Thursday, December 25, 2008

The Fundamentals

I heard an interview of Michael Pollan yesterday on Talk of the Nation. He made some important points about nutrition that bear repeating. He's fond of saying "don't eat anything your grandmother wouldn't recognize as food". That doesn't mean your grandmother specifically, but anyone's grandmother, whether she was Japanese, American or African. The point is that commercial food processing has taken us away from the foods, and traditional food preparation methods, on which our bodies evolved to thrive. At this point, we don't know enough about health to design a healthy synthetic diet. Diet and health are too complex for reductionism at our current level of understanding. For that reason, any departure from natural foods and traditional food processing techniques is suspect.

Mainstream nutrition science has repeatedly contradicted itself and led us down the wrong path. This means that traditional cultures still have something to teach us about health. Hunter-gatherers and certain other non-industrial cultures are still the healthiest people on Earth, from the perspective of non-communicable disease. Pollan used the example of butter. First we thought it was healthy, then we were told it contains too much saturated fat and should be replaced with hydrogenated vegetable margarine. Now we learn that trans fats are unhealthy, so we're making new margarines that are low in trans fats, but are still industrially processed pseudo-foods. How long will it take to show these new fats are harmful? What will be the next industrial fat to replace them? This game can be played forever as the latest unproven processed food replaces the previous one, and it will never result in something as healthy as real butter.

The last point of Pollan's I'll mention is that the world contains (or contained) a diversity of different cultures, living in dramatically different ways, many of which do not suffer from degenerative disease. These range from carnivores like the Inuit, to plant-heavy agriculturalists like the Kitavans, to pastoralists like the Masai. The human body is adapted to a wide variety of foodways, but the one it doesn't seem to like is the modern Western diet.

Pollan's new book is In Defense of Food. I haven't read it, but I think it would be a good introduction to the health, ethical and environmental issues that surround food choices. He's a clear and accessible writer.

Merry Christmas, happy Hanukkah, and happy holidays to everyone!

36 comments:

rnikoley said...

Cool, Stephan. I'm going to see if I can access that on NPR's site.

Interesting points about the complexity thing. We must have been communicating via ESP while both writing our latest posts.

http://www.freetheanimal.com/root/2008/12/vitamin-supplements.html

Brock Cusick said...

Having just read Nutrition and Physical Degeneration in the last month, I did notice one thing - while all of the populations Weston Price studies were in marvelous health relative to the average Westerner, the healthiest of the populations (dentally, at least) were the ones closest to pure carnivorism. The Inuit and Masai (as I recall) had 99-100% immunity to dental caries while the agriculturalist populations that supplemented with some animal fats had "only" 94-96% immunity. The populations with very high fish and shellfish diets were in the 98% range.

Just "food for thought."

Stephan said...

Richard,

Good post, I feel the same way.

Brock,

That's a good point. I also think it's interesting that (if I recall correctly) among the healthy cultures, the one with the highest cavity rate was also the only one that ate gluten. It was the Swiss villagers of the Loetschental valley.

Bryan - oz4caster said...

Eat like Michael Pollan?

While I agree with most of Pollan's diet recommendations, I disagree with his gorilla diet of "eat mostly plants, especially leaves". I prefer Prices' top foods: animal seafoods, organ meats, and dairy for optimal health. Plants should be secondary and only when properly prepared to minimize anti-nutrients and plant toxins (although that would fit in with his traditional approach to diet).

Just my 2 cents :)

Brock Cusick said...

Why would anyone think that eating like a gorilla is a good idea? Our digestive system is nothing like theirs. Ours is most similar to a dog's, while theirs is more like a cow's. They can synthesize the essential amino acids internally which we need to get from animal proteins. It also wouldn't surprise me to learn that they retained the ability to convert K1 to K2, which humans appear to have mostly lost.

Matt Stone said...

I just like picking on Pollan because he thinks he's like the smartest person in the world - a renegade crusading against commodity agriculture. Oops Pollan, your "mostly plants" advice unfortunately stems, in large part, from the influence that those very industries had over what eventually became, modern Bob Greene-ism.

Telling someone in America with hyperinsulinemia to eat mostly plants and don't eat too much is like telling someone not to masturbate, but watch 'mostly porn.'

FUMP that.

Juhana Harju said...

