Thursday, December 30, 2010

How much protein does one need to be in nitrogen balance?

The figure below, from Brooks et al. (2005), shows a graph relating nitrogen balance and protein intake. A nitrogen balance of zero is a state in which body protein mass is stable; that is, it is neither increasing nor decreasing. The graph was taken from this classic study by Meredith et al. The participants in the study were endurance exercisers. As you can see, age is not much of a factor for nitrogen balance in this group.


Nitrogen balance is greater than zero (i.e., an anabolic state) for the vast majority of the participants at 1.2 g of protein per kg of body weight per day. To convert lbs to kg, divide by 2.2. A person weighing 100 lbs (45 kg) would need 55 g/d of protein; a person weighing 155 lbs (70 kg) would need 84 g/d; someone weighing 200 lbs (91 kg) would need 109 g/d.

The above numbers are overestimations of the amounts needed by people not doing endurance exercise, because endurance exercise tends to lead to muscle loss more than rest or moderate strength training. One way to understand this is compensatory adaptation; the body adapts to endurance exercise by shedding off muscle, as muscle is more of a hindrance than an asset for this type of exercise.

Total calorie intake has a dramatic effect on protein requirements. The above numbers assume that a person is getting just enough calories from other sources to meet daily caloric needs. If a person is in caloric deficit, protein requirements go up. If in caloric surplus, protein requirements go down. Other factors that increase protein requirements are stress and wasting diseases (e.g., cancer).

But what if you want to gain muscle?

Wilson & Wilson (2006) conducted an extensive review of the literature on protein intake and nitrogen balance. That review suggests that a protein intake beyond 25 percent of what is necessary to achieve a nitrogen balance of zero would have no effect on muscle gain. That would be 69 g/d for a person weighing 100 lbs (45 kg); 105 g/d for a person weighing 155 lbs (70 kg); and 136 g/d for someone weighing 200 lbs (91 kg). For the reasons explained above, these are also overestimations.

What if you go well beyond these numbers?

The excess protein will be used primarily as fuel; that is, it will be oxidized. In fact, a large proportion of all the protein consumed on a daily basis is used as fuel, and does not become muscle. This happens even if you are a gifted bodybuilder that can add 1 lb of protein to muscle tissue per month. So excess protein can make you gain body fat, but not by protein becoming body fat.

Dietary protein does not normally become body fat, but will typically be used in place of dietary fat as fuel. This will allow dietary fat to be stored. Dietary protein also leads to an insulin response, which causes less body fat to be released. In this sense, protein has a fat-sparing effect, preventing it from being used to supply the energy needs of the body. As long as it is available, dietary protein will be favored over dietary or body fat as a fuel source.

Having said that, if you were to overeat anything, the best choice would be protein, in the absence of any disease that would be aggravated by this. Why? Protein contributes fewer calories per gram than carbohydrates; many fewer when compared with dietary fat. Unlike carbohydrates or fat, protein almost never becomes body fat under normal circumstances. Dietary fat is very easily converted to body fat; and carbohydrates become body fat when glycogen stores are full. Finally, protein seems to be the most satiating of all macronutrients, perhaps because natural protein-rich foods are also very nutrient-dense.

It is not very easy to eat a lot of protein without getting also a lot of fat if you get your protein from natural foods; as opposed to things like refined seed/grain products or protein supplements. Exceptions are organ meats and seafood, which generally tend to be quite lean and protein-rich.

References

Brooks, G.A., Fahey, T.D., & Baldwin, K.M. (2005). Exercise physiology: Human bioenergetics and its applications. Boston, MA: McGraw-Hill.

Wilson, J., & Wilson, G.J. (2006). Contemporary issues in protein requirements and consumption for resistance trained athletes. Journal of the International Society of Sports Nutrition, 3(1), 7-27.

Tuesday, December 28, 2010

How much dietary protein can you store in muscle? About 15 g/d if you are a gifted bodybuilder

Let us say you are one of the gifted few who are able to put on 1 lb of pure muscle per month, or 12 lbs per year, by combining strength training with a reasonable protein intake. Let us go even further and assume that the 1 lb of muscle that we are talking about is due to muscle protein gain, not glycogen or water. This is very uncommon; one has to really be genetically gifted to achieve that.

And you do that by eating a measly 80 g of protein per day. That is little more than 0.5 g of protein per lb of body weight if you weigh 155 lbs; or 0.4 per lb if you weigh 200 lbs. At the end of the year you are much more muscular. People even think that you’ve been taking steroids; but that just came naturally. The figure below shows what happened with the 80 g of protein you consumed every day. About 15 g became muscle (that is 1 lb divided by 30) … and 65 g “disappeared”!


Is that an amazing feat? Yes, it is an amazing feat of waste, if you think that the primary role of protein is to build muscle. More than 80 percent of the protein consumed was used for something else, notably to keep your metabolic engine running.

A significant proportion of dietary protein also goes into the synthesis of albumin, to which free fatty acids bind in the blood. (Albumin is necessary for the proper use of fat as fuel.) Dietary protein is also used in the synthesis of various body tissues and hormones.

Dietary protein does not normally become body fat, but can be used in place of fat as fuel and thus allow more dietary fat to be stored. It leads to an insulin response, which causes less body fat to be released. In this sense, dietary protein has a fat-sparing effect, preventing it from being used to supply the energy needs of the body.

Nevertheless, the fat-sparing effect of protein is lower than that of another "macronutrient" – alcohol. That is, alcohol takes precedence over carbohydrates for use as fuel. However, protein takes precedence over carbohydrates. Neither alcohol nor protein typically becomes body fat. Carbohydrates can become body fat, but only when glycogen stores are full.

What does this mean?

As it turns out, a reasonably high protein intake seems to be quite healthy, and there is nothing wrong with the body using protein to feed its metabolism.

Having said that, one does not need enormous amounts of protein to keep or even build muscle if one is getting enough calories from other sources.

In my next post I’ll talk a little bit more about that.

Thursday, December 23, 2010

38 g of sardines or 2 fish oil softgels? Let us look at the numbers

The bar chart below shows the fat content of 1 sardine (38 g) canned in tomato sauce, and 2 fish oil softgels of the Nature Made brand. (The sardine is about 1/3 of the content of a typical can, and the data is from Nutritiondata.com. The two softgels are listed as the “serving size” on the Nature Made bottle.) Both the sardine and softgels have some vegetable oil added; presumably to increase their vitamin E content and form a more stable oil mix. This chart is a good reminder that looking at actual numbers can be quite instructive sometimes. Even though the chart focuses on fat content, it is worth noting that the 38 g sardine also contains 8 g of high quality protein.


If your goal with the fish oil is to “neutralize” the omega-6 fat content of your diet, which is most people’s main goal, you should consider this. A rough measure of the omega-6 neutralization “power” of a food portion is, by definition, its omega-3 minus omega-6 content. For the 1 canned sardine, this difference is 596 mg; for the 2 fish oil softgels, 440 mg. The reason is that the two softgels have more omega-6 than the sardine.

In case you are wondering, the canning process does not seem to have much of an effect on the nutrient composition of the sardine. There is some research suggesting that adding vegetable oil (e.g., soy) helps preserve the omega-3 content during the canning process. There is also research suggesting that not much is lost even without any vegetable oil being added.

Fish oil softgels, when taken in moderation (e.g., two of the type discussed in this post, per day), are probably okay as “neutralizers” of omega-6 fats in the diet, and sources of a minimum amount of omega-3 fats for those who do not like seafood. For those who can consume 1 canned sardine per day, which is only 1/3 of a typical can of sardines, the sardine is not only a more effective source of omega-3, but also a good source of protein and many other nutrients.

As far as balancing dietary omega-6 fats is concerned, you are much better off reducing your consumption of foods rich in omega-6 fats in the first place. Apparently nothing beats avoiding industrial seed oils in that respect. It is also advisable to eat certain types of nuts with high omega-6 content, like walnuts, in moderation.

Both omega-6 and omega-3 fats are essential; they must be part of one’s diet. The actual minimum required amounts are fairly small, probably much lower than the officially recommended amounts. Chances are they would be met by anyone on a balanced diet of whole foods. Too much of either type of fat in synthetic or industrialized form can cause problems. A couple of instructive posts on this topic are this post by Chris Masterjohn, and this one by Chris Kresser.

Even if you don’t like canned sardines, it is not much harder to gulp down 38 g of sardines than it is to gulp down 2 fish oil softgels. You can get the fish oil for $12 per bottle with 300 softgels; or 8 cents per serving. You can get a can of sardines for 50 cents; which gives 16.6 cents per serving. The sardine is twice as expensive, but carries a lot more nutritional value.

