Resistant starch: the missing ingredient? Part 1

Just when you think you have everything in your diet dialed in, something new comes along and upsets your carefully constructed nutrition knowledge applecart. This particular compound has been getting nutritionists a little giddy with excitement for a while, and now it is receiving more and more media exposure causing everyday folk scratch their heads at the new wonder boy. It’s hard not to get swept away in general enthusiasm when our popular morning TV show touts Resistant Starch (RS) as a “sneaky fat fighter”.

Remember when things were simple and we were told to just eat more fibre? Well, that is so 1990s. CSIRO in Australia note that while Aussies eat more fibre than many other Western countries we still have the highest incidence of bowel cancer in the world. They call it ‘the Australian paradox’ (what number paradox is it now? I lose track). So looks like adding more fibre in form of All-Bran and bran muffins into our diet has done bugger all to keep those pesky intestinal cells from going bananas and turning into some evil little suckers. All hail resistant starch.

However, as most of you know, I am naturally a fairly skeptical person when it comes to dietary ‘miracles’, especially when the recommendations to increase RS in our diet from the above mentioned morning program look like this:

  • Eat more canned or soaked legumes such as kidney beans, chickpeas and butter beans.
  • Include more intact wholegrains, seeds and cereals, in your diet e.g. oats, barley corn and linseeds.
  • Eat fruit such as bananas before it’s ripe.
  • Eat salads that have been cooked and cooled, such as potato salad, rice salad and pasta salad.
  • Look for breads and cereals with added resistant starch

So what the hell is it? And are you missing out on this miracle food substance?

The official website named Resistantstarch.comAn Information Portal for Health Professionals (don’t you wish that broccoli had an official website?), gives us this definition:

”Resistant starch is the sum of starch and products of starch digestion not absorbed in the small intestine of healthy individuals”

It is also classified as the third type of fibre (together with soluble and insoluble) by several health agencies, including Food Standards Australia and New Zealand, and its MO is to bypass the normal absorption process in the small intestine straight to the colon where it is fermented by colonic bacteria (which also makes it a “prebiotic”).

There are plenty of resistant polysaccharides (starches) that you won’t find in your average shopping trolley and this is reflected in 4 types of RS. Here is a handy table from one of the published reviews (1) on RS (click for better resolution):

Source: Nugent 2005

Source: Nugent 2005

Kind of makes you wonder whether you should start munching on raw potatoes in spite of what Momma always told you and inflict your bean-eating habits on your nearest and dearest for the sake of digestive health. Or should you just trust the clever scientists who conveniently altered the chemical structure of polysaccharides via esterification in order to escape your digestive enzymes? Why are we doing this again?

Oh yes, the claims. I will be relying on the enthusiastic RS article (2) by an Australian dietician Robert Landon written for the official Resistant Starch website to provide the claims to benefits. My facetious comments will follow for your reading pleasure.

Satiety, metabolic health and obesity

I’ll start with this one because clearly this is the stuff that makes big headlines.

“Recent breakthrough research has linked the fermentation of resistant starch with increased levels of gut hormones (PYY and GLP-1) that play a role in satiety and potentially, long-term energy balance.”

“We believe the fermentation of resistant starch may be an effective, natural approach to the treatment of obesity.” says Dr Keenan, the study author.

You can read the study in question here (3) and decide for yourself if feeding 30 rats a carefully engineered concoction of corn oil, methylcellulose or high-amylose corn starch is applicable to human metabolism or behaviour around food. And more importantly, does the release of those “satiety” hormones correspond with actual satiety? Sadly, the previously mentioned (1) 2005 British Nutrition Foundation review by Nugent (peer-reviewed) mentions that the studies which looked at satiety as the end point appeared “to show a weak or no association between RS and satiety over the course of several hours or an entire day.”

Incidentally, I know of a way to increase GLP-1 and PYY levels in humans in a real world which does correspond with satiety: feed them a high protein diet.

This excerpt from the 2013 review on RS (4) made me laugh:

“The physiological effects of resistant starch make it extremely difficult to assess its impact on weight. Resistant starch increases stool bulk, luminal thickness, and bacterial numbers in the colon. These factors add to overall body weight, perhaps masking any differences that do exist due to resistant starch ingestion”

You know you need a new weight loss strategy if your current progress is easily masked by the weight of your poo. Just sayin’.

And I love it when researchers get excited about postprandial glucose and insulin levels. Sounds like this stuff is pretty important, eh?

“… a number of human studies have demonstrated the capacity for Hi-maize® resistant starch to elicit a positive impact on both postprandial glucose levels as well as insulin response.
Most recently, a human trial with maize-based resistant starch incorporated into test beverages showed effective reductions in the relative glycaemic response without any change in palatability”.

Again,  the review by Nugent is a little more cautious:

“There is a lack of consensus regarding the precise effects of RS on insulin and glucose responses: 15 studies have reported an improvement in these measures following the consumption of a RS-rich test-meal, while 10 have showed no, or a physiologically irrelevant effect. It is noteworthy that, to date, there are no reports of RS worsening insulin and glucose responses.”

Phew, it’s nice to know that at least this stuff doesn’t make our blood sugar go through the roof!

Several more recent studies looked at insulin sensitivity in men and women with slightly better results which were obtained by very high intakes of RS: up to 40-50g a day. A paper of note is by K.Maki et al published in the Journal of Nutrition in 2012 (5). The study subjects this time were human overweight and obese men and women broken into 3 groups: control group who received a digestible starch meal and 2 intervention groups, one with 15g of RS a day and the other with 30g of RS. They had to add the products to their usual daily meals for 4 weeks, followed by a 3 week wash out period and then a swap. They underwent a glucose tolerance test at the end of the study.

Insulin sensitivity between 3 groups. Source: Maki et al, 2012

Insulin sensitivity between 3 groups. Source: Maki et al, 2012

The reason why this study caused a bit more of a stir is because it showed better insulin sensitivity in men with a more achievable dose of RS: 15g/day than in men who consumed starches (do you see a little problem here?). Interestingly, there was no effect in women and there was no effect with higher doses. The big problem of this and other similar studies in my opinion is that their control (the column in black) was digestible starch. So in fact,  any difference in insulin sensitivity was relative to the equivalent in starch consumption in people who already have poor glucose tolerance judging by their abdominal girth.

But seriously, can we come up with a plausible explanation why RS starch may improve markers of glucose metabolism? Sure! It reduces the amount of absorbed glucose. This wasn’t too hard, was it? It’s a bit like comparing nicotine levels in full strength vs half strength cigarette smokers. If you smoke low nicotine cigarettes your nicotine levels will be lower. Hooray! We found a measurable improvement! Ahem, you could just stop smoking, of course.

