, Dr. T. Colin Campbell

Jeezus, already.

It was over a week ago that I reported to you that Dr. T. Colin Campbell, author of best-selling The China Study was participating in a low-carb discussion forum. While he has been away for a while, he suddenly popped back in this weekend.

Mind numbing, to say the least. I just can't see how a person can reach such stature and still be so ignorant about so many things. While he expresses interest in the many good results that have been reported by those who've implemented low-carb and paleo eating practices, he just can't seem to bring himself to the obvious conclusion that when one eats mostly real food -- including animal meat and fat, or not -- that good things are likely to happen in comparison to a modern diet of industrially processed crap.

So, while many including myself are more than willing to acknowledge that his "plant-based diet of all natural foods" is better than a standard crap diet and will provide comparative benefit for many, he is simply stuck in the belief that his results are primarily from eliminating animals and their fat, not in spite of it, and that those who obtain similar or better results on paleo are simply obtaining temporary benefits. "They'll pay later" is implied in virtually all of his acknowledgements.

So, here's some examples of what I'm dealing with.

Richard Nikoley,

Who says we evolved on a high fat, high meat diet, as you imply?

My response.

~~~

Well Dr. Campbell, when you become willing to set aside the religion of plant-based dieting and accept the reality of our evolution, there's no other possibility. In addition to reams of archeological evidence supporting the fact that we were early stone tool makers and scavengers of carcasses, particularly high-fat bone marrow and brain, there's also the numbers.

Do the math. With our hugely energy-demanding brains, combined with our small guts, there is no possibility other than that we were not only meat & fat eaters, we were ENORMOUS meat & fat eaters.

I suggest you do some reading up on the Expensive Tissue Hypothesis, particularly in how it relates to Kleiber's Law. Here's a primer by Dr. Michael Eades, MD:

According to Kleiber’s law, an australopithecine weighing 80 pounds would have the same metabolic rate as a human weighing 80 pounds despite the disparity in brain size between the two. The much larger brain of the human would have 4-5 times the metabolic rate of the brain of the australopithecine, yet would have the same overall metabolic rate. What gives? [...]

Aiello and Wheeler examined the data on the metabolic rates and sizes of the various expensive tissues and learned that for a 65 kg primate, the heart, the kidneys, and the liver were approximately the same size as those of a 65 kg (143 lb) human. The greater metabolic rate of the large human brain was compensated for by a GI tract significantly decreased in size. It turns out that the GI tract of a 65 kg human is just a little over half the size of the GI tract of a similar sized primate. [...]

A considerable problem for the early hominids would have been to provide themselves, as large-bodied species, with sufficient quantities of high-quality food to permit the necessary reduction of the gut. The obvious solution would have been to include increasingly large amounts of animal-derived food in the diet.

Increasing the amount of easily-digested food of animal origin allowed us to shrink our guts while expanding our brains [Keep in mind: this was over millions of years. -ED] . Had we remained on a diet high in vegetation, we would no doubt not have been able to expand our brains irrespective of how much more thinking those brains would have needed to do. It just wouldn’t have been possible to do so without violating Kleiber’s law.

Take the gorilla, for example, almost pure vegetarians that spend their entire ‘working’ day foraging and eating, which they have to do to get enough calories to maintain their enormous bulk. They have large guts and pay for it by having small brains. Even smaller than that of our most primitive ancestors, the australophthecines.

Gorilla has one of the lowest levels of encephalization of any haplorhine primate, and the much higher level of encephalization of all the australopithecines suggests a diet of significantly higher quality than that of this genus.

Which makes sense when you consider that carbon 13 isotope analysis has shown that Australopithecus africanus (the species that came right after Lucy) consumed meat. As you go up the lineage from Australopithecus and through Homo, you find that more and more meat was consumed the higher up the tree you go.

You need to start facing reality, Dr. Campbell.

~~~

I might have added that Dr. Campbell doesn't seem to realize that he enjoys the luxury of a modern economy that can make sure he has spinach, even if it has to be shipped to him frozen, from...China! Put that in your "study," Doktor. The fact is that if he and his adherents had to subsist as hunter gatherers, they would quickly learn to hunt, or starve.