Stephan, Pollan's idea is romantic and it sounds nice when you first here it. However, I had a grandmother who ate whole and easily recognizable foods - potatoes, meat, full fat dairy, butter, and bread, but still she got the heart disease. So it seems that while Pollan's suspicion about highly processed industrial foods is correct, the advise of "don't eat anything your grandmother wouldn't recognize as food" may not be sufficient to lead to successful results. Not everything that is traditional is healthy.

Robert Andrew Brown said...

What Granny ate.

It may look like what granny ate, and be called what granny ate but is it what granny ate???

The centrality of minerals including iodine to health ties in with marine foods as the Price no 1. Marine foods are high in minerals including iodine.

Minerals in foodstuffs have decreased significantly over the last 50 years 20-70% depending on what mineral you look at.

That will go through into grass and feedstock so into meat and dairy, and we are back to the better nutrient content of wider grazing livestock etc.


We are also back to questions as to how we maintain the land organic fertilizers, human waste etc.

What happens to sewage solids these days (apart form dumping in seas lakes and rivers) and to what extent are they polluted with drugs heavy metals and toxins from our diet??

This is a link to a paper to 1991. There is a later one by David Thomas to 2002.

A study on the mineral depletion of the foods available to us as a nation over the period 1940 to 1991.

http://www.organicgarden.org.uk/files/min_dep_report.pdf



Juhana

Please see my post / question below on iodine and incidence of cardiac disease in Finland


Robert Brown

Author Omega Six The Devils Fat

www,omegasixthedevilsfat.com

Juhana Harju said...

Robert,

It appears that iodine deficiency was not a problem there. Please see my comments in the previous blog entry.

Stephan said...

Those are all good points. I don't agree with everything Pollan says, but I think he has a firm grip on the fundamentals. For example, he recognizes that the Inuit were healthy on a carnivorous diet, so he's not 100% stuck on a plant-based diet where health is concerned. It's just a small step from there to realize that hunter-gatherers didn't eat leaves very often! I think some of his recommendations stem from legitimate environmental concerns as well.

Scott W said...

I am currently reading Nutrition and Physical Degeneration by Price and am greatly influenced by its conclusions in my own life. My question is how closely we can realistically pursue this ideal on a society-wide basis. My wife teaches in one of the lowest-income neighborhoods in the state of Washington (US) and photos of the the parents and kids could easily be substituted for Price's post-western-contact pictures: rotting teeth (even setting aside the impact of meth), deformed dental arches, physical deformities leading to speech and physical deformities, etc. 1/3 of the kids are prescribed ADD/ADHD meds, a condition which is undoubtedly nutrition-influenced.

Bear in mind that American taxpayers are feeding these families: WIC (Women, Infants, Children) program for mothers, food stamps for the parents and free breakfast and lunch year-round for the kids. And the garbage my wife sees these kids eating in the cafeteria is nothing but processed stuff that fits within the food pyramid, which must be followed by law for government feeding programs.

Taxpayers are also paying for the dental and health care of these families, who (once again setting aside the impact of drugs) place a disproportionate burden on the medical system due in large part to horrible nutrition. This is the case now when they are accessing Medicaid and will the be case in the future if we move to more universal care.

I make no excuses for being poor; these parents simply make many bad choices. Example: Kids with rotting teeth not being taken in for state-provided free dental service because it would be inconvenient for the parents. Example: Kids with poor eyesight who can't see the blackboard not being taken in for state-provided free vision exams and free glasses for the same reason.

Note: Not all of the parents are like this; some really do care. Second note: My wife loves these kids and her job and prefers this school to any others in our district.

My points, and this is for discussion only as I certainly don't have any good answers:

1) There is a huge impact on society stemming from poor nutrition.

2) The vast majority of people are unable and/or unwilling to prioritize nutrition.

3) Food for the masses will continue to prioritize plant-based nutrition ahead of animal-based nutrition for the foreseeable future. The economics, while regrettable, make this unavoidable.

4) It is important to solve this horrible state of nutrition to lower the huge impact on society and taxpayers and innocents (children) who have no say in what they put in their mouths.

5) An 80% or 90% solution, based on current knowledge, manipulation of existing commodity food stocks and supplementation, would be better than waiting for a 100% solution based on whole foods.

What does this look like? Who knows. But I do know that it would be possible to take the following steps with relatively little disruption to our food industry:

1)Replace wheat flour with nearly any other flour (rice, etc.) or process wheat to remove the gluten and other anti-nutrients while retaining the starch as a base ingredient. A gluten-like additive would have to be developed, but if they can make a Twinkie surely this is not impossible.