[To all my sweet potato-loving friends, I am not suggesting that you stop eating carbohydrates. Just pointing out that if the only goal is to reduce glycaemic response one might decide to reduce dietary glycaemic input. Or add more protein. Or fat. And by the way, I consume large amounts of this orangy goodness on a daily basis.]

If you demolish your timber dining chair to shreds and sprinkle it onto your Coco-pops, it will also reduce your postprandial glucose levels. Don’t try this at home, kids.

And since we are trying to keep your family physician happy, how about that pesky cholesterol? While early animal studies were quite promising with significant reductions in triglycerides and total cholesterol, these were not replicated in human subjects. 13 human studies showed that RS had no effect on lipid metabolism (1). Sometimes we need a reminder that we are not rats in cages fed laboratory produced chow. Hang on…

So all in all, I wouldn’t be hanging your hat on RS as a shortcut to winning the obesity battle on a global or individual scale as yet. In my next post I will address the evidence behind RS effect on digestive health and, specifically, colorectal cancer. In the meantime, don’t go crazy with that potato starch.

References:

1. Nugent, A. P. (2005), Health properties of resistant starch. Nutrition Bulletin, 30: 27–54. doi: 10.1111/j.1467-3010.2005.00481.x

2. Landon S, Resistant Starch Review published for http://www.resistantstarch.com

3. Keenan et al (2006), Effects of resistant starch, a non-digestible fermentable fiber, on reduction in body fat. Obesity, 14(9): 1523-34

4. Higgins J, Brown I (2013), Resistant starch: a promising dietary agent for the prevention/treatment of inflammatory bowel disease and bowel cancer. Current Opinion in Gastroenterology, 29(2):190-194

5. Maki et al (2012), Resistant starch from high-amylose maize increases insulin sensitivity in overweight and obese men. The Journal of Nutrition, 142(4):717-723

P.S. I will keep the comment section closed at this stage as I will probably address some of the questions and comments in my next post.

 

A case for simplicity

Case 1. Bev

Bev is a jolly 63yo farmer who came in to the hospital after suffering a minor stroke. One quiet afternoon when I spot our medical student looking a bit out of place (well, even more so than usually) I take him to see Bev for a neurological exam practice. Bev looks flattered and obediently sits back in her bed, being the perfect patient. I remind the student that we start with a general observation of the patient,the side of bed assessment. He dutifully recites “alert, comfortable and in no respiratory distress”. I gently nudge him to describe the patient’s body habitus, the student gets instantly embarrassed and looks lost. How do you tell a patient she is fat? I explain while looking at Bev that her central obesity is an important risk factor which may be pertinent to diagnosis at hand. Bev chuckles good-naturedly: “I love me food, I’ve always been a good baker!”.

Most medical students hate the neuro exam: it’s tedious, long, complicated and seemingly impossible to make smooth. I don’t rush him and Bev seems happy with the attention. The student correctly identifies the weakness on the left side of Bev’s face. He asks Bev to blow up her cheeks, Bev makes a valiant attempt but ends up making a noise like letting out air of a balloon and promptly laughs. I hear laughs from the other side of the curtain: evidently this has been a source of amusement to other patients as well. Bev’s limb weakness is improving and we take her for a gait assessment. With her tiny feet, narrow shoulders, perfectly rotund middle and a wide crooked smile, she looks almost comically cute. The student summarises the findings of his examination and correctly identifies that Bev has likely suffered an ischaemic stroke in the area of a middle cerebral artery in the right brain hemisphere. I thank Bev for being the perfect model for us, she wisely nods:
- They all gotta learn somehow, don’t they? So you think it’s gonna get better for me, doc?
I point out that she already has made marked progress and then ask her how she feels about the future.
- Oh I know. I gotta watch that cholesterol, don’t I? No more fish’n’chips for this chickie! (laughs)
I tell her I’ll come back to chat to her about diet before her discharge, thinking I’ll get to her before she gets fed some pseudo-nutritional rubbish.

Two days later, on my day off, Bev suffered a major stroke. The nurse found her in the morning, stiff in her bed, unable to move, call out or ring the bell. The stroke affected the other side of her brain and left her completely paralysed on what just 2 days ago was her “good side”. I never got to see her again because she was transferred to another hospital to a dedicated stroke unit.

Case 2. John

I only find out about John at morning rounds as he was admitted last night. I barely have enough time to register “64yo male transferred post BKA” on my handover sheet as we enter his room. BKA stands for Below Knee Amputation. John has just had his second one. As I stand in the room while the consultant chats to John about his surgery my eyes keep drifting to an empty space below John’s knees. No matter how many times I have seen it, this sight still unnerves me.

I distinctly recollect one of my most distressing experiences in operating theatres when I was assisting in a BKA. My job was to stand at the bottom of the table and stabilise (a.k.a hold tightly) the foot and calf of the leg being amputated. I still remember own visceral startle when the toes suddenly started to move, as if in a mute protest, when the surgeon was severing the tendons at the knee. At some point through the cut the lower leg stopped being a part of the human being and became an object. As the last thread connecting it to the breathing body was dissected I was left holding that object in my hands, temporarily stunned, until the nurse offered a big bucket to deposit it in.

John is looking defiant. The consultant has just finished drawing a pretty bleak picture and suggesting a nursing home placement. I feel the hot wave of indignation at this seemingly cruel crushing of a patient’s determination to maintain independence and mobility. John repeats mulishly that he wants to have double prosthesis, he wants to walk again. Later that day I find out that my anger was misplaced. While his raging diabetes destroyed the small vessels in his feet and opened him up to ugly ulcers and gangrenous infections, John’s dementia caused him irretrievable short term memory loss and, consequently, an inability to learn new skills required for amputation rehab. He has been on insulin for years but has been steadily forgetting to inject himself in the evenings when he gets most confused.