Another "jewel" is his response to someone else who asked why he "thought" fat brought bad consequences.

I don't "think" that there are adverse consequences from high-fat. The scientific literature overflows with such evidence.

~~~

Ah, I see; so when it's a typical western diet of lots of processed foods, sugar, "franken-oils," grains and such, then it's always most certainly the animal fat, not the neolithic garbage people consume.

You're inconsistent, Dr., bordering on dishonest. You are very careful to stipulate that your plant-based diet is one derived from natural and not processed foods. I actually agree that's probably a more important factor (variable) than whether or not such natural diet includes meat and animal fat.

You, to your discredit, I believe, fail continually to acknowledge the same distinction with the paleo dietary approach.

~~~

More silliness?

You should know that high fat, like addictive drugs, also is addictive -- it gives a dopamine kick. Like nicotine, caffeine, and other addictive chemicals, it can be very hard for some to kick the habit.

Hysterical. Food, real food, the stuff we evolved to eat over millennia is now an "addictive drug."

The 'addiction to a dopamine high' caused by high fat consumption is supported the fact that when people switch to a low fat diet (no ADDED fat, not no fat), they gradually lose their strong preference for high fat and find it to be greasy and very unpleasant. This may take months in some cases.

The Occam's Razor evolutionary, correct, makes-perfect-sense, assume-the-least explanation is that dopamine exists for an evolutionary reason. If natural, saturated animal fat is so compelling, then it must be critically important for optimal health. We're talking about foods we evolved eating, not drugs.