You can also buy wild caught sardines, like I do. I also eat canned sardines. Wild caught sardines cost about $2 per lb, and are among the least expensive fish variety. They are not difficult to prepare; see this post for a recipe.

I don’t know how many sardines go into the industrial process of making 2 fish oil softgels, but I suspect that it is more than one. So it is also probably more ecologically sound to eat the sardine.

Wednesday, December 22, 2010

A Gluten-free January

Are You Gluten Sensitive?

Many people are totally unaware of the fact that they react poorly to gluten. Because they've been eating wheat, barley and/or rye products every day for virtually their entire lives, they don't know what their bodies feel like without gluten. In susceptible people, eating gluten is linked to a dizzying array of health problems that stem from an immune reaction to gliadins and other proteins in gluten (1). Are you a susceptible person? How do you know?

The gold standard way to detect a gluten sensitivity is to do a gluten "challenge" after a period of avoidance and see how you feel. People who react poorly to gluten may feel better after a period of avoidance. After a gluten challenge, symptoms can range from digestive upset, to skin symptoms, to fatigue or irritability within minutes to days of the gluten challenge.

With 2011 approaching, why not make your new year's resolution to go gluten-free for a month? A man named Matt Lentzner e-mailed me this week to ask if I would help with his (non-commercial) project, "A Gluten-free January". I said I'd be delighted. Although I don't typically eat much gluten, this January I'm going 100% gluten-free. Are you on board? Read on.

A Message from Matt Lentzner


Hi There.

My name is Matt Lentzner. I'm just some guy who lifts weights on his patio and tries to eat healthy. That's not important, but I have an idea that just might be.

I am trying to get as many people as possible to go gluten-free for one month - this January 2011.

I've considered this whole ancestral diet thing and I've come to a conclusion. If you could only do just one thing to improve your health then not eating gluten would be it. This is not to say that avoiding other nasty things like fructose or industrial vegetable oil is not important. They are, but you'd get the most bang for your buck from not eating gluten.

"Eat No Gluten" is simple and easy to remember. I think that sometimes the rules get so complicated and overwhelming and people just give up on it. We're keeping it simple here. Even at this simplified level I see that it's difficult for a lot of folks. I think people, Americans especially, tend not to pay much attention to what they're eating - what it is, where it came from, etc.

Getting people to get out of their eating ruts and think a little about what goes into their mouths is a valuable exercise. It sets the stage for better choices in the future. I hope that some success with the simple step will encourage people to further improve their diets.

I have a website at www.glutenfreejan.com. If you want to sign up just send an email with your first name, last initial, and town of residence to glutenfreejan@gmail.com. If you are on Facebook there's a community you can 'Like' called: Gluten Free January. So far I have over 120 people all over the world signed up. If you are already gluten-free then I still want you to sign up - the more the merrier. You can also use this opportunity to spread the word and sign up your family and friends.

Merry Christmas - Looking forward to a gluten-free New Year.

Matt

Monday, December 20, 2010

Dairy Fat and Diabetes

Introduction

Having access to embargoed news from the Annals of Internal Medicine is really fun. I get to report on important studies at the same time as the news media. But this week, I got my hands on a study that I'm not sure will be widely reported (Mozaffarian et al. Trans-palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in US Adults. Ann Internal Med. 2010). Why? Because it suggests that dairy fat may protect against diabetes.

The lead author is Dr. Dariush Mozaffarian, whose meta-analysis of diet-heart controlled trials I recently criticized (1). I think this is a good opportunity for me to acknowledge that Dr. Mozaffarian and his colleagues have published some brave papers in the past that challenged conventional wisdom. For example, in a 2005 study, they found that postmenopausal women who ate the most saturated fat had the slowest rate of narrowing of their coronary arteries over time (2). It wasn't a popular finding but he has defended it. His colleague Dr. Walter Willett thinks dietary fat is fine (although he favors corn oil), whole eggs can be part of a healthy diet, and there are worse things than eating coconut from time to time. Dr. Willett is also a strong advocate of unrefined foods and home cooking, which I believe are two of the main pillars of healthy eating.

Let's hit the data


Investigators collected two measures of dairy fat intake in 3,736 Americans:
  1. 24 hour dietary recall questionnaires, six times. This records volunteers' food intake at the beginning of the study.
  2. Blood (plasma phospholipid) content of trans-palmitoleate. Dairy fat and red meat fat are virtually the only sources of this fatty acid, so it reflects the intake of these foods. Most of the trans-palmitoleate came from dairy in this study, although red meat was also a significant source.
After adjustment for confounding factors, trans-palmitoleate levels were associated with a smaller waist circumference, higher HDL cholesterol, lower serum triglycerides, lower C-reactive protein, lower fasting insulin and lower calculated insulin resistance. Furthermore, people with the highest trans-palmitoleate levels had 1/3 the risk of developing diabetes over the three years volunteers were followed. Keep in mind, however, that this is an observational study and does not prove that dairy fat prevents diabetes.

Even though certain blood fatty acids partially represent food intake, they can also represent metabolic conditions. For example, people on their way to type II diabetes tend to have more saturated blood lipids, independent of diet (3, 4)*. So it's reassuring to see that dietary trans-palmitoleate intake was closely related to the serum level. The investigators also noted that "greater whole-fat dairy consumption was associated with lower risk for diabetes," which increases my confidence that serum trans-palmitoleate is actually measuring dairy fat intake to some degree. However, in the end, I think the striking association they observed was partially due to dairy fat intake, but mostly due to metabolic factors that had nothing to do with dairy fat**.

Here's a nice quote:
Our findings support potential metabolic benefits of dairy consumption and suggest that trans-palmitoleate may mediate these effects***. They also suggest that efforts to promote exclusive consumption of low-fat and nonfat dairy products, which would lower population exposure to trans-palmitoleate, may be premature until the mediators of the health effects of dairy consumption are better established.
Never thought I'd see the day! Not bad, but I can do better:
Our findings support eating as much butter as possible****. Don't waste your money on low-fat cream, either (half-n-half). We're sorry that public health authorities have spent 30 years telling you to eat low-fat dairy when most studies are actually more consistent with the idea that dairy fat reduces the risk obesity and chronic disease.
What are these studies suggesting that dairy fat may be protective, you ask? That will be the topic of another post, my friends.


*Probably due to uncontrolled de novo lipogenesis because of insulin resistance. Many studies find that serum saturated fatty acids are higher in those with metabolic dysfunction, independent of diet. They sometimes interpret that as showing that people are lying about their diet, rather than that serum saturated fatty acids don't reflect diet very well. For example, in one study I cited, investigators found no relationship between dietary saturated fat and diabetes risk, but they did find a relationship between serum saturated fatty acids and diabetes risk (5). They then proceeded to refer to the serum measurements as "objective measurements" that can tease apart "important associations with diabetes incidence that may be missed when assessed by [food questionnaires]." They go on to say that serum fatty acids are "useful as biomarkers for fatty acid intake," which is true for some fatty acids but not remotely for most of the saturated ones, according to their own study. Basically, they try to insinuate that dietary saturated fat is the culprit, and the only reason they couldn't measure that association directly is that people who went on to develop diabetes inaccurately reported their diets! A more likely explanation is that elevated serum saturated fatty acids are simply a marker of insulin resistance (and thus uncontrolled de novo lipogenesis), and had nothing to do with diet.

**Why do I say that? Because mathematically adjusting for dairy and meat fat intake did not substantially weaken the association between phospholipid trans-palmitoleate and reduced diabetes risk (Table 4). In other words, if you believe their math, dairy/meat fat intake only accounted for a small part of the protective association. That implies that healthy people maintain a higher serum phospholipid trans-palmitoleate level than unhealthy people, even if both groups eat the same amount of trans-palmitoleate. If they hadn't mentioned that full-fat dairy fat intake was directly associated with a lower risk of diabetes, I would not find the study very interesting because I'd have my doubts that it was relevant to diet.

***I find it highly doubtful that trans-palmitoleate entirely mediates the positive health outcomes associated with dairy fat intake. I think it's more likely to simply be a marker of milk fat, which contains a number of potentially protective substances such as CLA, vitamin K2, butyric acid, and the natural trans fats including trans-palmitoleate. In addition, dairy fat is low in omega-6 polyunsaturated fat. I find it unlikely that their fancy math was able to tease those factors apart, because those substances all travel together in dairy fat. trans-palmitoleate pills are not going to replace butter.

****That's a joke. I think butter can be part of healthy diet, but that doesn't mean gorging on it is a good idea. This study does not prove that dairy fat prevents diabetes, it simply suggests that it may.

Nuts by numbers: Should you eat them, and how much?

Nuts are generally seen as good sources of protein and magnesium. The latter plays a number of roles in the human body, and is considered critical for bone health. Nuts are also believed to be good sources of vitamin E. While there is a lot of debate about vitamin E’s role in health, it is considered by many to be a powerful antioxidant. Other than in nuts, vitamin E is not easily found in foods other than seeds and seed oils.