Case 3. Pat

Pat is a 47 year old Indigenous woman who presented to our Emergency Department with chest pain. The ECG and cardiac markers do not show any signs of heart muscle damage but she is at high risk for coronary artery disease as she is a former heavy smoker and a diabetic. Routine nursing observations show that her average blood sugar has been between 25-30 mmol/L (450-540 mg/dL) over the last day. She normally takes metformin but it’s clearly not doing very much. Like many Indigenous patients she doesn’t look grossly overweight, with her skinny arms and legs sticking out of her hospital gown. The gown cannot fully hide her round belly though, and I have to double check the notes that she is not pregnant. No, she is not. I try to be gentle when I tell Pat that she is likely going to need “the needles”. Sometimes the mere mention of injecting insulin serves as a good wake up call and a good opener to the lifestyle modification conversation. Pat doesn’t seem phased: “Ok doc”. I feel a hint of frustration: the conversation is not going the way I planned. I try to bring it back to the diet, saying that stopping junk food may be an easier solution than injecting yourself every day. “I don’t eat junk food, doc! I didn’t have Maccas for yonks!” – she protests. I note a half empty 2 L apple juice bottle on her bedside table: “And what’s this? You can’t have that with your sugars!” She looks confused. I take a breath and start to rant about soft drinks and sugar but she has already turned off and when her mobile phone rings she picks it up leaving me with my mouth open mid-sentence. As she starts to chat, I walk away taking the juice bottle off her table and pouring it out into the nearest sink.

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My other life, on this blog, as a part of Whole9, on social media, is like another world. Highly motivated people sharing their success stories, intelligent eyes watching our Whole9 South Pacific presentation, challenging questions being asked – I find my enthusiasm recharged and renewed. Although recently I see more and more splinters appear in the community.

Recently a video made rounds in “Paleosphere”. Some bloggers that I respect and follow found it offensive in its simplicity. I won’t comment on the video itself, I have a few minor quibbles with it myself, although I wouldn’t hesitate for a moment to show it to my average patient. I want to comment on the “It’s not that simple” critique. Maybe it’s not that the message is too simple, maybe we are trying to make it too complicated. We dissect this diet thing to its smallest constituents, calories vs grams vs ratios vs micronutrients vs cytokines vs endocannabinoids. Critical scientific discussion is enormously valuable and discourse should only be viewed as the way forward. But somehow discourse all too quickly  turns into a personal attack, a spiteful tweet or a post from the safety of a computer screen. And, sadly, some who used to offer valuable contribution to the body of knowledge now seem to offer nothing but negativity. Are we turning into the equivalent of elderly cranky academics arguing about the best fire-fighting methods while the room is engulfed in flames?

What about your average reader who has just googled Paleo or primal or ancestral health? Are we causing “paralysis by analysis” by not making it crystal clear what we actually all agree on? Even those firmly indoctrinated in beef broth/bacon/kale seem occasionally lost. Sometimes getting lost is easy if you are given a way out – maybe Lustig is wrong and sugar is ok? Maybe Taubes is delusional and it’s time to count calories again? Oh no, this thing is not simple at all! Let’s browse through some blogs, maybe we can catch the author out, find an error in the archives and pronounce the final judgment. It’s not exactly helpful for own health problems but sure is satisfying.

I did not choose the three cases for their dramatic value, I chose them because they are average. I see between 20 and 30 Bevs, Johns and Pats daily. Sure, I love reading the latest research papers in a search for truth but for these guys I want SIMPLE. I need a heuristic. If your goals are getting to a single percentage body fat, running a marathon or continue setting PBs by doing smashfit 5 days a week (hopefully not all at the same time!) you may need more tweaking but you are not exactly your Average Joe, are you? My favourite Internet testimonial this year is a 71 yo lady on a social security budget who reduced her HbA1C, came off insulin and halved her blood pressure medications, probably without giving a second thought to the latest blogosphere drama.

We are onto something good here. It’s real and, let me tell you, it may better than any expensive medication I can offer my patients. SIMPLE will get most people most of the way there. Here is my heuristic:

- eat meat/fish/eggs + vegetables (tubers, greens) three times a day to satiety and activity levels

- prioritise your sleep

- move in a way you enjoy

Do this every day for 3 months. Without dissecting, or philosophising, or looking for a loophole. This may just be enough to see change.

 

 

 

 

 

 

Whole30, Goldilocks and evil carbses

Back to posting after long silence.

Things have been downright crazy here at primalmeded/Whole9SouthPacific HQ. Jamie and I have successfully held our first ever W9SP workshop in Cairns. I expect this to be the flashiest workshop we will ever have since it was conducted in the Shangri-La rather than in a Crossfit gym surrounded by pull up bars, chalked up weights and breathing in the sweat the smell of victory. But hey, we can talk to people about nutrition anywhere as long as nobody decided to punch out 20 burpees when they get bored of our ramblings. The Paleo Cafe in Cairns were awesome organisers and they will be conducting a Whole30 in February and we will get to judge the winner. Our next stop is Crossfit Toowoomba which is getting close to being booked out!

Jamie dropping some knowledge bombs to a full house in Cairns

Jamie dropping some knowledge bombs to a full house in Cairns

Me, with my "d'er" slide

Me, with my “d’er” slide

The obligatory glam shot: me and Julianne Taylor from Paleo Zone Nutrition who was our special guest. Post workshop dinner at Cairns marina

The obligatory glam shot: me and Julianne Taylor from Paleo Zone Nutrition who was our special guest. Post workshop dinner at Cairns marina

This post is mostly about Whole30 and random thoughts on troubleshooting. This is my 4th whole30 and yes, I’m getting pretty good at this. Plus I have the benefit of being intimately familiar with the book, knowing the references and also presenting that material. Not to blow my own trumpet but I think it’s fair to say it gives me a little bit of an insight. But in spite of all this, I found myself wide-eyed and amazed at how much I learnt this time around.

A little bit of personal background to put this into perspective. I have been eating low carb/primal/Paleo for over 2.5 years now. I don’t have any medical conditions or an overt food intolerance. Junk food (sugar, grains, processed food) gives me pimples, makes me bloated and pushes me to the sarcastic bitch end of the spectrum. When I eat well I contain my natural impatience with stupidity a lot better. I never thought I had problems with dairy but I have been having less and less of it in the last few months and my skin which was already pretty good improved more. Plus I don’t really miss it. I put on some weight this year mostly due to stress, irregular hours and meals, and sleep deprivation. I have made it my priority to improve those areas in the last few months and was already getting good results. We decided to do the January Whole30 to “walk the talk” (so nobody could tell us “eating THIS way is soooo hard”) and see what results we can achieve with perfect focus.