You need to begin looking at this stuff in the light of evolution.

~~~

My, oh my.

Later: "it gives a dopamine kick." Not a shove, nudge push,or slight influence? No? It's a"kick." Oh wow!

Good News & Bad News: Vitamin D vs. Statins

First, the good news. Yep, it's vitamin D, again (thanks to Chris for the link).

New study links vitamin D deficiency to cardiovascular disease and death

Study finds inadequate levels of Vitamin D may significantly increase risk of stroke, heart disease and death

For more than a year, the Intermountain Medical Center research team followed 27,686 patients who were 50 years of age or older with no prior history of cardiovascular disease. The participants had their blood Vitamin D levels tested during routine clinical care. The patients were divided into three groups based on their Vitamin D levels – normal (over 30 nanograms per milliliter), low (15-30 ng/ml), or very low (less than 15 ng/ml). The patients were then followed to see if they developed some form of heart disease.

Researchers found that patients with very low levels of Vitamin D were 77 percent more likely to die, 45 percent more likely to develop coronary artery disease, and 78 percent were more likely to have a stroke than patients with normal levels. Patients with very low levels of Vitamin D were also twice as likely to develop heart failure than those with normal Vitamin D levels. [emphasis added]

[...]

A wealth of research has already shown that Vitamin D is involved in the body's regulation of calcium, which strengthens bones — and as a result, its deficiency is associated with musculoskeletal disorders. Recently, studies have also linked Vitamin D to the regulation of many other bodily functions including blood pressure, glucose control, and inflammation, all of which are important risk factors related to heart disease. From these results, scientists have postulated that Vitamin D deficiency may also be linked to heart disease itself.

[...]

"We concluded that among patients 50 years of age or older, even a moderate deficiency of Vitamin D levels was associated with developing coronary artery disease, heart failure, stroke, and death," she says. "This is important because Vitamin D deficiency is easily treated. If increasing levels of Vitamin D can decrease some risk associated with these cardiovascular diseases, it could have a significant public health impact. When you consider that cardiovascular disease is the leading cause of death in America, you understand how this research can help improve the length and quality of people's lives."

Now for the bad news.

Vytorin trial shows little or no benefit against heart disease

For the second time in as many years, a large clinical trial has found that the key ingredient in the heavily advertised drug Vytorin provides little or no benefit in preventing heart disease compared to a competing product. The ingredient is ezetemibe, which blocks the absorption of cholesterol in the intestines. It is sold alone under the brand name Zetia or in combination with the cholesterol-lowering drug simvastatin under the brand name Vytorin. The combination of drugs has been shown to reduce cholesterol more than simvastatin alone, but that apparently does not translate into a lower risk of heart disease.

In the original trial, reported last year in January, Vytorin was compared with generic simvastatin in a group of 720 patients with a genetic disorder called heterozygous familial hypercholesterolemia, in which unusually high levels of low-density lipoproteins, commonly known as LDL or "bad" cholesterol, accumulate in the blood, increasing the risk of cardiovascular disease. Vytorin reduced the level of LDL in the blood of the patients by 58%, compared with a 41% reduction produced by simvastatin, which blocks production of cholesterol in the liver. But to determine how the drugs affected the risk of heart disease, researchers looked at the thickness of plaque in the carotid and other arteries. Thicker plaque increases the risk of plaque breaking off and producing clots that lead to heart attacks. The researchers found that plaque actually grew slightly more in the patients taking Vytorin than it did in those taking only simvastatin. Since then, prescriptions for Zetia have fallen from nearly 16.5 million in 2007 to less than 13 million in 2008, while those for Vytorin fell from 22 million to 16.5 million. The new results could lead to further declines.

And that's not even the whole story. Turns out niacin (vitamin B3, nicotenic acid) is actually more effective than statins in improving an LDL particle profile, raising HDL, and improving cartoid artery intima thickness (arterial plaques actually increased in size under statin therapy alone).

Both Dr. Driffa and Dr. Eades have posts about this. And by the way, while the statins are a multi-billion-dollar annual fraud and scam, both vitamin D and niacin can be had for a few dollars per month.

Bavette, Bone Stock Reduction & Sweet Potato Fries

Thanks to Mark Sisson for alerting me to this cheap but, oh so kind cut of beef. The bavette (flap steak). Funny. I just wasted like 10 minutes trying to find it on his blog to link to it before I realized it was in his Insider newsletter.

But I wasted no time in securing some. I was due to make another order to La Cense, and so I got four of them. Tonight was the first.

Bavette or Flap Steak
Bavette or Flap Steak