Some of the foods that we call nuts are actually seeds; others are legumes. For simplification, in this post I am calling nuts those foods that are generally protected by shells (some harder than others). This protective layer is what makes most people call them nuts.

Let us see how different nuts stack up against each other in terms of key nutrients. The quantities listed below are per 1 oz (28 g), and are based on data from Nutritiondata.com. All are raw. Roasting tends to reduce the vitamin content of nuts, often by half, and has little effect on the mineral content. Protein and fat content are also reduced, but not as much as the vitamin content.

These two figures show the protein, fat, and carbohydrate content of nuts (on the left); and the omega-6 and omega-3 fat content (on the right).


When we talk about nuts, walnuts are frequently presented in a very positive light. The reason normally given is that walnuts have a high omega-3 content; the plant form of omega-3, alpha-linolenic acid (ALA). That is true. But look at the large amount of omega-6 in walnuts. The difference between the omega-6 and omega-3 content in walnuts is about 8 g! And this is in only 1 oz of walnuts. That is 8 g of possibly pro-inflammatory omega-6 fats to be “neutralized”. It would take many fish oil softgels to achieve that.

Walnuts should be eaten in moderation. Most studies looking at the health effects of nuts, including walnuts, show positive results in short-term interventions. But they usually involve moderate consumption, often of 1 oz per day. Eat several ounces of walnuts every day, and you are entering industrial see oil territory in terms of omega-6 fats consumption. Maybe other nutrients in walnuts have protective effects, but still, this looks like dangerous territory; “diseases of civilization” territory.

A side note. Focusing too much on the omega-6 to omega-3 ratio of individual foods can be quite misleading. The reason is that a food with a very small amount of omega-6 (e.g., 50 mg) but close to zero omega-3 will have a very high ratio. (Any number divided by zero yields infinity.) Yet, that food will contribute little omega-6 to a person’s diet. It is the ratio at the end of the day that matters, when all foods that have been eaten are considered.

The figures below show the magnesium content of nuts (on the left); and the vitamin E content (on the right).


Let us say that you are looking for the best combination of protein, magnesium, and vitamin E. And you also want to limit your intake of omega-6 fats, which is a very wise thing to do. Then what is the best choice? It looks like it is almonds. And even they should be eaten in small amounts, as 1 oz has more than 3 g of omega-6 fats.

Macadamia nuts don’t have much omega-6; their fats are mostly monounsaturated, which are very good. Their protein to fat ratio is very low, and they don’t have much magnesium or vitamin E. Coconuts (i.e., their meat) have mostly medium-chain saturated fats, which are also very good. Coconuts have little protein, magnesium, and vitamin E. If you want to increase your intake of healthy fats, both macadamia nuts and coconuts are good choices, with macadamia nuts providing about 3 times more fat.

There are many other dietary sources of magnesium around. In fact, magnesium is found in many foods. Examples are, in approximate descending order of content: salmon, spinach, sardine, cod, halibut, banana, white potato, sweet potato, beef, chicken, pork, liver, and cabbage. This is by no means a comprehensive list.

As for vitamin E, it likes to hide in seeds. While it may be a powerful antioxidant, I wonder whether Mother Nature really had it “in mind” as she tinkered with our DNA for the last few million years.

Sunday, December 19, 2010

Potato Diet Interpretation

If you read my post on December 16th, you know that Chris Voigt saw remarkable fat loss and improvements in health markers as a result of two months of eating almost nothing but potatoes. This has left many people scratching their heads, because potatoes are not generally viewed as a healthy food. This is partially due to the fact that potatoes are very rich in carbohydrate, which also happens to be a quickly digested type, resulting in a high glycemic index. The glycemic index refers to the degree to which a particular food increases blood glucose when it's eaten, and I've questioned the relevance of this concept to health outcomes in the past (1, 2, 3). I think Mr. Voigt's results once again argue against the importance of the glycemic index as a diet-health concept.

It's often pointed out that potatoes are low in vitamins and minerals compared to vegetables on a per-calorie basis, but I think it's a misleading comparison because potatoes are much more calorie-dense than most vegetables. Potatoes compare favorably to other starchy staples such as bread, rice and taro.

Over the course of two months, Mr. Voigt lost 21 pounds. No one knows exactly how much of that weight came out of fat and how much out of lean mass, but the fact that he reported a decrease in waist and neck circumference indicates that most of it probably came out of fat. Previous long-term potato feeding experiments have indicated that it's possible to maintain an athletic muscle mass on the amount of protein in whole potatoes alone (4). So yes, Mr. Voigt lost fat on a very high-carbohydrate diet (75-80% carbohydrate, up to 440g per day).

On to the most interesting question: why did he lose fat? Losing fat requires that energy leaving the body exceed energy entering the body. But of course, that's obvious but it doesn't get us anywhere. In the first three weeks of his diet, Mr. Voigt estimates that he was only eating 1,600 calories per day. Aha! That's why he lost weight! Well, yes. But let's look into this more deeply. Mr. Voigt was not deliberately restricting his calorie intake at all, and he did not intend this as a weight loss diet. In my interview, I asked him if he was hungry during the diet. He said that he was not hungry, and that he ate to appetite during this period, realizing only after three weeks that he was not eating nearly enough calories to maintain his weight*. I also asked him how his energy level was, and he said repeatedly that it was very good, perhaps even better than usual. Those were not idle questions.

Calorie restriction causes a predictable physiological response in humans that includes hunger and decreased energy. It's the starvation response, and it's powerful in both lean and overweight people, as anyone knows who has tried to lose fat by decreasing calorie intake alone. The fact that he didn't experience hunger or fatigue implies that his body did not think it was starving. Why would that be?

I believe Mr. Voigt's diet lowered his fat mass 'setpoint'. In other words, for whatever reason, the diet made his body 'want' to be leaner that it already was. His body began releasing stored fat that it considered excess, and therefore he had to eat less food to complete his energy needs. You see this same phenomenon very clearly in rodent feeding studies. Changes in diet composition/quality can cause dramatic shifts in the fat mass setpoint (5, 6). Mr. Voigt's appetite would eventually have returned to normal once he had stabilized at a lower body fat mass, just as rodents do.

Rodent studies have made it clear that diet composition has a massive effect on the level of fat mass that the body will 'defend' against changes in calorie intake (5, 6). Human studies have shown similar effects from changes in diet composition/quality. For example, in controlled diet trials, low-carbohydrate dieters spontaneously reduce their calorie intake quite significantly and lose body fat, without being asked to restrict calories (7). In Dr. Staffan Lindeberg's Paleolithic diet trials, participants lost a remarkable amount of fat, yet a recent publication from his group shows that the satiety (fullness) level of the Paleolithic group was not different from a non-Paleolithic comparison group despite a considerably lower calorie intake over 12 weeks (8, 9). I'll discuss this important new paper soon. Together, this suggests that diet composition/quality can have a dominant impact on the fat mass setpoint.

One possibility is that cutting the wheat, sugar, most vegetable oil and other processed food out of Mr. Voigt's diet was responsible for the fat loss.  Many people find, for example, that they lose fat simply by eliminating wheat from their diet.

Another possibility that I've been exploring recently is that changes in palatability (pleasantness of flavor) influence the fat mass setpoint. There is evidence in rodents that it does, although it's not entirely consistent. For example, rats will become massively obese if you provide them with chocolate flavored Ensure (a meal replacement drink), but not with vanilla or strawberry Ensure (10). They will defend their elevated fat mass against calorie restriction (i.e. they show a physiological starvation response when you try to bring them down to a lower weight by feeding them less chocolate Ensure) while they're eating chocolate Ensure, but as soon as you put them back on unpurified rodent pellets, they will lose fat and defend the lower fat mass. Giving them food in liquid or paste form often causes obesity, while the same food in solid pellet form will not. Eating nothing but potatoes is obviously a diet with a low overall palatability.

So I think that both a change in diet composition/quality and a decrease in palatability probably contributed to a decrease in Mr. Voigt's fat mass setpoint, which allowed him to lose fat mass without triggering a starvation response (hunger, fatigue).

The rest of his improvements in health markers were partially due to the fat loss, including his decreased fasting glucose, decreased triglycerides, and presumably increased insulin sensitivity. They may also have been partially due to a lack of industrial food and increased intake of certain micronutrients such as magnesium.