First the results:

  1. My satiety levels are the best they have EVER been. I used to snack occasionally (i.e. daily) and felt no hunger in the morning, then was practically starving by lunch, and again before bedtime. Now I have 3 full meals spaced out at around 6hrs with some gentle hunger around hour 5.
  2. My energy levels improved dramatically. We go to the gym 3 days a week doing basic strength. On the days that we don’t train we go for beach walks, sprints and short hikes. Instead of wanting to collapse into the couch when I come home and play dead, I actually look forward to getting out of the house and dissipating some pent-up energy.
  3. Strength gains. This year my training has been really inconsistent. I remember thinking at my surgical rotation that the only exercise I get is holding the retractors in OT. Last few months I introduced more gymnastics-style training which I hugely enjoyed. I sustained a minor injury in late December and somehow found myself coerced convinced to take a month off gymnastics and do a strength block instead. Never thought I’d say it but I actually do enjoy it and will introduce some deadlifts (gasp!) into my regular program. Ok, ok, I’m loving it. I have no doubt that having extra energy and good recovery contributed to that.
  4. Body composition. If you are expecting the Before and After photos you are out of luck. It ain’t happening. The water weight and some extra insulation (he he) that I picked up over winter started to shift in the last few months. But in the last few weeks I felt like somebody just pushed the right button. I am leaner with the biggest differences in my stomach and waist. I probably could say more but I am going to stop there. Let’s just say I am very happy with the change.

So what did I do differently???

  • More food. Seriously. I have always considered that I eat a lot “for a girl”. I thought I was tired and apathetic because of work, stress, “I am just lazy”. It is practically ingrained in women that they should eat less than a man. Dishing out dinner I would go with the Goldilocks principles: papa bear meal, mama bear meal and a baby bear. And of course, somehow accurately estimating with a trained eye that my portion should be about 30% less than Jamie’s. This time we decided to run an experiment and fill my plate. So now we plate out a portion of protein about 150-200g each and fill the white gaps on the plate with veggies and fruit. Occasionally it’s too much and I don’t finish it. More often than not, I do.

I had a few people ask me recently on Twitter and at the workshop whether it was 200g per day or per meal which caused me a lot of merriment. Get you calculators ready, doubters!
3 eggs at 11g protein each = 33g (breakfast)
Smoked salmon 150g = 32g (lunch)
Lamb chop = 33g (dinner)
Total around 100g protein a day. I weigh 60kg. Which makes it ~1.6g of protein per kilo. Hardly a huge amount for a young active female. Don’t forget, you have eliminated snacks with “healthy” sources of useless protein, a.k.a. gluten, like Nutrigrain cereal bars. 3 meals of between 25 and 40g each does not add up to a whole lot.

 

Very typical dinner: lamb chop (of course!), sweet potato+orange+pecans in olive and ginger marinade, braised cabbage with garlic

Very typical dinner: lamb chop (of course!), sweet potato+orange+pecans in olive and ginger marinade, braised cabbage with garlic

Just in case you think I used an entree plate. Palm size is a minimum, ladies!

Just in case you think I used an entree plate. Palm size is a minimum, ladies!

So yeah, I lost MORE body fat eating MORE food. Still think calories count?

  • More vegetables. When Dallas and Melissa said “Fill the rest of your plate with veggies” they weren’t joking. When I talk to people about vegetables I normally get this slightly guilty shifty look: “Yeah yeah I know they are good for me…” and the voice trails into the distance. Yes, they are bloody good for you. Eat them. I don’t go into throws of ecstasy over broccoli and bok choy. But I eat it. I am a grown up, FFS. I love how people who dislike them find all sort of reasons to avoid them. I know there are many with autoimmune conditions etc. who genuinely need to avoid nightshades or FODMAPs. But something tells me that it’s all too easy to use that excuse to avoid “boring” veggies. Which actually undermines the distress of those who actually cannot tolerate these veggies. Needless to say, all our veggies are cooked in fat (I don’t just want to chew fibre, I actually want to absorb some micronutrients here). And try not to spot diagnose yourself with intolerance to <coconut, onions,=”” radishes=””> after 1 week just because your gut is not used to that amount of fibre and you feel a little bloated. Don’t blame the food. Give it some time to adjust then reassess.
  • Whole30 Meal Template. One of the mistakes that I see often in the newcomers (and sometimes old-timer paleos) is focusing on Whole30/Paleo-approved ingredients. People tend to forget about the fact that these ingredients still need to add up to a MEAL. So yes, almonds, blueberries and cocoa are technically all Whole30-approved but it is still not a meal. Swapping your protein+veggie lunch for a “light” soup with some nuts may sound like a good idea but you are shortchanging yourself on nutrition and will likely crumble like an almond meal cookie in a day or two. The Whole30 Meal Template does not just apply for dinner (most of us are down with that) but also to your Meal1 and Meal2. We successfully melted a few brains at our Cairns workshop suggesting slow cooked lamb and stir-fried veggies for breakfast. For us every single meal but 2 (caught out at Brisbane airport)  followed the protein and veg (and some fruit) format.
Breakfast: 3 eggs, slow cooked lamb and random veggies. Oh and an apple

Breakfast: 3 eggs, slow cooked lamb and random veggies. Oh and an apple

Work lunch sitting on my lap

Work lunch sitting on my lap

  • More starchy vegetables. Oh boy. I am in the process of actively opening a Pandora’s box and I know it. Let’s get one thing straight: “starches” are vegetables. I am not talking about tucking into potato starch with a tablespoon or sprinkling flour over steak. They are VEGETABLES. Since when are vegetables bad for us? News flash: they have more than strings of glucose held together by glycosidic bonds: vitamins, minerals, nutrients. They are cellular carbohydrate sources (if you haven’t yet read this paper you must!)

For those concerned about their glucose tolerance. The glycaemic effect of a meal hugely depends on its fat content. And if you were a diabetic who decided to tuck in a bowl of plain white potato on its own on an empty stomach your BSL may indeed shoot up. But why would you do that unless you were getting paid by a sugar company keen to sell their low GI sugar? If you incorporate the same potato into a normal size meal containing meat/fish and a decent source of fat to slow the stomach emptying I betcha you will see some different numbers.

But of course, everything is a spectrum. And as much as this applies to the middle of the bell curve there are always outliers. I have seen people get a BSL of 18 after a piece of fish and 10 after a bowl of pasta, making me swallow the pill of humility and bite my tongue. If your glucose tolerance is indeed shot to pieces you may have to watch your sweet potato “allowance”. AND you need to look at your activity level and building some good muscle where you can sink some glucose. If you are bed/couch-ridden you will tolerate less. If you get yourself a decent muscle sink and empty it regularly you will tolerate more.