It's just seasoned with some salt, pepper and garlic powder, then onto the grill on high. In the meantime, sweet potato fries in coconut oil & lard and a reduction of some fresh bone stock which I now have plenty of.

Bavette and Sweet Potato Fries
Bavette and Sweet Potato Fries

I must say that if you are considering going grassfed, this is a particularly nice cut, as is hanger and flank steak. Really great flavor, fast to cook, versatile (think fajitas) and tender.

Well, almost finished with part II of my saturated fat series. That should go up within hours.

Primal Tacos

This took no more than 15 minutes prep time. I went ahead and uploaded a larger version that you can see by clicking on the image.

Primal Taco
Primal Taco

So, while I cooked leftover grassfed ground beef on low in the skillet, I took a nice large ripe avocado, mashed it up, and added about 1 level tsp of sea salt. Do that to taste, however. I think one of the biggest deficiencies in most guacs I taste is not enough salt; I like it a bit on the salty side as I find it really brings out the flavor.

Beyond that, it's about 1/3-1/2 cup chopped cilantro, 1/2 small to medium jalapeno pepper chopped fine (with seeds), about 1/3-1/2 yellow onion chopped fine, and 1/2 medium vine ripened tomato, chopped (with juice).

Cook the ground beef on low so as to not scorch the fat, don't drain, then add in your taco seasoning powder to taste and to soak up all the nutritious tallow. Served on a leaf of green lettuce, garnished with fresh tomato and coarsely chopped cilantro.

That was breakfast, served up at 11am, which is Bea's and my typical first meal time.

Grassfed Burgers with Cheddar Cheese on a Paleo Bun

Well, based on comments here, I decided to give another try at baking. This time it was to try and make some hamburger buns.

Hamburger Buns
Hamburger Buns

I did about 2/3:1/3 of almond meal to coconut flour. Still too dense & heavy. But, still pleasing to eat with a nice thick, juicy grassfed gourmet burger.

Juicy Grassfed Burger with Cheddar
Juicy Grassfed Burger with Cheddar

Next time I'm going to use more coconut flour and I'm also going to try separating the eggs and beating the whites with some cream of tartar and folding the rest of the ingredients in.

Alternate Day Fasting, Weight Loss, and Food

A reader sent a link this morning to an interesting study of alternate day fasting for obese adults.

Even though the study participants ate whatever they wanted on their non-fasting days, they lost an average of 5.6 kilograms (about 12 pounds) after eight weeks, Dr. Krista A. Varady of the University of Illinois at Chicago and her colleagues found. [...]

"People lost anywhere from about 7 pounds to about 30 pounds and that was in a very short amount of time," Varady said. And, she added, the program was pretty easy for the study participants to follow.

So, what did they do? Apparently oblivious to the underlying paleo principle at work, they've made the shocking discovery that if you simulate unavailability of food that people begin to revert to a normal [hunting] weight. News flash: wild animals including wild humans don't have pantries and refrigertors or local supermarkets & restaurants. They've got to hunt, gather and prepare their food, and they've also got to think and plan in case migration or other measures will be required for future food. That all adds up, and it's why HGs are typically lean.

To test alternate-day fasting in obese adults, Varady and her colleagues had 12 obese women and 4 obese men begin by eating normally for a two-week control period. Then, for eight weeks, they ate just 25 percent of the calories they needed to maintain their weight, between noon and 2 p.m., every other day.

So, they ate with no restrictions every over day, and on the "fasting" days they ate 25% baseline caloric intake in a 2-hr feeding window. So, not even a true fast in the way we typically do but still quite impressive in terms of results.

I'm fasting today until dinner and got in a pretty intense workout a couple of hours ago. This was my last meal, roasted chicken and a simple sauce. I had no chicken stock, but I do keep some of the Trader Joe's paste packets around for just such contingencies. No unpronounceable ingredients. So, two chicken and one vegetable in 1 1/2 cups of water, to a boil; add about 1/2 tsp of tarragon, 1/2 tsp of bay leaves, and a light shake of paprika.  Then, about 1/3 cube of sweet organic butter. Reduce, then just a 4-finger dash of potato flour to thicken, which is no more than about 5g of carb.

Roasted Chicken Sauce
Roasted Chicken & Sauce

No veggies. Instead, I had a few walnuts and then 5 frozen cherries in some full fat yogurt.

Paleo Days of Fall

While I continue to think about and draft the next in my series on Saturated Fat a-la Prof. Rod Jackson in New Zealand, I thought I'd empty the queue of various food photos. So, here goes, quickly.

Who doesn't love soup, especially beef & vegetable with the remainder of my bone stock as the base?

Beef Vegetable Soup
Beef Vegetable Soup

That was a crosscut beef shank, with the bone. Other ingredients included onion, carrot, celery and I had some frozen peas that I finished off, too. So simple and so delicious and satisfying. Cut 'er up, brown in lard, add stock, vegetables, bring to a boil, cover and simmer low for a coupla hours. Eat.

Bone Stock
Bone Stock