One of the most striking changes was in his calculated LDL cholesterol ("bad" cholesterol), which decreased by 41%, putting him in a range that's more typical of healthy non-industrial cultures including hunter-gatherers. Yet hunter-gatherers didn't eat nothing but potatoes, often didn't eat much starch, and in some cases had a high intake of fat and saturated fat, so what gives? It's possible that a reduced saturated fat intake had an impact on his LDL, given the relatively short timescale of the diet. But I think there's something mysterious about this setpoint mechanism that has a much broader impact on metabolism than is generally appreciated. For example, calorie restriction in humans has a massive impact on LDL, much larger than the impact of saturated fat (11). And in any case, the latter appears to be a short-term phenomenon (12). It's just beginning to be appreciated that energy balance control systems in the brain influence cholesterol metabolism.

Mr. Voigt's digestion appeared to be just fine on his potato diet, even though he generally ate the skins. This makes me even more skeptical of the idea that potato glycoalkaloids in common potato varieties are a health concern, especially if you were to eliminate most of the glycoalkaloids by peeling.

I asked Mr. Voigt about what foods he was craving during the diet to get an idea of whether he was experiencing any major deficiencies. The fact that Mr. Voigt did not mention craving meat or other high-protein foods reinforces the fact that potatoes are a reasonable source of complete protein. The only thing he craved was crunchy/juicy food, which I'm not sure how to interpret.

He also stopped snoring during the diet, and began again immediately upon resuming his normal diet, perhaps indicating that his potato diet reduced airway inflammation. This could be due to avoiding food allergies and irritants (wheat anyone?) and also fat loss.

Overall, a very informative experiment! Enjoy your potatoes.


*Until the last 5.5 weeks, when he deliberately stuffed himself beyond his appetite because his rapid weight loss worried him. Yet, even with deliberate overfeeding up to his estimated calorie requirement of 2,200 calories per day, he continued to lose weight. He probably was not quite reaching his calorie goal, or his requirement is higher than he thought.

Saturday, December 18, 2010

Trouble With RSS Feed?

I've received several comments that my blog posts are no longer showing up in peoples' RSS feeds. I've gone into my settings, and the blog is still set to full feed mode, so I don't know why that would be. I'm trying to understand if the problem is widespread or only affects a few people. Please let me know in the comments section if new posts (since the potatoes and human health series) are not showing up in your reader. Also, please let me know if new posts are showing up. Thanks!

Thursday, December 16, 2010

Interview with Chris Voigt of 20 Potatoes a Day

Introduction

Chris Voigt is the executive director of the Washington State Potato Commission, which supports and promotes the Washington state potato industry (1). On October 1st, Mr. Voigt began a two month, potato-only diet to raise awareness about the health properties of potatoes. It was partially in response to the recent decision by the federal WIC (Women, Infants and Children) low-income assistance program to remove potatoes from the list of vegetables it will pay for. Mr. Voigt's potato diet has been a media sensation, leading to widespread coverage in several countries. He maintains a website and blog called 20 Potatoes a Day.


Diet Facts


For 60 days, Mr Voigt's diet consisted of nothing but potatoes and a small amount of cooking oil (canola and olive), with no added nutritional supplements. Based on what he has told me, I estimate that 10-15% of his calories came from fat, 10% from protein and 75-80% from high-glycemic carbohydrate. His calorie intake ranged from 1,600 kcal (first 3 weeks) to 2,200 kcal (remaining 5.5 weeks) per day. Prior to the diet, he estimated that his calorie requirement was 2,200 kcal, so he attempted to stay as close to that as possible.

Health Markers

Mr. Voigt has posted the results of physical examinations, including bloodwork, from the beginning, middle and end of the diet. The change he experienced during that time is nothing short of remarkable. He shed 21 pounds, his fasting glucose decreased by 10 mg/dL (104 to 94 mg/dL), his serum triglycerides dropped by nearly 50%, his HDL cholesterol increased slightly, and his calculated LDL cholesterol dropped by a stunning 41% (142 to 84 mg/dL). The changes in his HDL, triglycerides and fasting glucose are consistent with improved insulin sensitivity (2, 3), and are not consistent with a shift of LDL particle size to the dangerous "small, dense" variety (4).

Interview
What was your diet like prior to the potato diet?
My best estimate is that it was probably a little better than the average US citizen only because of a high rate of produce consumption. I generally would eat about 10 servings of fruits and vegetables a day. But I ate everything else too. I would eat a wide range of food, a little bit of everything, including foods that aren’t considered “healthy”.
You essentially ate nothing but potatoes, fat and flavorings for two months. Can you give us an idea of how much fat you were eating? What kind of fat was it?
I averaged about 2 tablespoons of cooking oil a day over the span of the 60 days. Canola oil was used for frying and olive oil was used for roasting.


How was your digestion?
Potatoes are pretty easy on the digestive system. I actually got a lot of emails from people who suffer from severe digestive disorders and literally, potatoes are the only thing they can eat. My 60 days of potatoes was nothing compared to some folks with these digestive disorders. I was getting a lot of fiber so things were pretty regular, but not too regular :)

You lost 21 pounds during your two months of eating only potatoes. Do you have a sense of whether it came out of fat, muscle or both? For example, did your pants become looser?
Pants definitely became looser. I also noticed it in my neck size for shirts. I’m assuming most all of it was due to fat loss.

Do you think you were able to meet your calorie goal of 2,200 calories per day? Were you hungry during the diet?
I was not meeting the goal of 2,200 calories a day during the first 3 weeks of the diet. During the first three weeks of the diet I only ate until I was full. I didn’t realize that potatoes would give me such a high sense of fullness after each meal. So for those first 3 weeks, I was only consuming about 1,600 calories a day. After the third week I had lost 12 pounds and realized that I needed to change strategy. I then began to eat more potatoes despite the sense of fullness I was experiencing. So for the remaining 5 ½ weeks I was very diligent about eating the 2,200 calories. I continued to lose weight but at a slower place. I lost an additional 9 pounds over the course of those remaining 5 1/2 weeks. At the start of my diet I estimated, via a couple different on line calorie calculators, that I burn about 2,200 calories a day. Since I continued to lose weight, I’m assuming I actually burn closer to 2,800 calories a day. Something that may have also played a role in continued weight loss was the amount of resistant starch I was getting from potatoes. I ate a lot of cooked potatoes that had been refrigerated. These are generally higher in resistant starch. If I were to do the diet again, I would like to set up an experiment to gauge the effect of resistant starch.
What foods did you crave the most?
I craved mostly foods that had a “juicy crunch”, like an apple, or cucumbers, or carrots, or celery. I never acquired a taste for raw potatoes so virtually all the potatoes I consumed were cooked. No matter how you cook your potatoes, you always get that same soft cooked texture. I craved foods with a crisper texture.
How was your energy level?
My energy level was very good the entire time of the diet. I really didn’t notice a change in energy at the start of the diet so I assumed that the potato diet didn’t have a positive or negative effect on my energy level. It wasn’t until I finished the diet and started to consume other foods that I noticed my energy level has seemed to drop a bit.

How did you feel overall? Were there any unexpected effects of the diet?
I felt really good on the diet. I had lots of energy, slept good at night, and seemed to avoid the cold viruses that circulated at home and work.

The only unusual thing that occurred is what my wife told me. I’m a habitual snorer. The day I started eating only potatoes, my snoring stopped. It restarted the day I started to include other foods in my diet. I’m assuming it was just some weird coincidence but that’s what she tells me.

My doctor and I expected my cholesterol to drop but not at the level we saw. I’ve had borderline high cholesterol for the past decade. I started the diet at 214 and saw it drop to 147 at the end of 60 days. We anticipated a drop of maybe 10-25 points. It was a huge surprise to see a 67 point drop.
Your fasting glucose went from 104 mg/dL, which I consider high, to 94 mg/dL, which is on the high side for someone eating a high-carbohydrate diet, but within the clinically normal range. Do you have a family history of diabetes?
No history of diabetes. My parents are in their early eighties and their parents lived to their 70’s and 80’s with no history of type one or two diabetes.