What I find infinitely more frustrating is not the glucose intolerant individuals who have to have a little less sweet potato because they are sick, unable to exercise, their pancreas is on its last legs and they are trying to minimise the damage. It is those who claim that a piece of pumpkin with dinner sends them into hyperglycaemic coma and goes straight to their thighs but pumpkin gluten-free pancakes/cookies/muffins on the other hand are totally “Paleo”. I’m sorry, what? Sure, I like to let my hair down from time to time, I am not some boring Paleo prune who never has fun, I want to give some treats to my child and help her grow up well adjusted. So I will bake her some nut flour/maple syrup/honey/cocoa concoction but will vilify half a sweet potato? Holding onto paleofied sugar methadone with a death grip will prevent you from assessing your real starchy vegetable tolerance. Those evil carbses might actually work for you if you let go of the dessert addiction.

Argh. Ok. This is turning a little more ranty than I intended. I’ll get off my soap box and stop my preaching. Take from it what you want. There is no need to send me BSL measurements to prove that beetroot gets you higher than cocaine. This may not be you. But I sure do see this a lot from people who then go: “This Paleo thing doesn’t work for me!!!!!! I tried it, was tired all the time, couldn’t lose weight, got weak in the gym. It’s a fad people, get over it”.

Anyways.

Good luck with your Whole30.

The weight loss conundrum

Disclaimer: this post expresses my personal opinions. Fancy that. On my personal blog too. And guess what, this opinion may even be different to yours. You can let me know if you agree or disagree with the views expressed here. You might even go as far as to tell me that I am wrong. I may or may not care about that. Enjoy reading.

Phew. Now that we got that out of the way let’s talk weight loss. Everyone on the internet knows that the best way to get traffic is to tag your pearls of wisdom  “weight loss tips” and “Jessica Biel’s diet secrets”. I have neither. Sorry. But this post was mostly brought on by the frustration that the topic of losing body mass is still a priority not just in conventional women’s magazines but in ancestral health community.

You know the one: “Yes, I’ve given up grains because Robb Wolf told me to, I don’t eat refined carbs after reading Gary Taubes, I stopped sugar after watching that Lustig’s video and I force down a tablespoon of fermented cod liver oil since attending Weston A.Price conference. I feel great but… How do I lose another 10kgs?”

And of course there is no shortage of available experts on the interwebz:
- eat less carbs
- eat more safe starches
- introduce interval training
- stop HIIT to salvage your burned out adrenals
- eat sauerkraut for healthy gut
- calories don’t matter
- calories matter
- start IF
- use FitDay to track your daily intake
et cetera.

It’s all very sad.

In the meantime the average long term success of most weight loss strategies is around 1%. Yeah, sure, most people do it wrong. They choose the wrong diet (Lemon Detox, anyone?), they choose the worst possible exercise (if you are a female with a cup size C and above, for god’s sake stop running). And they just don’t have the willpower that the new dieter has (sarcasm font). Because the new dieter knows that he/she will be different. I will be in that 1% who does it right and stays skinny ever after. The End.

There are numerous reasons why weight loss strategies fail. And there are numerous reasons why they succeed. Temporarily. You can lose weight in literally thousands of different ways: Paleo, low fat, low carb, low calorie, ketogenic, vegetarian, aerobic exercise, HIIT, IF, bariatric surgery, liposuction…

That’s why the to and fro arguments on which approach is better for weight loss is kinda pointless. YES! YOU CAN LOSE WEIGHT EATING MARS BARS AND DRINKING COKE! (feel free to leave this page at this point and celebrate).

We have this love and hate relationship with a number that determines our body mass. Lily Allen famously said: “And everything’s cool as long as I’m getting thinner”. There is another number that we have become very preoccupied with in the last few decades: serum cholesterol. Chasing that number (down) is the name of the game, mostly by pharmacological means. Of course, you could tilt this snow globe upside down and decide that the number per se is not very meaningful and in fact represents some other pathological process in the body. Ideally you would choose an intervention that both addresses the cause of the problem and pushes that number in the direction you want. A nutrient-rich diet free of processed junk and pro-inflammatory toxins accompanied by reasonable physical activity is likely to address the chronic inflammatory state that leads to dyslipidaemia and therefore drop the dreaded cholesterol numbers down and please your conscientious doctor.

But sometimes it doesn’t get you to the magic 5.5 mmols that your doctor wants to see. Just like your 6 month foray into the Paleo diet fails to get you to that elusive number that determines your weight, size and consequently happiness. Time to go on PaleoHacks and shout for help.

I am not having a go at the desire to be slimmer. Sure, I wouldn’t mind losing a few kgs. I also wouldn’t mind losing my freckles or having bigger hands (it sucks trying to find surgical gloves that fit). Neither affects my sense of self worth.

So for what it’s worth, these are my ideas in relation to weight loss (note, doesn’t say FOR weight loss):

I am overweight? Oh thank you, kind sir, I wish I knew this earlier! Let me just switch to a healthy diet and start running.

1. If your primary focus is weight loss you are already behind the eighth ball. If being skinny was a powerful motivator we wouldn’t have 2/3rds of Western world overweight or obese. Wanting to lose weight tends to screw with people’s heads even with the best foundation: they start stressing (excess cortisol=bad), they start reducing/counting/starving/hating their bland food/exercising at 5am and generally stop listening to the bodies.

Things are quite different when you eat to nourish every cell in your body. Shift your focus to wellness and flip the switch.

1a Unless you have congestive heart failure or chronic kidney disease, chuck your scales. Like now. Get up and throw them in the bin.

2. Start with having a nutrient-rich diet and get rid of junk. Use whatever framework takes your fancy: Paleo, primal, perfect health diet, whole30, Mediterranean, vegetarian (gasp! ). Minimize the “healthy” versions of unhealthy food, you don’t want any food holding you emotionally hostage.

Until you have that down pat, forget the words “Do you have these pants in a smaller size?”

3. Find a regular consistent physical activity you enjoy. I know exercise is supposed to be about torture. That’s ok if you enjoy torture, no judgement here. Do something you can see yourself doing regularly in a year. Or five.

3a. Do not ramp up the volume/intensity of the said activity to accelerate weight loss beyond the level you see yourself comfortably doing long term. Did I hear you say “bootcamp”? Pfft.

4. You cannot fix self esteem issues with weight loss. The two have very little to do with each other.

4a. In the same vein, having weight loss as a dangling carrot in the future can derail your enjoyment of today. Don’t put off activities, clothes or happiness until you get thinner. See point 1.

5. It seems that the thoughts of weight loss frequently return when people are still longing for a six pack in spite of measurable improvements in their physical and mental health. This is where we hit a little snag.