Yep, since that was the last of the stock to make the soup, I had to retreat to the freezer. I now typically write "bone stock" instead of beef stock because what I do is a random mix of beef, pork, and lamb bones that I save and, friends save for me. The batch before this came out dark brown and like syrup. This one is light, less fat (I save that separately, BTW), but totally gelatinous. Should be interesting. I've already got a batch going of pure beef marrow bone stock. I've got the lid ajar on the crockpot because I want to reduce and concentrate it. It's going to be my "private stash" for Bea, I, and the friends who got me the marrow bones.

Soft Boiled Eggs
Soft Boiled Eggs

Don't you just love soft boiled eggs -- so pure in taste? I have recently experienced an inexplicable but very distinct diminished craving for eggs of any kind. My mom, too, only more severe (she gets nauseated). However, when I do get that feeling, it's for soft boiled. I add a pat of butter per egg, to melt as I burn the shit out of my fingers scooping out the goodness.

Looking forward to the delivery of Doc Eades' Sous-Vide Supreme. I can have these ready, waiting, and perfectly runny yolk in the morning.

What would this many disperate photos be without an abortion?

Paleo Biscuits
Paleo Biscuits

This was for my "Paleo Biscuits & Gravy."

Meh. Well, I didn't realize I didn't have any coconut milk, didn't want to go out, friends were out of stock, so I improvised with butter, heavy cream and some creme fraiche. Still not moist enough (the gravy), and the buscuits were too dry. Plus, I'm not sure I like concentrating omega-6 PUFAs like this. One full cup of almonds for four biscuits... Seems excessive.

Anyone have a recipe for moist biscuits involving coconut flour or some alternative?

Diet Obsession

A reader email this morning with an important question I ought to address here.

Let me preface this by saying I'm just starting out on my Paleo/Primal journey. I am also terrible at wading my way through scientific studies, and have the kind of luck where I think I've got something covered, and then some other group of studies pops up and I'm on my ass again. In short: as a layman I tend to steer clear of grand scientific statements, like "fat is good/bad" for fear of sounding like an ass. [...]

However, I come across things like this. [A discussion on Mark Sisson's forum as to whether too much fat can be bad. -Ed]

And I'm more than a little lost. This guy seems to have a rather solid case that one group, who I thought were a prime example of what a good diet could be like, actually have serious health problems. Things like this always leave me worrying that I don't have my ass covered on the data here and, well, I just worry that I might have made a mistake and end up paying for it 20-30 years down the line. [...]

I am serious about committing myself to a diet, even it means a major overhaul, but only if it's right. I just think it's obvious, given what we know about diabetes as well as what man's body is designed to handle, that anything which is basically sugar must be avoided, so it didn't take much to convince me to give these up... but going the other way, determining what I ought to eat has been a lot harder to figure out. [...]

Do you recommend any method for really going about learning to integrate all this data about and learning what is right? I fear that, because I only come across scientific articles from what you and people like Mark recommend, that I'm getting a biased perspective, and not getting a really good, overall view of the data.

Have you read Good Calories, Bad Calories by Taubes? In that book and others (like The Great Cholesterol Con by Colpo) much in the way of studies that supposedly support the "lipid hypothesis" are cited. It should not be difficult to find studies that support conventional wisdom. Just look at the news outlets regularly.

Well I read that whole thread and was quickly reminded why I don't generally partake in such discussions any longer. Yep, I think both the Kitavan diet of 70% natural carbs and the Inuit diet of 80% natural fats are extremes on both ends of the spectrum, are likely both healthful, but, as extremes, are probably not optimal.

I think a person does well to just eat real food better than 90% of the time and don't worry and obsess about it. And, I think that what one likes to eat is something that changes -- ebbs & flows -- over time. Initially, I was big on lots of protein (big steaks). However, since getting better and better at the tasty, fatty sauces I make, I'm eating less protein and I feel fine. Sometimes I like veggies, and then I'll go periods where by the time my fat & meat are eaten (often I end up leaving food) I have no appetite for veggies -- and besides, I often skip the veggies altogether in preference for a couple of enormous teaspoons of full fate Fage yogurt with a few berries, cherries and/or nuts.

I have absolutely no idea -- I have never had an idea -- what my macronutrient ratios are beyond knowing my carbs are relatively low, my fat relatively high, and I'm getting enough protein. I have no interest in knowing specifics beyond that. The more variety and randomness in my diet, the better. I never count anything, never measure anything, and I never will. I tried FitDay for about 2-3 days once and promptly concluded that it was an enormous waste of time, and boring to boot.

Seriously, it absolutely drives me nuts, sometimes, the BLATANT OBSESSION going on out there, and it's certainly not helpful for you and other newbies to the paleo / primal / evfit scene.