Reading your blog posts, it seemed like you were having a hard time with the diet at first, but after a while you complained less and even seemed to enjoy it at times. Did you get used to it?
I would say that week 2 and 3 were probably the hardest. The first week was easy probably because of the novelty of the diet. Then reality set in for week 2 and 3. After that, I found my groove and it got easier. During the work week was easy but weekends, particularly Sunday’s, were the hardest. During the work week I did most of my eating at my desk so I wasn’t around a lot of other people eating or surrounded by other foods. Weekends were more difficult because I was around other people every meal and always had other foods in front of me at home.
What kinds of potatoes did you eat?
I literally ate every kind of potato I could get my hands on. I ate yellow skin/yellow flesh potatoes, red skin/white flesh, red skin/red flesh, purple skin/white flesh, purple skin/purple flesh, russet potatoes with white flesh, russet potatoes with yellow flesh, white potatoes, yellow potatoes with white flesh, purple fingerlings, yellow fingerlings, red fingerlings and numerous experimental varieties.
Did you peel them or eat the skin?
I ate the skin at least 90% of the time if not more. There is a myth that all the nutrition in a potato is in the skin or right under the skin. That’s not true, there are nutrients spread throughout the potato but most of the fiber is located in the skin.
What variety of potato is your favorite?
It really depended on the cooking method. For frying, I preferred russet potatoes. For baking, I preferred red potatoes. For mashed, I preferred yellow potatoes. For roasting, a toss-up between russets and reds.
How long did it take you after the diet ended to eat another potato?
As strange as it sounds, potatoes were my first two meals after my diet ended. I was saving my first non-potato meal for a special event that was planned at the local Head Start facility. The beef, dairy, apple, and potato producers put together a nice dinner event and nutrition workshop for all the kids and their parents at the Head Start center in Moses Lake. I still eat potatoes pretty regularly, but most of the time now I’m eating them with more than just seasonings.
Are there any other facts about potatoes you think Whole Health Source readers might find interesting?
Just a reminder that I’m not encouraging anyone to follow in my footsteps and eat just potatoes. This diet is not intended to be the next “fad” diet but was simply a bold statement to remind people that there is a tremendous amount of nutrition in a potato. There is no one food product that can meet all of your nutritional needs. I fully support a well balanced healthy diet, which potatoes can be a part of.

In 2008, the United Nations declared it to be the “Year of the Potato”. This was done to bring attention to the fact that the potato is one of the most efficient crops for developing nations to grow, as a way of delivery a high level of nutrition to growing populations, with fewer needed resources than other traditional crops. In the summer of 2010, China approved new government policies that positioned the potato as the key crop to feed its growing population. The Chinese government formed a partnership with the International Potato Center in Peru to help them facilitate this new emphasis on the potato.
Thanks Chris, for doing your experiment and taking the time to share these details with us!

In the next post, I'll give my interpretation of all this.

Maknig to mayn tipos? Myabe ur teh boz

Undoubtedly one of the big differences between life today and in our Paleolithic past is the level of stress that modern humans face on a daily basis. Much stress happens at work, which is very different from what our Paleolithic ancestors would call work. Modern office work, in particular, would probably be seen as a form of slavery by our Paleolithic ancestors.

Some recent research suggests that organizational power distance is a big factor in work-related stress. Power distance is essentially the degree to which bosses and subordinates accept wide differences in organizational power between them (Hofstede, 2001).

(Source: talentedapps.wordpress.com)

I have been studying the topic of information overload for a while. It is a fascinating topic. People who experience it have the impression that they have more information to process than they can handle. They also experience significant stress as a result of it, and both the quality of their work and their productivity goes down.

Recently some colleagues and I conducted a study that included employees from companies in New Zealand, Spain, and the USA (Kock, Del Aguila-Obra & Padilla-Meléndez, 2009). These are countries whose organizations typically display significant differences in power distance. We found something unexpected. Information overload was much more strongly associated with power distance than with the actual amount of information employees had to process on a daily basis.

While looking for explanations to this paradoxical finding, I recalled an interview I gave way back in 2001 to the Philadelphia Inquirer, commenting on research by Dr. David A. Owens. His research uncovered an interesting phenomenon. The higher up in the organizational pecking order one was, the less the person was concerned about typos on emails to subordinates.

There is also some cool research by Carlson & Davis (1998) suggesting that bosses tend to pick the communication media that are the most convenient for them, and don’t care much about convenience for the subordinates. One example would be calling a subordinate on the phone to assign a task, and then demanding a detailed follow-up report by email.

As a side note, writing a reasonably sized email takes a lot longer than conveying the same ideas over the phone or face-to-face (Kock, 2005). To be more precise, it takes about 10 times longer when the word count is over 250 and the ideas being conveyed are somewhat complex. For very short messages, a written medium like email is fairly convenient, and the amount of time to convey ideas may be even shorter than by using the phone or doing it face-to-face.

So a picture started to emerge. Bosses choose the communication media that are convenient for them when dealing with subordinates. If the media are written, they don’t care about typos at all. The subordinates use the media that are imposed on them, and if the media are written they certainly don’t want something with typos coming from them to reach their bosses. It would make them look bad.

The final result is this. Subordinates experience significant information overload, particularly in high power distance organizations. They also experience significant stress. Work quality and productivity goes down, and they get even more stressed. They get fat, or sickly thin. Their health deteriorates. Eventually they get fired, which doesn’t help a bit.

What should you do, if you are not the boss? Here are some suggestions:

- Try to tactfully avoid letting communication media being imposed on you all the time by your boss (and others). Explicitly state, in a polite way, the media that would be most convenient for you in various circusmtances, both as a receiver and sender. Generally, media that support oral speech are better for discussing complex ideas. Written media are better for short exchanges. Want an evolutionary reason for that? As you wish: Kock (2004).

- Discuss the ideas in this post with your boss; assuming that the person cares. Perhaps there is something that can be done to reduce power distance, for example. Making the work environment more democratic seems to help in some cases.

- And ... dot’n wrory soo mach aobut tipos ... which could be extrapolated to: don’t sweat the small stuff. Most bosses really care about results, and will gladly take an email with some typos telling them that a new customer signed a contract. They will not be as happy with an email telling them the opposite, no matter how well written it is.

Otherwise, your organizational demise may come sooner than you think.

References

Carlson, P.J., & Davis, G.B. (1998). An investigation of media selection among directors and managers: From "self" to "other" orientation. MIS Quarterly, 22(3), 335-362.

Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions, and organizations across nations. Thousand Oaks, CA: Sage.

Kock, N. (2004). The psychobiological model: Towards a new theory of computer-mediated communication based on Darwinian evolution. Organization Science, 15(3), 327-348.

Kock, N. (2005). Business process improvement through e-collaboration: Knowledge sharing through the use of virtual groups. Hershey, PA: Idea Group Publishing.

Kock, N., Del Aguila-Obra, A.R., & Padilla-Meléndez, A. (2009). The information overload paradox: A structural equation modeling analysis of data from New Zealand, Spain and the U.S.A. Journal of Global Information Management, 17(3), 1-17.

Monday, December 13, 2010

What is a reasonable vitamin D level?

The figure and table below are from Vieth (1999); one of the most widely cited articles on vitamin D. The figure shows the gradual increase in blood concentrations of 25-Hydroxyvitamin, or 25(OH)D, following the start of daily vitamin D3 supplementation of 10,000 IU/day. The table shows the average levels for people living and/or working in sun-rich environments; vitamin D3 is produced by the skin based on sun exposure.


25(OH)D is also referred to as calcidiol. It is a pre-hormone that is produced by the liver based on vitamin D3. To convert from nmol/L to ng/mL, divide by 2.496. The figure suggests that levels start to plateau at around 1 month after the beginning of supplementation, reaching a point of saturation after 2-3 months. Without supplementation or sunlight exposure, levels should go down at a comparable rate. The maximum average level shown on the table is 163 nmol/L (65 ng/mL), and refers to a sample of lifeguards.

From the figure we can infer that people on average will plateau at approximately 130 nmol/L, after months of 10,000 IU/d supplementation. That is 52 ng/mL. Assuming a normal distribution with a standard deviation of about 20 percent of the range of average levels, we can expect about 68 percent of the population to be in the 42 to 63 ng/mL range.

This might be the range most of us should expect to be in at an intake of 10,000 IU/d. This is the equivalent to the body’s own natural production through sun exposure.

Approximately 32 percent of the population can be expected to be outside this range. A person who is two standard deviations (SDs) above the mean (i.e., average) would be at around 73 ng/mL. Three SDs above the mean would be 83 ng/mL. Two SDs below the mean would be 31 ng/mL.

There are other factors that may affect levels. For example, being overweight tends to reduce them. Excess cortisol production, from stress, may also reduce them.

Supplementing beyond 10,000 IU/d to reach levels much higher than those in the range of 42 to 63 ng/mL may not be optimal. Interestingly, one cannot overdose through sun exposure, and the idea that people do not produce vitamin D3 after 40 years of age is a myth.

One would be taking in about 14,000 IU/d of vitamin D3 by combining sun exposure with a supplemental dose of 4,000 IU/d. Clear signs of toxicity may not occur until one reaches 50,000 IU/d. Still, one may develop other complications, such as kidney stones, at levels significantly above 10,000 IU/d.

See this post by Chris Masterjohn, which makes a different argument, but with somewhat similar conclusions. Chris points out that there is a point of saturation above which the liver is unable to properly hydroxylate vitamin D3 to produce 25(OH)D.

How likely it is that a person will develop complications like kidney stones at levels above 10,000 IU/d, and what the danger threshold level could be, are hard to guess. Kidney stone incidence is a sensitive measure of possible problems; but it is, by itself, an unreliable measure. The reason is that it is caused by factors that are correlated with high levels of vitamin D, where those levels may not be the problem.