Let’s say you start off in the obese category. Up to a certain point weight loss and health gains go together. Then you reach a state where your body is happy, healthy and well-nourished. To lose more subcutaneous fat from this point will not gain any further health benefit. In fact, you may dip down into negative territory. If you are body builder, dancer, gymnast or any athlete dependent on low body mass this is the risk you have to take. If you are a suburban mother of 2, disappointed she doesn’t look like her graduation photo any longer, you may be playing a dangerous game. If you still choose to continue down this path that’s cool. Your choice. It’s way harder to shift the happy-healthy weight so you may have to pull out all stops. Some of those deviate even further from the path to long term health and wellness. Obviously if you are naturally lean and small you have to flip this scenario 180 degrees. Getting massive past the point of diminishing returns may not be optimal for your body either.

When I see an obese patient I do not have an overwhelming desire to help them lose fat. To me their weight is nothing more but an external manifestation of serious internal issues.  I worry about their risk of heart disease, diabetes, Alzheimer’s and autoimmune conditions. I feel the same level of concerns for the skinny-fat: normal BMI with little muscle and obvious visceral adiposity.

Incredibly sexist and quite offensive to naturally thin women. However we don’t think twice when the ads are turned the other way around.

For a health-conscious and somewhat rebellious community we are still remarkably superficial and eager to conform to the current body image stereotype.

Saturation be damned

Night time reading

I love interacting with this informed and educated community of ours who take responsibility for own health, read and interpret scientific articles, ask intelligent and incredibly tricky questions and look at the world through a prism of human evolution. It’s really really cool. I also don’t own a television or read newspapers. I know, I am missing out on the vital information on the recent exciting advances in the field of laundry detergents, easily foldable exercise equipment and female hygiene products. But I’ll take my chances.

So when I was approached recently by an Australian reporter to comment on why saturated fat might not be as bad as everyone thinks, I was temporarily stunned. Everyone still thinks that? An hour-long lunch outside in the company of co-workers brought me back to reality. Listening to the less-than-lithe lady lecturing a younger employee that “pasta is perfectly healthy as long as you avoid creamy sauces and stick with tomato-based ones and add psyllium husks to increase fibre” plunged me back to earth from the AHS12-induced heights.

Oh boy. On this planet, margarine is still a health food.

So I thought I’d write down some thoughts on fats, why we still need to talk about them, the strength of evidence and where we go from here. The article ended up being published at The Age and I was amused to see our hour-long phone conversation and the exchange of several emails with attached studies reduced to one sentence quoted from me, but I am not complaining since I think the article was quite well-balanced and hopefully gives people some food for thought. Here is the link.

If you are totally new to all this, I recommend that you read my post on fat basics and the slightly more complicated polyunsaturated fat primer.

Don’t all scientists and doctors agree that saturated fat is bad?

My main gripe with conventional advice to reduce saturated fat in the diet is that it makes it sound that everyone in science and medicine agrees that it is the right thing to do. They say “scientists” and you imagine a group of nerdy-looking men and women in lab coats and glasses with clipboards, all nodding in unison: “Saturated fat will kill you”.

Bad cow, bad!

Sorry, no. Far from it. In the year 2012 we still run trials on dietary fat and its effect on mortality, cardiovascular disease and weight. In fact, a Pubmed search on “dietary fat” yields close to 700 article from 2010 to present date.

If “saturated fat will kill you” is a done deal why do all these folks get research grants and waste years of their life on the pointless pursuit of the truth that has long been discovered and incorporated into every government-led nutrition advice?

And yet, the consensus is farther away than ever. Nutrition and Metabolism Society publishes critiques of the American Dietary Guidelines, as well as scores of papers on the subject. Then there is THINCS, The International Network of Cholesterol Skeptics, which really sounds like an evil mad scientist organisation from a Bond movie, but in fact has respected members like a biochemist Dr Mary Enig and a scientific researcher Dr Uffe Ravnskov.

Not to mention a fine gathering of clinicians, scientists, nutritionists, researchers, physiotherapists, bloggers at Harvard Law School this year for 2012 Ancestral Health Symposium, most of whom seemed to think that bacon is rad and margarine is bad.

Can you refute XYZ study and the rest of the body of evidence on saturated fat?

Yawn. I have no intention on memorising every study conducted in the last 50 years, no matter how bad or good they are. We have been eating fat, lard, meat, eggs, butter, ghee, coconut oil for thousands of years. I think the burden of proof lies on those who say that these traditional foods have been our silent killer all along. All I can do is to politely present the vast body of scientific evidence that does not support the lipid hypothesis (YES! IT IS STILL A HYPOTHESIS!)

Sarcasm alert. Lipid Hypothesis 2.0 = we have come to realise that total fat intake has no bearing on heart disease or weight (sorry! Our bad!) But it’s all about the type of fat. There are only 2 types of fat: saturated (=evil, comes from animals, eating animals is bad, you immoral cruel self-serving glutton) and unsaturated (=pure good, comes from vegetables, like cottonseed, soybean, canola and sunflower, botany be damned). Substituting unsaturated for saturated fat is the real reason why we are healthier, thinner and fitter than thousands of generations of traditional cultures because they couldn’t work out how to get 10% of their daily calories from PUFA, suckers.

 

He needs to be told how unhealthy he is from his 40% SAFA intake. Those coconuts will kill you, buddy! (Source: http://www.thatpaleoguy.com)

Several studies have shown improvement in CV markers and mortality when saturated fats were replaced with PUFA. Regardless of how good/bad sat fats are, shouldn’t we make the substitution just in case anyway?

This is a very common reasoning from many educated doctors and academics. They are now aware that sat fats are not much of a problem. Great. But what’s the harm in tinkering our diets if all we have is improvement, right?

Wrong.

I have a real problem with a blanket advice to increase PUFA in general as if they are all the same. PUFA are not all created equal, they have different physiological functions and effects on the body! (go back to basics). At the very least they should be differentiated into omega-3 and omega-6. However, even that’s too simplistic.

If you are planning on dividing fats on the basis of the biochemical structure and biological function, you have just only scratched the surface. Behold! All saturated fats are actually not the same either. Lauric fatty acid is metabolised differently and has different effects on serum lipid profiles than stearic. Even omega-3 are not a homogenous group (gasp!). The intake of the shorter-chained ALA (alpha-linolenic acid) does not come close to providing the same benefit as the long-chained DHA due to inefficient conversion.