For a great book on diet that I'm currently reading, check out Nora Gedgaudas' Primal Body Primal Mind. While Mark's Primal Blueprint is indeed excellent and everyone should read it, it's more of a total lifestyle work, whereas the former is a body and mind integration focused on nutrient intake.

I hope that helps. Don't let people freak you out. This all makes sense and it would be extremely odd if it didn't (make sure to read Part II of my Saturated Fat series that should go up later today or tomorrow). Eat Real Food -- as much or as little as you desire, when you desire, and sometimes eat nothing and sometimes pig out, even on natural carbs.

Carbs Kill and Eating Animals Saves Lives

This is a continuation of two previous posts on saturated fat epidemiology and looking at the government data in different ways. For the background, see the previous posts:

  1. Saturated Fat Intake vs. Heart Disease & Stroke
  2. Drilling Down: Saturated Fat Epidemiology

As you'll discover, the impetus behind the second post was Shangi-La Diet author Seth Roberts' complaint about how some of the data was presented. He now appears satisfied, but one of his readers isn't. You can read those comments here. Essentially, Vince ran the numbers but corrected for GDP in each country and the significance went away. Well, at least the correlation didn't reverse the other way.

One thing Alex Thorn remarked to me about early on in constructing this data is that the saturated fat was given as a percentage of total energy intake, not an absolute amount. We initially thought that was a better way to present but in Vince's analysis, and the discussion that ensued, it came to light that there was vast differences in total quantity of saturated fat consumption even where percentage intake was relatively close. And, so, I suggested that Alex run the data on absolute consumption rather than relative, and then have Vince adjust for wealth.

And, so, Alex reports. BTW, you can click on those last two graphs to open the full-size versions.

Please find attached the graphs using the DALYs statistics plotted against absolute animal fat intake (g/person/day) - the source of these particular statistics had not broken down fat consumption into saturated, mono-unsaturated & polyunsaturated but rather animal and vegetable.

I also used CVD mortality statistics (per 100,000 head of population) from the WHO website plotted against total animal food intakes (g/person/day), which is made up of meat, offal and animal fat (not including eggs or dairy), and also the ratio between total CHO, which includes cereals, starchy roots, fruits, vegetables and sugars & sweeteners, and total animal foods. These graphs are also attached.

These latter two are quite interesting. The first (total animal foods vs CVD mortality) has a marked trend for greater CVD mortality in populations who consume less total animal foods. While the second takes into account that poorer nations make up the shortfall in animal foods with cheap CHO foods especially cereals and starchy roots. In this one there is a trend line sloping upwards (the greater the ratio of CHO to animal foods the greater the CVD mortality rate). There is an impressive clumping of the countries with the lowest ratio of CHO:Animal Foods (France, Denmark, etc - known for low CVD rates). It should be pointed out that these countries also have higher rates of absolute CHO consumption, so the ratio is kept low by having very high animal food consumption.

CHD vs Animal Fat
CHD vs Animal Fat
Stroke vs Animal Fat
Stroke vs Animal Fat
Other CHD vs Animal Fat
Other CHD vs Animal Fat
CVD vs Animal Food
CVD vs Animal Food
CVD Death vs Carb Animal Food Ratio
CVD Death vs Carb Animal Food Ratio

So, the more animal fat, the less CHD, Stroke and Other CHD. The more animal food altogether, less CVD deaths, and...

The More Carbohydrate That Was Eaten in Place of Animal Food, the More CVD Death.

11/12/09 Update: Commenter Ricardo "O Primitivo" Carvalho has done some further number crunching and posted graphs, which he describes...

Here are a few graphs relating the “animal to vegetal energy ratio” with several epidemilogical variables. The x-axis data is from FAO-STAT Consumption: “Animal Products + (kcal/day), 2003″ and “Vegetal Products + (kcal/day), 2003″ and the y-axis data is from the BHF-British Heart Foundation and the WHO-World Health Organisation. -> http://www.canibaisereis.com/download/animal-vegetal-ratio.pdf

Go have a look.

Saturated Fat and Coronary Heart Disease, Part I: Introducing Professor Rod Jackson

The other day I got an email from David Brown, proprietor over at Nutrition Education Project alerting me to an exchange he and Jimmy Moore had with a professor of epidemiology in New Zealand. Now, the first thing you need to know is that David, unlike me, is a meticulously nice guy and he employs that graciousness in what he does to try and inform and educate policy makers, researchers, nutritionists, the media and so forth.

I'm just a slash & burn, hit & run kinda guy who stumbled into this whole nutrition and fitness thing, and now here I am. So, David and Jimmy Moore have engaged professor Jackson in a polite & cordial manner. After nearly three weeks of considering what I might do, if anything, I've decided to do likewise; and moreover, to make it a multi-part effort over the next week or so.