2) Replace vegetable oil by returning to tallow and lard from the factory farm industry.

3) Replace sugar with pure dextrose in cooking (to obtain the chemical properties conveyed by sugar in recipes)and by artificial sweeteners in soft drinks.

4) Return dairy products to full fat.

5) Provide a daily supplement that incorporates a normal vitamin pill plus high doses of A and D, extra K and EPA/DHA.

Based on the evidence gathered by Price and our current knowledge, these steps (which could be implemented now with little new technology) would probably solve 80% to 90% of our nutrition-induced problems in the developled world.

Yes, this is a "frankenfood" approach. As for myself, I won't eat this way and I suspect that none of the other readers of this excellent blog will either. And we would be free to pursue our own road to health and continue to encourage a fundamental societal shift to whole foods. But in the meantime, untold amounts of expense and human misery could be ameliorated by a somewhat synthetic approach to human nutrition.

Just a thought piece as we search for solutions for the world at large in our little corner of the blogosphere. And thank you to Stephan for maintaining this thought-provoking forum.

Scott W

Dr. B G said...

Scott W,

You're opening the doors for GINORMOUS political discussions here...

Guess who pays for that $100,000 heart attack and subsequent disability Mr. and Mrs. Wheat-Belly at McDonald's are going to have?

Guess who pays for the un-employment for the children who cannot obtain work after being brain-damaged from poor nutrition/omega-6/refined carbs provided by public school cafeterias and ignorant (though well-intended) parents?

-G

Mark said...

First, thank you for the blog, it's a great resource that affirms my beliefs behind diet. I have a couple of questions that may have been answered in the past and if so, I apologize for repetition:

1. Regarding dairy, I know the more fermented and concentrated sources are recommended like butter and cream but what are your thoughts on organic whole milk and full-fat greek yogurt (or even 2% because Stop and Shop doesn't carry full fat all the time)

2. Natural Protein Powder, Optimum Nutrition carries a product that looks pretty natural as it uses Stevia. Just not sure if I should stay away due to the insulin response of stevia and the processing of the whey
http://www.optimumnutrition.com/products/natural-100-whey-gold-standard-p-202.html?zenid=a31e7b4a69f73fc2e0e6ae84b12b78c1

3. Does anyone know of an insulin index as I think this would be more useful than glycemic index (I'm just not sure about fructose).

Thank You!

Richard Nikoley said...

Stephan:

A bit off-topic, but since high-fat and carnivory have been discussed vis-a-vis Pollan, what they hey?

Someone dropped a comment at my place asking about this study purportedly showing that a high-fat diet during pregnancy sets up the offspring for overeating.

http://news.bbc.co.uk/2/hi/health/7721438.stm

I found the full text:

http://tinyurl.com/9kts28

I got through some of it and put up a comment in reply.

http://tinyurl.com/7g98yn

Don't know if you consider any of that worthy of your attention, but since you're the resident neurobiologist, who else would I tell? :)

Debs said...

Pollan's idea about foods your grandmother wouldn't recognize may need to be taken back a generation for those of us who are younger. I'm realizing, after the last few days spent with my grandmother, that her generation (born in the 20s) spent a lot of time cooking in the 50s and beyond when foods of tradition started being replaced by foods of convenience.

Homemade chicken broth was replaced by canned stuff with three kinds of MSG. Good butter turned into a tub of whipped "butter" that's half vegetable oil.

Unlike many of her generation, she still shops at a farmers market religiously. But she's definitely internalized some of the marketing about convenience and new food over the last few decades.

I wonder what her grandmother would have thought.

Debs
Food Is Love/Seattle Local Food

Stephan said...

True, he must be talking about his own grandmother, who would be older than our grandmothers.

Stephan said...

Scott W,

You bring up many good points. I think one thing that's useful to keep in mind is that animal foods don't have to make up the majority of calories. Poor people have been making their diets work for thousands of years by the judicious selection and preparation of starchy tubers and grains, along with limited amounts of nutrient-dense animal foods. I think it's a cultural problem. We've lost our knowledge, our motivation and our time.

That being said, of course part of the problem is that we have cheap, convenient processed food in our faces all the time. That stems at least partly from farm bill subsidies that keep prices artificially low on wheat, corn and soybeans.

I like some of your ideas. One idea that's already being implemented is breeding oil seeds that are low in linoleic acid, such as high-oleic sunflower oil. We're feeding beef tallow back to cows on feedlots, so we could definitely reclaim that for the deep fryers. I'm definitely all for bringing back full-fat milk.