Jacobsen’s analysis of 11 cohort studies, quoted in the article as the final proof of the miracle qualities of PUFA,  showed that substituting PUFA for SAFA seemed to reduce CV events and mortality. However, simplification, as usual, can only take you this far. The analysis lumped omega-3 and omega-6 PUFA together and did not take into account the deleterious effect of trans fatty acids separately from SAFA.

“Linoleic acid selective PUFA interventions produced no indication of benefit but rather a fairly consistent, but non-significant, signal toward increased risk of coronary heart disease and death. ” (Kuipers ER al, 2011, hyperlinked above)

That’s what happens when you simplify a complex concept. Why? Because the public are so dumb they won’t get it? Because 2 types of fat is quite enough to remember? And to make things even more visually and conceptually appealing let’s represent them as ying and yang, bad and good, dark and light?

So you have some studies, “they” have some studies. How do lay people know who to trust?

As much as I respect Evidence Based Medicine, I am well aware of its limitations. You can pull apart every study, point out the confounders, small sample size, confirmation bias, lack of double-blinding, the grant approved by a completely impartial third party with key investments in related area. Let’s not reduce the process to “Mine is bigger than yours.”

Nothing in biology makes sense except in the light of evolution“. Repeat this 5 times before going to bed every night.

How much omega-6 was available in our diet as Homo sapiens for 2 million years up to the advent of industrial processing? How much oil can you get out of a soybean without the benefit of extraction chemicals?

Aaaaaaah! Would you just tell me how much PUFA/SAFA/Carbs I should be eating?

Talking about macronutrients (fatty acids, carbs, etc) is useless unless it applies to food. If the advice to increase PUFA translates into “eat more fish” I will be the first one to shout it from the rooftops! But what if it translates into “eat more peanut butter”? Still PUFA! But are you going to get the same benefits? You don’t need to read an insightful review by Christopher Ramsden on omega-3 vs omega-6 to know that peanut butter ain’t gonna make you healthier than salmon. But sometimes we really really want to believe it. And deluding ourselves is oh so easy when somebody in a position of authority gives you the green light.

Yum

Focusing too much on macronutrients is what allowed abominations like “low fat banana bread” to become a healthy morning tea snack. The “reductionism” approach has successfully indicted natural foods such as eggs, coconut, avocado, butter. At the same time we have low fat sausage rolls, sugary cereal, margarine and other foods devoid of any nutrition, riding on the coat tails of the lipid hypothesis 2.0.

One of the benefits of using the evolutionary approach is that it allows you to make rational decisions about your life choices without having to double-check them with Pubmed. And it doesn’t involve re-enactment of Paleolithic times, although heaven knows, I find some modern social conventions really tedious (like people requesting to know how I am going on a Monday morning prior to my first cup of coffee). As the opponents of the Paleo approach correctly point out, we don’t really know what our ancestors ate. But I sure as hell know what they DIDN’T eat: excessive amounts of sugar, grains, seed oils and other industrially produced food-like substances. Not even almond flour cupcakes. Sorry.

Regulating your fat intake is easy: eat fish, seafood, meat (preferably grass-fed), eggs, some nuts, seasonal fruit and veggies.

Go back to eating food, not labels.

Imperfect Day

 

When people embark on a new venture, like a new nutrition program, they do not expect to fail. Full of vigour and enthusiasm, they feel ready to improve their diet, exercise and lifestyle. But if you ask them how they imagine their new life, almost inevitably you will get a picture of a PERFECT day. The day where they bounced out of bed early to go for workout (or at the very least, an energising walk), had all their meals prepared for the day, felt perfectly satisfied and full after each one, managed their work stress, astonished their work colleagues with own weight loss and vitality, had enough energy to attempt a deadlift PB in the evening, spent quality time with their family, browsed through at least 20 Paleo blogs, meditated, mastered a homemade jerky recipe and had a restoring 8 hour sleep undisturbed by blue light.

Nobody wants to think that one day they will want to throw their alarm clock across the room in the morning. Or that their work pressures will pile up over the course of the day culminating in a massive verbal punch up with a co-worker. Or that they will have a fight with their boyfriend and the thought of a pity party for one, complete with a tub of ice-cream and Lindt chocolate balls (ahem), seems like a perfectly reasonable idea.

Because that would be failure. And it wouldn’t happen. And, anyway, if it did, you would know exactly how to deal with it. Sure, 99.99% of people in your situation, would crumble and lose the plot. But you are different. You are SPECIAL. You have superhuman willpower, steely determination and you totally mean it this time.

Sorry to break it to you, a unique snowflake you are not.

But I was soooo strong…

Reality will bite you on the arse just like everyone else. Human physiology trumps willpower every single time. If you are working shift work, don’t expect to have energy for daily WODs. If you are stressed at work, don’t marvel at your increased appetite, and for God’s sake, don’t hover around a muffin platter. One of you is going to lose, and it ain’t gonna be the muffins.

So my new theory is, prepare for a IMPERFECT day. Think of everything that can go wrong (yes, I know, it’s a bit morbid) and work out a strategy of how you are going to overcome it, minimize it or at least mitigate the damage.

Here are a few of my strategies:

1. Too tired to cook healthy food at night -> Do a massive cook up prep with cut up veggies and pre-cooked meats Melissa Joulwan style on Sundays
2. No motivation to work out -> go for a long walk on uneven terrain, accelerate on a few stairs and recover in the open air
3. Fatigue/stress/frustration building in the afternoon -> take a 5 mins break outside, preferably on the open air, and take 20 deep breaths with your eyes closed
4. Cold/sore throat/cough/fever -> (I can’t believe I have to write this) please do not go to the gym. If energy levels are still ok, go for a short walk. If feeling tired, go home and curl up on the couch. Please.
5. Everything went wrong for you today, personal life in shambles, work has been shit, you want to cry, watch soppy movies and eat chocolate -> cry, watch soppy movies and eat the best goddam chocolate you can lay your hands on.


 

The spice of life

I’m sick of nutritional thought-terminating clichés. They are repeated ad nauseum everywhere from morning TV to a doctor’s surgery. One of my pet peeves is “Eat a wide variety of food“. I was not surprised to see this statement in the recent draft of Australian Dietary Guidelines.

What does it even mean?

There seems to be a strange notion floating around regarding our human nutritional  requirements. Since we need a wide variety of micronutrients and each food (apparently) only contains a limited amount, we best to stay on the safe side and eat a little bit of everything. This idea is perpetuated by the constant mentions of newly discovered “miracle” compounds in the media.