In this post, I'm going to introduce you to the professor and quote some key assertions of his from that exchange with David and Jimmy. Those assertions will be the basis of the next posts. The second post is going to lay the foundation of principles. That is, our evolution strongly suggests (when not already dictated) certain things about our diet, and when those principles come in conflict with current observational study and hypotheses, we ought to be extra demanding of quality evidence.

The weight of evidence for an extraordinary claim must be proportioned to its strangeness. -Pierre-Simon Laplace

I then wish to spend some time looking at what Prof. Jackson and other researchers like him may regard as the best evidence for their position that saturated fat is atherogenic. This is where I could use some help from readers who may know what, say, the top five studies might be. Please drop your thoughts in comments as we proceed -- such comments will in part guide how I put together subsequent parts of this series.

Finally, we'll take a look at the best contradictory evidence and try to draw some conclusions.

So, just who is professor Rod Jackson? Here's his page at the School of Population Health, Faculty of Medical and Health Sciences, University of Auckland.

Rod Jackson is Professor of Epidemiology and Head of Epidemiology & Biostatistics at the School of Population Health, Faculty of Medical and Health Sciences, University of Auckland. He is also the director of EPIQ (www.epiq.co.nz), an in-house group undertaking teaching, research and consultancies in Evidence-based Practice (EP), health Informatics (I) and Quality improvement (Q), for healthcare services. He is medically trained, has a PhD in Epidemiology and is a member of the Australasian Faculty of Public Health Medicine. He has published approximately 200 peer-reviewed papers. His main research interest for the last 25 years has been the epidemiology of chronic diseases, particularly cardiovascular diseases. He is one of the architects of New Zealand risk-based clinical guidelines for managing CVD risk. He is currently involved in developing and implementing a web-based decision support system – PREDICT - to help primary care practitioners across the country systematically manage CVD and diabetes risk at the ‘moment of care’ for their practice populations.

Well, that's quite a resume. From that I think we can trust that professor Jackson will have a very good familiarity with everything we ultimately touch on in this series.

And now, let's take a look at some of the statements and claims made in the aforementioned exchange with Jimmy and David.

Saturated fat is the underlying cause of coronary heart disease – the single biggest killer in the western world. Fortunately most Americans are aware of this and over the last 40 years consumption of saturated fats, including butter, which is almost pure saturated fat, have fallen dramatically. Over the same period coronary heart disease deaths have fallen by almost 75%. No other common disease has fallen by so much so quickly. [...]

The totality of the evidence on millions of people from basic biochemistry through metabolic ward studies, large scale cohort studies, randomised controls and finally the plummeting coronary heart disease death rates across the western world in line with major falls in saturated fat consumption and blood cholesterol levels, provides better evidence for the saturated fat – CHD relationship than anything else in medicine. I have spent over 25 years reviewing this evidence and it is important not to cherry pick the individual studies that suggest it is not true. There will always be some conflicting evidence – it is the nature of science – and the modern way to address this is to undertake systematic reviews of all the high quality evidence. [...]

The advice people like me have been giving governments and the public about reducing their risk of heart disease over the last 25 years seems to have been extremely successful.

Then, there's this this item: Professor calls for tax on 'poison' butter.

A top public health expert is calling for a health tax on butter, saying it's "pure, natural poison" and as bad as cigarettes.

New Zealanders eat more butter per head than any other nationality and Auckland University epidemiologist Professor Rod Jackson says that's why our cholesterol levels are also among the world's highest.

"We have a health tax on alcohol and cigarettes and there should be a health tax on butter. It's the most poisonous commonly consumed food in New Zealand. It's about the purest form of saturated fat you can eat and it has no protein and no calcium. Butter has had all the good things taken out and just left the poison."

[...]

New Zealanders get about 20 per cent of their saturated fat intake (and therefore bad cholesterol) from butter. We average around 8kg a year - three times as much as Australians and 16 times more than the Japanese.

Jackson says while the dairy industry had done some "fabulous" things to produce low-fat alternatives, "its one major weakness is butter". "If only they could find a nice effective process for turning butter into biofuel."

So there you have it. Looks like I have my work cut out for me.

On one final note, I am going to insist this time around that all comments directed toward professor Jackson be respectful. Yes, that's ironic, coming from me, but I wish for this series to not be tainted with irrelevancies, no matter their propensity to inspire and entertain.