There is some evidence that kidney stones are associated with living in sunny regions. This is not, in my view, due to high levels of vitamin D3 production from sunlight. Kidney stones are also associated with chronic dehydration, and populations living in sunny regions may be at a higher than average risk of chronic dehydration. This is particularly true for sunny regions that are also very hot and/or dry.

Reference

Vieth, R. (1999). Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. American Journal of Clinical Nutrition, 69(5), 842-856.

Saturday, December 11, 2010

Strength training: A note about Scooby and comments by Anon

Let me start this post with a note about Scooby, who is a massive bodybuilder who has a great website with tips on how to exercise at home without getting injured. Scooby is probably as massive a bodybuilder as anyone can get naturally, and very lean. He says he is a natural bodybuilder, and I am inclined to believe him. His dietary advice is “old school” and would drive many of the readers of this blog crazy – e.g., plenty of grains, and six meals a day. But it obviously works for him. (As far as muscle gain is concerned, a lot of different approaches work. For some people, almost any reasonable approach will work; especially if they are young men with high testosterone levels.)

The text below is all from an anonymous commenter’s notes on this post discussing the theory of supercompensation. Many thanks to this person for the detailed and thoughtful comment, which is a good follow-up on the note above about Scooby. In fact I thought that the comment might have been from Scooby; but I don’t think so. My additions are within “[ ]”. While the comment is there under the previous post for everyone to see, I thought that it deserved a separate post.

***

I love this subject [i.e., strength training]. No shortages of opinions backed by research with the one disconcerting detail that they don't agree.

First one opening general statement. If there was one right way we'd all know it by now and we'd all be doing it. People's bodies are different and what motivates them is different. (Motivation matters as a variable.)

My view on one set vs. three is based on understanding what you're measuring and what you're after in a training result.

Most studies look at one rep max strength gains as the metric but three sets [of repetitions] improves strength/endurance. People need strength/endurance more typically than they need maximal strength in their daily living. The question here becomes what is your goal?

The next thing I look at in training is neural adaptation. Not from the point of view of simple muscle strength gain but from the point of view of coordinated muscle function, again, something that is transferable to real life. When you exercise the brain is always learning what it is you are asking it to do. What you need to ask yourself is how well does this exercise correlate with a real life requirements.

[This topic needs a separate post, but one can reasonably argue that your brain works a lot harder during a one-hour strength training session than during a one-hour session in which you are solving a difficult mathematical problem.]

To this end single legged squats are vastly superior to double legged squats. They invoke balance and provoke the activation of not only the primary movers but the stabilization muscles as well. The brain is acquiring a functional skill in activating all these muscles in proper harmony and improving balance.

I also like walking lunges at the climbing wall in the gym (when not in use, of course) as the instability of the soft foam at the base of the wall gives an excellent boost to the basic skill by ramping up the important balance/stabilization component (vestibular/stabilization muscles). The stabilization muscles protect joints (inner unit vs. outer unit).

The balance and single leg components also increase core activation naturally. (See single legged squat and quadratus lumborum for instance.) [For more on the quadratus lumborum muscle, see here.]

Both [of] these exercises can be done with dumbbells for increased strength[;] and though leg exercises strictly speaking, they ramp up the core/full body aspect with weights in hand.

I do multiple sets, am 59 years old and am stronger now than I have ever been (I have hit personal bests in just the last month) and have been exercising for decades. I vary my rep ranges between six and fifteen (but not limited to just those two extremes). My total exercise volume is between two and three hours a week.

Because I have been at this a long time I have learned to read my broad cycles. I push during the peak periods and back off during the valleys. I also adjust to good days and bad days within the broader cycle.

It is complex but natural movements with high neural skill components and complete muscle activation patterns that have moved me into peak condition while keeping me from injury.

I do not exercise to failure but stay in good form for all reps. I avoid full range of motion because it is a distortion of natural movement. Full range of motion with high loads in particular tends to damage joints.

Natural, functional strength is more complex than the simple study designs typically seen in the literature.

Hopefully these things that I have learned through many years of experimentation will be of interest to you, Ned, and your readers, and will foster some experimentation of your own.

Anonymous

Monday, December 6, 2010

Pressure-cooked meat: Top sirloin

Pressure cooking relies on physics to take advantage of the high temperatures of liquids and vapors in a sealed container. The sealed container is the pressure-cooking pan. Since the sealed container does not allow liquids or vapors to escape, the pressure inside the container increases as heat is applied to the pan. This also significantly increases the temperature of the liquids and vapors inside the container, which speeds up cooking.

Pressure cooking is essentially a version of high-heat steaming. The food inside the cooker tends to be very evenly cooked. Pressure cooking is also considered to be one of the most effective cooking methods for killing food-born pathogens. Since high pressure reduces cooking time, pressure cooking is usually employed in industrial food processing.

When cooking meat, the amount of pressure used tends to affect amino-acid digestibility; more pressure decreases digestibility. High pressures in the cooker cause high temperatures. The content of some vitamins in meat and plant foods is also affected; they go down as pressure goes up. Home pressure cookers are usually set at 15 pounds per square inch (psi). Significant losses in amino-acid digestibility occur only at pressures of 30 psi or higher.

My wife and I have been pressure-cooking for quite some time. Below is a simple recipe, for top sirloin.

- Prepare some dry seasoning powder by mixing sea salt, garlic power, chili powder, and a small amount of cayenne pepper.
- Season the top sirloin pieces at least 2 hours prior to placing them in the pressure cooking pan.
- Place the top sirloin pieces in the pressure cooking pan, and add water, almost to the point of covering them.
- Cook on very low fire, after the right amount of pressure is achieved, for 1 hour. The point at which the right amount of pressure is obtained is signaled by the valve at the top of the pan making a whistle-like noise.

As with slow cooking in an open pan, the water around the cuts should slowly turn into a fatty and delicious sauce, which you can pour on the meat when serving, to add flavor. The photos below show the seasoned top sirloin pieces, the (old) pressure-cooking pan we use, and some cooked pieces ready to be eaten together with some boiled yam.




A 100 g portion will have about 30 g of protein. (That is a bit less than 4 oz, cooked.) The amount of fat will depend on how trimmed the cuts are. Like most beef cuts, the fat will be primarily saturated and monounsatured, with approximately equal amounts of each. It will provide good amounts of the following vitamins and minerals: iron, magnesium, niacin, phosphorus, potassium, zinc, selenium, vitamin B6, and vitamin B12.

Sunday, December 5, 2010

Interview with a Kitavan

Kitava is a Melanesian island that has maintained an almost entirely traditional, non-industrial diet until very recently. It was the subject of a study by Dr. Staffan Lindeberg and colleagues, which I have written about many times, in which they demonstrated that Kitavans have a very low (undetectable) rate of heart attack, stroke, diabetes and overweight. Dr. Lindeberg described their diet as consisting mostly of yam, sweet potato, taro, cassava, coconut, fruit, fish and vegetables. Over the seven days that Dr. Lindeberg measured food intake, they ate 69% of their calories as carbohydrate, 21% as fat (mostly from coconut) and 10% as protein.

I recently received an e-mail from a Kitavan by the name of Job Daniel. He's working at the Papua New Guinea Institute of Medical Research in Madang, studying the social and economic impacts of malaria and related health issues in Papua New Guinea. He recalls many details of Dr. Lindeberg's visit to Kitava, which Dr. Lindeberg has confirmed are correct. Job generously offered to answer some of my questions about the traditional Kitavan diet. My questions are in bold, and his responses are below.

How many meals a day do Kitavans eat?
People on the island eat mostly two meals a day. But nowadays, breakfast is mainly comprised of tubers (yam and sweet potato and greens all cooked in coconut cream and salt) and dinner is the same with the inclusion of fish as protein most often. In between these two meals, lunch is seen as a light refreshment with fruits or young coconut only to mention these two popular ones. In between the morning and the evening, we mostly eat fruits as snack or lunch. Generally speaking, there are only two main meals per day, i.e breakfast and dinner.

Do Kitavans eat any fermented food?

There are fermented fruits and nuts like you've said for breadfruit, nuts, yams and not forgetting fish. We ferment them by using the traditional method of drying them over the fire for months. And this fermented foods last for almost one to two years without getting stale or spoiled. Food preservation is a skill inherited from our great grand fathers taking into consideration the island's location and availability of food. Foods such as bread fruit and fish are fermented and preserved to serve as substitutes to fresh food in times of trouble or shortage. Otherwise, they're eaten along the way.