I was just looking at a graph of butter and margarine consumption in the US and the decrease in butter intake and corresponding increase in margarine lines up pretty well with the cardiovascular disease epidemic in the US int he 20th century. It's just an association, but interesting nonetheless.

Mark,

1) Go for it.

2) Industrially processed food is not healthy even if it comes from a nutrition store.

3) There have been a few studies on the insulin index of foods. Some protein foods have unexpectedly high insulin indices, most notably dairy protein. You can find it bumping around on the internet if you Google it.

Richard,

Just took a quick look. They didn't control for linoleic acid. The high-fat diet contained more LA, perhaps as much as 10% total by calories. LA seems to have developmental effects on fat mass, why not appetite? I'd like to see it repeated where they control for the amount of LA and the omega-3 content. Eating industrial lard and vegetable oil as your sole fats will give you a terrible n-6/n-3 ratio.

It really annoys me how "high-fat diet" means so many different things in different studies. It seems to me that they adjust the fat composition until they get the result they want, then simply label it as high-fat. Sometimes thay even add sugar to it without mentioning it outside the methods section!

Juhana Harju said...

Stephan wrote:

"I was just looking at a graph of butter and margarine consumption in the US and the decrease in butter intake and corresponding increase in margarine lines up pretty well with the cardiovascular disease epidemic in the US int he 20th century. It's just an association, but interesting nonetheless."

How do you explain the results of the Lyon Diet Heart Trial? One of the major changes was that butter was replaced with a rapeseed oil based margarine. This resulted over 70 lower cardiovascular mortality. If a good quality margarine would be an unhealthy choice that kind of result would not be possible. (It is obvious that margarines containing transfats should be avoided.)

LeenaS said...

To juhana:
Actually, replacing butter with rapeseed margarine was not the major change in Lyon, not even in fats. The main (although quite well hidden) idea was that margarines with plenty of omega-6 and transfats were replaced with a trans-fat free alternative lower in omega-6, while further improving the omega6/omega3 balance with fish oil suplements.

This bit of evidence is clearly shown in the omega-6 data of the Lyon study. Replacing butter (or animal any fat) with rapeseed cannot decrease omega-6 content but increases it. And the omega-6 was clearly decreased in Lyon.

Juhana Harju said...

Leena,

There was also a decrease in saturated fats in the intervention group. That shows that some butter was replaced with margarine. It should be noticed that the intervention group was also advised to use olive oil or rapeseed oil. The observed decrease in omega-6 fats was probably due to replacement of omega-6 rich vegetable oils with olive oil and rapeseed oil.

LeenaS said...

Why should it show that? Partial hydrogenation also makes fats saturated. And full hydrogenation makes them even more so.

Which is why all margarines and commercial bakery products of old were also rich in saturated fats. So, the butter-to-be-replaced may have been as small as in those poor Finns which made the poor North Karelian (no, actually it happened throughout Finland) heart attack statistics.

If I were you, I would make the calculations instead of just arguing. They show better than anything else that the changes shown in Lyon can happen only via change of the partially or fully hydrogenated margarine products.

Juhana Harju said...

We don't have to rely on our own reasoning as the changes made have been described in scientific articles:

"The Lyon Diet Heart Study, a randomized, controlled trial with free-living subjects, tested the effectiveness of a Mediterranean-type diet (consistent with the new AHA Dietary Guidelines) on composite measures of the coronary recurrence rate after a first myocardial infarction. Subjects in the experimental group were instructed by the research cardiologist and dietitian to adopt a Mediterranean-type diet that contained [...] margarine supplied by the study to replace butter and cream. The saturated fatty acid (15% kcal) and oleic acid (48% kcal but 5.4% kcal 18:1 trans) contents in the margarine were comparable to those in olive oil, with the exception that the margarine was higher in linoleic acid (16.4% versus 8.6% kcal) and more so in {alpha}-linolenic acid (4.8% versus 0.6% kcal). Exclusive use of rapeseed oil and olive oil was recommended for salads and food preparation."

Emphasis JH.

Source: Lyon Diet Heart Study. Circulation. 2001;103:1823.
http://www.circ.ahajournals.org/cgi/content/full/103/13/1823

LeenaS said...

But with that you do not make the changes seen in omega listing, so something else had to be in there do, wouldn't it?