Is this really fermentation or simply drying?
To your query about the fermentation methods we use, apart from drying food over the fire, we also use this method like the Hawaiians do with taro [poi- SJG]. For our case we bury a special kind of fruit collected from the tree and buried in the ground to ripen, which takes about 2 - 3 days. I don't really know the English name, but we call it 'Natu' in vernecular. There's also a certain nut when it falls from the tree, women collect them and peel off the rotten skin, then mumu [earth oven- SJG] them in the ground covered with leaves to protect them from burning from the extreme heat of the fire, both from the open fire on top and hot stones underneath. After a day, the nuts are removed from the mumu and loaded into very big baskets which are then shifted to the sea for fermentation. This takes a week (minimum) to ferment or be ready for consumption at last. After the fermentation period is over, i.e one week some days or two
weeks to be exact, then the nuts are finally ready for eating. The length of time it takes before the nuts are no longer edible is roughly one week.

What parts of the fish are eaten?
As islanders, we eat almost every creature and body part of a sea creature. Especially fish eggs, it is one of the favorites of children. They always prefer it burnt on the fire and consumed greedily. Every part of the fish is eaten except for the feces, gall bladder, bones and the scales.

Is food shortage really rare on Kitava?
Generally speaking it is rare. BUT sometimes we run out of food only if there is a drought and the sea is useless. Otherwise, we tend to use the preserved or fermented foods on the dryer in the kitchen. As you would understand, we have seasons and they affect the type and availability of food on the island. In the beginning of the year, we eat sweet potato, cassava and mostly tuna for protein. During mid year, before yam comes in to replace sweet potato and cassava, taro is then ready for harvest. And then yams are ready for harvesting so the food supply is continued on. OK when yams are harvested, some are eaten, some are stored away for reserve and seedlings. In this way, we don't run out food towards the end of the year before sweet potato would be ready for harvest. So as you can see, the food supply on the island is somewhat planned by our ancestral economists where it continues throughout the year without stopping.

Do Kitavans traditionally eat pork, and if so, how often?
We do eat pork but not that often because pork meat is chiefly regarded important on the island. We only eat pork on special occasions so I'd rather say that pork is only eaten occasionally. In most cases in the middle of the year when the yams are harvested (yam harvest celebrations and towards the end of the year for certain rites and activities). Otherwise the everyday meal is always topped with fish.

How long are infants breast fed on Kitava?
Women breast feed for a minimum of 2 years. But breast feeding is again determined by the size and health situation of the baby. If the baby is looking healthy and big, it is most likely that this baby would be adopted temporarily by someone else so as to be removed from breast milk after two years of age minimum. Child care nowadays is paramount as people start to realize the importance of health and hygiene in general. But Kitavans are well known in that part of the country for their hygiene practices. They also got the provincial and district awards for a 'clean community' in early 90s and right now, they still maintain their hygiene level and awareness.

Are there any other foods that are commonly eaten on Kitava that I might not be aware of?
Bananas, pineapple, corn and watermelons. For watermelon and corn, they are plentiful especially at this time of the year.

Thanks for your help, Job! I know many people will appreciate reading these responses.

Thursday, December 2, 2010

Diet-Heart Controlled Trials: a New Literature Review

Many controlled studies have measured the cardiovascular effects of replacing animal ("saturated") fats with seed oils (predominantly the omega-6 polyunsaturated fat linoleic acid) in humans. A number of these studies recorded heart attacks and total mortality during the following 1-8 years. Several investigators have done meta-analyses (literature reviews) to try to tease out overall conclusions from these studies.

I'm pleased to point out a new meta-analysis of these controlled trials by Dr. Christopher Ramsden and colleagues (1). This paper finally cleans up the mess that previous meta-analyses have made of the diet-heart literature. One recent paper in particular by Dr. Dariush Mozaffarian and colleagues concluded that overall, the controlled trials show that replacing animal fat with linoleic acid (LA)-rich seed oils reduces heart attack risk (2). I disagreed strongly with their conclusion because I felt their methods were faulty (3).

Dr. Ramsden and colleagues pointed out several fundamental flaws in the review paper by Dr. Mozaffarian and colleagues, as well as in the prevailing interpretation of these studies in the scientific literature in general. These overlap with the concerns that I voiced in my post (4):
  1. Omission of unfavorable studies, including the Rose corn oil trial and the Sydney diet-heart trial.
  2. Inclusion of weak trials with major confounding variables, such as the Finnish mental hospital trial.
  3. Failure to distinguish between omega-6 and omega-3 fatty acids.
  4. Failure to acknowledge that seed oils often replaced large quantities of industrial trans fats in addition to animal fat in these trials.
Dr. Ramsden and colleagues accounted for all of these factors in their analysis, which has never been done before. They chose inclusion criteria* that made sense, and stuck with them. In addition, they did an impressive amount of historical work, digging up old unpublished data from these trials to determine the exact composition of the control and experimental diets. The paper is published in the British Journal of Nutrition, an excellent journal, and overall is written in a scientific and professional manner.

What did they find?
  • Interventions that replaced animal and trans fat with seed oils that were rich in LA but low in omega-3 caused a non-significant trend toward increased heart attacks (13% increase) and overall mortality.
  • Interventions that replaced animal and trans fat with a combination of LA and omega-3 fats significantly reduced heart attacks (by 22%). The numbers for total mortality followed a similar trend.
In other words, LA-rich seed oils do not prevent heart attacks (and may actually promote them), but correcting an omega-3 deficiency and reducing industrial trans fat intake may be protective. This is similar to what I've been saying for a while now, based on my own interpretation of the same studies and others. However, Dr. Ramsden and colleagues have taken the idea to a new level by their thorough and sophisticated detective work and analysis. For example, I didn't realize that in virtually all of these controlled trials, the intervention group reduced its trans fat intake substantially in addition to reducing animal fat. From the paper:
...experimental diets replaced common ‘hard’ margarines, industrial shortenings and other sources of [trans fat] in all seven of the [controlled trials] included in the meta-analysis by Mozaffarian et al. The mean estimated [trans fat] content of the seven control diets was 3·0 [% of calories] (range 1·5–9·6 [%]).
...the displacement of [trans fat], rather than the substitution of mixed n-3/n-6 [polyunsaturated fat] for [saturated fat], may account for some or all of the 22% reduction in non-fatal [heart attacks and heart attack] death in our meta-analysis. By contrast, the increased [heart attack] risks from n-6 specific [polyunsaturated fat] diets in our meta-analysis may be underestimated as n-6 [polyunsaturated fat] also replaced substantial quantities of [trans fat] (Table 3). The consistent trends towards increased [heart attack] risk of n-6 specific [polyunsaturated fat] diets may have become significant if the n-6 [polyunsaturated fat] replaced only [saturated fat], instead of a combination of [saturated fat] and [trans fat].
In other words, it looks like trans fat is probably the issue, not animal fat, but these trials replaced both simultaneously so we can't know for sure. I will note here that trans fat does not generally promote atherosclerosis (thickening and hardening of arteries) in animal models, so if it does truly increase heart attack risk as many studies suggest, it's probably through a mechanism that is independent of atherosclerosis.

The article also contains an excellent discussion of the Finnish mental hospital trial (5, 6) and why it was excluded from the meta-analysis, in which Dr. Ramsden and colleagues point out major design flaws, some of which I was not aware of. For example, trans fat intake was on average 13 times higher in the control groups than in the experimental groups. In addition, one of the control groups received more than twice as much of the antipsychotic drug thioridazine, which is known to be highly toxic to the heart, as any other group. Ouch. I'm glad to see this study finally discussed in an open and honest manner. I discussed my own problems with the Finnish trial in an earlier post (7).

I was also glad to see an open discussion of the Oslo Diet-heart study (8), in which diet changes led to a reduction in heart attack risk over five years. Dr. Mozaffarian and colleagues included it in their analysis as if it were a controlled trial in which animal fat was replaced by seed oils only. In reality, the investigators changed many variables at once, which I had also pointed out in my critique of Dr. Mozaffarian's meta-analysis (9). Here's what Dr. Ramsden and colleagues had to say about it:
First, experimental dieters were instructed to substitute fish, shellfish and ‘whale beef’ for meats and eggs, and were actually supplied with ‘considerable quantities of Norwegian sardines canned in cod liver oil, which proved to be popular as a bread spread’(32)... Second, the experimental group consumed massive amounts of soybean oil, which provided large quantities of both LA (15·6 en %) and ALA (2·7 en %). ALA consumption was about 4·5 times average US intake(42), or about twelve typical flax oil pills (1 g pill ¼ 560 mg ALA) per d. In addition, the fish and cod liver oil consumption provided Oslo (598N latitude) dieters with 610 IU (15·25 mg) of daily vitamin D3, recently linked to lower blood pressure, plaque stabilisation, and reduced [heart attack risk] (64). Furthermore, experimental dieters were encouraged to eat more nuts, fruits, and vegetables; to limit animal fats; and to restrict their intake of refined grains and sugar.
trans fat intake was also reduced substantially by excluding margarine in the experimental group. Other review papers have used this trial as a justification to replace animal fat with seed oils. Hmm... The only reason they get away with this is because the trial was published in 1966 and almost no one today has actually read it.

One criticism I have of Dr. Ramsden's paper is that they used the Oslo trial in their analysis, despite the major limitation described above. However, they were extremely open about it and discussed the problem in detail. Furthermore, the overall result would have been essentially the same even if they had excluded the Oslo trial from the analysis.

Overall, the paper is an excellent addition to the literature, and I hope it will bring a new level of sophistication to the dialogue on dietary prevention of cardiovascular disease. In the meantime, brace yourselves for an avalanche of criticism from the seed oil brigade.


* Guidelines that determine which studies to include in the analysis. For example, you want to exclude any study that wasn't randomized, because it will not be interpretable from a statistical standpoint. You also want to exclude trials where major variables differ between groups besides the specific variable you're trying to test. The Finnish mental hospital trial fails by both criteria.

How lean should one be?

Loss of muscle mass is associated with aging. It is also associated with the metabolic syndrome, together with excessive body fat gain. It is safe to assume that having low muscle and high fat mass, at the same time, is undesirable.

The extreme opposite of that, achievable though natural means, would be to have as much muscle as possible and as low body fat as possible. People who achieve that extreme often look a bit like “buff skeletons”.

This post assumes that increasing muscle mass through strength training and proper nutrition is healthy. It looks into body fat levels, specifically how low body fat would have to be for health to be maximized.

I am happy to acknowledge that quite often I am working on other things and then become interested in a topic that is brought up by Richard Nikoley, and discussed by his readers (I am one of them). This post is a good example of that.

Obesity and the diseases of civilization

Obesity is strongly associated with the diseases of civilization, of which the prototypical example is perhaps type 2 diabetes. So much so that sometimes the impression one gets is that without first becoming obese, one cannot develop any of the diseases of civilization.

But this is not really true. For example, diabetes type 1 is also one of the diseases of civilization, and it often strikes thin people. Diabetes type 1 results from the destruction of the beta cells in the pancreas by a person’s own immune system. The beta cells in the pancreas produce insulin, which regulates blood glucose levels.

Still, obesity is undeniably a major risk factor for the diseases of civilization. It seems reasonable to want to move away from it. But how much? How lean should one be to be as healthy as possible? Given the ubiquity of U-curve relationships among health variables, there should be a limit below which health starts deteriorating.

Is the level of body fat of the gentleman on the photo below (from: ufcbettingtoday.com) low enough? His name is Fedor; more on him below. I tend to admire people who excel in narrow fields, be they intellectual or sport-related, even if I do not do anything remotely similar in my spare time. I admire Fedor.


Let us look at some research and anecdotal evidence to see if we can answer the question above.

The buff skeleton look is often perceived as somewhat unattractive

Being in the minority is not being wrong, but should make one think. Like Richard Nikoley’s, my own perception of the physique of men and women is that, the leaner they are, the better; as long as they also have a reasonable amount of muscle. That is, in my mind, the look of a stage-ready competitive natural bodybuilder is close to the healthiest look possible.

The majority’s opinion, however, seems different, at least anecdotally. The majority of women that I hear or read voicing their opinions on this matter seem to find the “buff skeleton” look somewhat unattractive, compared with a more average fit or athletic look. The same seems to be true for perceptions of males about females.

A little side note. From an evolutionary perspective, perceptions of ancestral women about men must have been much more important than perceptions of ancestral men about women. The reason is that the ancestral women were the ones applying sexual selection pressures in our ancestral past.

For the sake of discussion, let us define the buff skeleton look as one of a reasonably muscular person with a very low body fat percentage; pretty much only essential fat. That would be 10-13 percent for women, and 5-8 percent for men.

The average fit look would be 21-24 percent for women, and 14-17 percent for men. Somewhere in between, would be what we could call the athletic look, namely 14-20 percent for women, and 6-13 percent for men. These levels are exactly the ones posted on this Wikipedia article on body fat percentages, at the time of writing.

From an evolutionary perspective, attractiveness to members of the opposite sex should be correlated with health. Unless we are talking about a costly trait used in sexual selection by our ancestors; something analogous to the male peacock’s train.

But costly traits are usually ornamental, and are often perceived as attractive even in exaggerated forms. What prevents male peacock trains from becoming the size of a mountain is that they also impair survival. Otherwise they would keep growing. The peahens find them sexy.

Being ripped is not always associated with better athletic performance

Then there is the argument that if you carried some extra fat around the waist, then you would not be able to fight, hunt etc. as effectively as you could if you were living 500,000 years ago. Evolution does not “like” that, so it is an unnatural and maladaptive state achieved by modern humans.

Well, certainly the sport of mixed martial arts (MMA) is not the best point of comparison for Paleolithic life, but it is not such a bad model either. Look at this photo of Fedor Emelianenko (on the left, clearly not so lean) next to Andrei Arlovski (fairly lean). Fedor is also the one on the photo at the beginning of this post.

Fedor weighed about 220 lbs at 6’; Arlovski 250 lbs at 6’4’’. In fact, Arlovski is one of the leanest and most muscular MMA heavyweights, and also one of the most highly ranked. Now look at Fedor in action (see this YouTube video), including what happened when Fedor fought Arlovski, at around the 4:28 mark. Fedor won by knockout.

Both Fedor and Arlovski are heavyweights; which means that they do not have to “make weight”. That is, they do not have to lose weight to abide by the regulations of their weight category. Since both are professional MMA fighters, among the very best in the world, the weight at which they compete is generally the weight that is associated with their best performance.

Fedor was practically unbeaten until recently, even though he faced a very high level of competition. Before Fedor there was another professional fighter that many thought was from Russia, and who ruled the MMA heavyweight scene for a while. His name is Igor Vovchanchyn, and he is from the Ukraine. At 5’8’’ and 230 lbs in his prime, he was a bit chubby. This YouTube video shows him in action; and it is brutal.

A BMI of about 25 seems to be the healthiest for long-term survival

Then we have this post by Stargazey, a blogger who likes science. Toward the end the post she discusses a study suggesting that a body mass index (BMI) of about 25 seems to be the healthiest for long-term survival. That BMI is between normal weight and overweight. The study suggests that both being underweight or obese is unhealthy, in terms of long-term survival.

The BMI is calculated as an individual’s body weight divided by the square of the individual’s height. A limitation of its use here is that the BMI is a more reliable proxy for body fat percentage for women than for men, and can be particularly misleading when applied to muscular men.

The traditional Okinawans are not super lean

The traditional Okinawans (here is a good YouTube video) are the longest living people in the world. Yet, they are not super lean, not even close. They are not obese either. The traditional Okinawans are those who kept to their traditional diet and lifestyle, which seems to be less and less common these days.

There are better videos on the web that could be used to illustrate this point. Some even showing shirtless traditional karate instructors and students from Okinawa, which I had seen before but could not find again. Nearly all of those karate instructors and students were a bit chubby, but not obese. By the way, karate was invented in Okinawa.

The fact that the traditional Okinawans are not ripped does not mean that the level of fat that is healthy for them is also healthy for someone with a different genetic makeup. It is important to remember that the traditional Okinawans share a common ancestry.

What does this all mean?

Some speculation below, but before that let me tell this: as counterintuitive as it may sound, excessive abdominal fat may be associated with higher insulin sensitivity in some cases. This post discusses a study in which the members of a treatment group were more insulin sensitive than the members of a control group, even though the former were much fatter; particularly in terms of abdominal fat.

It is possible that the buff skeleton look is often perceived as somewhat unattractive because of cultural reasons, and that it is associated with the healthiest state for humans. However, it seems a bit unlikely that this applies as a general rule to everybody.

Another possibility, which appears to be more reasonable, is that the buff skeleton look is healthy for some, and not for others. After all, body fat percentage, like fat distribution, seems to be strongly influenced by our genes. We can adapt in ways that go against genetic pressures, but that may be costly in some cases.

There is a great deal of genetic variation in the human species, and much of it may be due to relatively recent evolutionary pressures.

Life is not that simple!

References

Buss, D.M. (1995). The evolution of desire: Strategies of human mating. New York, NY: Basic Books.

Cartwright, J. (2000). Evolution and human behavior: Darwinian perspectives on human nature. Cambridge, MA: The MIT Press.

Miller, G.F. (2000). The mating mind: How sexual choice shaped the evolution of human nature. New York, NY: Doubleday.

Zahavi, A. & Zahavi, A. (1997). The Handicap Principle: A missing piece of Darwin’s puzzle. Oxford, England: Oxford University Press.