Juhana Harju said...

Leena wrote:

"But with that you do not make the changes seen in omega listing, so something else had to be in there do, wouldn't it?"

The omega-3 fat content of the margarine supplied by the study is higher than the omega-3 content in butter. The subjects were also advised to use rapeseed oil (contains omega-3) along with olive oi. These changes explain the higher omega-3 fats in the intervention diet.

At that time it was common to use sunflower oil as a cooking oil. When that is replaced by olive oil and rapeseed oil, as the subjects in the intervention diet did, the linoleic acid (omega-6) content is reduced and oleic acid (omega-9) is increased.

LeenaS said...

Have you made the calculations?

It seems that they don't match except in the case of partially hydrogenated vegetable fats and fully hydrogenated veg.fats, both of which were common in margarines of those times. If they do, please show me how to get the reported omega3 and omega6 values before and after - without hydrogenated margarines.

I have not managed to work that so far with butter and cream. The only solution with reported values is with hydrogenated fats - which had the manmade trans fats, which are known to cause fatal CHD, among other things.

Stephan said...

I can't see how the saturated fat change in Lyon could have been relevant, given the fact that randomized intervention trials have consistently shown that reducing saturated fat alone has no effect on total or cardiac mortality.

An intervention that has been shown to work by controlled trials is improving the omega-6/3 balance. Lyon was unique in that participants reduced n-6 substantially while increasing n-3, which may have added to the intervention's efficacy. The change in saturated fat intake was probably irrelevant.

Juhana Harju said...

Stephan,

I am not talking about saturated fat change per se, but a successful replacement of butter by margarine.

Pam Maltzman said...

MARK: I have been using stevia in my tea. I am a type II diabetic. I had been led to believe that stevia was okay for diabetics to use, and had not seen anything (yet) about an insulin response to stevia. I will check out the URL you provide, but if you can point me to any more information I'd be grateful.

I know that many artificial sweeteners can stimulate an insulin response (using them will make me hungry again), but if stevia is out, I may have to pretty much give up tea, because I don't like totally unsweetened tea.

Sven said...

"I am not talking about saturated fat change per se, but a successful replacement of butter by margarine."

A lot of variables were changed, therefore you can´t conclude that replacing butter with margarine was the culprit.

Sven said...

"I know that many artificial sweeteners can stimulate an insulin response"

Actually I have not seen a single study, that confirms this. Anyone?

Juhana Harju said...

Sven wrote:

"A lot of variables were changed, therefore you can´t conclude that replacing butter with margarine was the culprit."

There was over 70 percent reduction in cardiovascular events and mortality in the Lyon Diet Heart Trial compared to the control group. Almost everything has to be done right to achieve that kind of success.

LeenaS said...

No, you don't. According to Harvard Nurses Study 1 this could be achieved simply by reducing the margarine transfat content into one fourth of the original. (... while, btw, according to the same Harvard animal fats did nothing to CHD risk).

According to Harvard every 2 E% of elaidic acid (i.e. 4 grams) equals to doubling of the CHD mortality. And the cheap, much used "butter replacements" of that time had plenty of transfats in them.

If I were you, I'd still perform the calculations, based on given omega3, omega6 and saturated fat contents, just to be on the safe side. They are surprisingly informative.

Sven said...

Juhana wrote:

"There was over 70 percent reduction in cardiovascular events and mortality in the Lyon Diet Heart Trial compared to the control group. Almost everything has to be done right to achieve that kind of success."

What kind of scientific method is that? Wow 70% sounds a lot therefore everything must have been changed to perfection? Lyon is one of the biggest success-stories in diet-trials but that does not mean they created the perfect diet.

At Lyon they have done something right. No doubt about that. It´s likely it has something to to with n3 because other trials have shown n3-benefits. On the other hand it´s unlikely reducing butter has been a major contributor because others trials have shown no benefit of reducing sat fat.

You think butter is bad because your grandmother ate it and developped heart disease? What you should consider is the possibility that the heart disease of your grandmother had nothing to do to with her diet. Maybe it did, but you can´t be sure.

Juhana Harju said...

Sven,

It is no scientific method. It is called common sense.

Sven said...

Well, then we have a different definition of common sense.

trinkwasser said...

I found an excellent series of papers on the history of dietary research

http://trinkwasser.wordpress.com/2010/02/25/a-short-history-of-nutritional-science/

Well worth a read.

Does anyone know of a similar paper/s which bring the story up to date?