Reading all these you would be forgiven to think that to obtain optimal health you need a fridge full of exotic berries from Africa, a pseudo-grain from South America, tea leaves grown on a particular valley in Sri Lanka and a vegetable you have never heard of from the Pacific islands.

The ADG draft pitches another argument in support of the variety theory:

“Dietary variety has the benefit of diluting potential toxicants found naturally in food”

They go on to mention the potential vitamin A toxicity from excess liver consumption (most westerners today would gag at the mention of liver anyway) and a potential of mercury poisoning from fish for pregnant women (enough to scare off anyone from consuming any measurable quantities of DHA/EPA. What? Babies’ brains need those?)

This makes no sense (#FFS).

Let’s take ourselves from our first world everything-is-readily-available-when-I-need-it mentality and apply some good old fashioned common sense and a bit of evolutionary logic. Is it really likely that the compound which will turn on some beneficial gene expression in humans world wide just happens to be only found in a berry from Colombia? Hey, evolution, that’s a major oversight! It took the rest of us, non-Colombian population, 2 million years to work out how to build planes and stuff and this perfect nugget of nutrition was sitting there all this time?

It amused me no end that quinoa made it into the list of cereals recommended to be eaten as part of the 5 food groups daily (Guideline 1) in Australia.

“Eat a wide variety of nutritious foods from these five food groups daily: 3. grain (cereal) foods mostly wholegrain, such as bread, cereal, rice, pasta, noodles, polenta, cous cous, oats, quinoa, barley”.

But enough about South American wonder foods. What about a humble blueberry? All those anthocyanins and phenolics repairing the oxidative damage inflicted by the food group number 3. Has to be good for you, right? And lucky for us, health-conscious consumers, blueberries are available all year around courtesy your friendly local supermarket giant.

I still remember picking wild blueberries in a Russian forest as a child. We looked forward to a month-long blueberry season,  doing a few forest trips around July to check if berries were ready for picking. Some super keen villagers would go a few days early just to beat the crowds, their payback for keenness was a few extra hours of forest-wandering. The official start of the season would see whole families venture into the woods, each person laden with a ten litre bucket, me, a child, proudly carrying a one litre container. People would gorge on blueberries for a few short weeks, sell the excess, make mountains of blueberry jam. Every kid would be walking around with a dead giveaway of blueberry gluttony: purple lips. And then it was over for another year.

Think of it next time you buy your punnet of blueberries in the middle of February.

In the world where most fruit, vegetable and berries are farmed and/or transported across the planet we have lost a concept of seasonality. Even a 100 years ago these foods were not available everywhere all year round.  Is there any scientific evidence to suggest that eating food out of season or out of your area is harmful? Nope. But I don’t see any sense in chasing variety for variety’s sake.

“The most recent dietary survey data available for Australian adults – the National Nutrition Survey 1995 – showed an increasing number of foods being consumed by adults in that year compared with 1983 [44]. It is expected that the variety of foods consumed has continued to increase since 1995. This is largely as a result of cultural diversity in the population arising from waves of immigration from European countries after World War II and Asian and African countries since the 1970s [99, 100]. Initially, new varieties of fresh fruit and vegetables, grain (cereal) foods and different types of meat and legume/beans became available. Increasing demand for convenience and/or fast foods – also as a result of changes in social and economic conditions – has led to the availability of approximately 30,000 different types of foods and drinks [101]. However, many of these – particularly snack and fast foods and drinks – are energy-dense and nutrient-poor, so care is required to choose diets consistent with the Guidelines [102]. ” (the draft of ADG)

(my bold italics)

30,000 types of food? Looks like our diet is varied enough. And it’s not just the snacks, fast foods and drinks. Ask your grandmother if she knows what cous cous is (forgo this step if you grandmother is from North Africa).

Wow so much variety!

I am not for a minute suggesting that you should stick to the boring bland diet of steak and 3 veg (of which one is potato, the other is corn, the third is beans). But the concept of “you will develop a secret micronutrient deficiency unless you eat a huge variety of foods just in case” is dubious at best.

Once again they missed the mark, mistaking quantity for quality.

Milan vegetable market.

The definition of insanity…

It is now exactly 3 days until I start working. To say that I am nervous would be an understatement of the century. For now, I’ve been pushing any hospital-related thoughts to the deepest corner of my mind (from whence they tend to re-emerge just as I’m falling asleep causing me to break into cold sweat). My plans for my last few days of freedom and frivolity are to soak up as much sunshine as possible, ride my bike, watch really bad action movies from the last century (Lethal Weapon, yes, really) and overall do as little as possible.

In between all these exciting activities I also read the draft of the new Australian Dietary Guidelines, as a special type of punishment for my laziness. 288 pages of government-speak is no joke. I find myself re-reading the same paragraph 3-4 times and its meaning still devilishly eludes me. I don’t want my readers to suffer the same fate so I will be feeding you those pearls of wisdom one post at a time. Just a few statements and observations for you today.

“Diet is arguably the single most important behavioural risk factor that can be improved to have a significant impact of health”

I was very impressed with this profound statement in the Introduction. I am sure many of you feel like doing a little fist pump in the air: finally, the role of diet is getting recognised and appreciated not just as something that might make one fat and obese. But also as an important health determinant. Good stuff.

However, seeing diet as a “behavioural” problem has never sat well with me. We fall into that thinking all too easily. Ever glanced over an obese woman eating an ice-cream and did a little “tsk, tsk, tsk” to yourself? But overweight has not always been seen as primarily a  character flaw. One of Leo Tolstoy’s best characters, Pierre Bezukhov, (for those of you who braved “War and Peace”) is described as a big stout man. And no, it is not a reflection of his lack of willpower. And yes, he gets the girl in the end.

Venus and the Lute Player, Titian c.1560. Source Wikimedia Commons

Interestingly, because the media and government health agencies are so preoccupied with being PC, they use different tactics to accuse overweight and unhealthy people of being disgusting slobs without actually calling them “disgusting slobs”.

Here is one used in the Introduction to the Guidelines in the chapter dedicated to adherence.

“Adherence to dietary guidelines in Australia is poor”.

=disgusting slobs continue ignoring our well-meaning advice and insist on becoming a chronic disease burden while laughing into their French fries.

It is such a sad sentence I think they need an emoticon :(

A couple of paragraphs later:

“There have been changes in the intakes of macro-nutrients over the past 3 decades, generally in the direction encouraged by previous dietary guidelines” (my bold italics)

Say what? The compliance is SO POOR that people change their intakes in accordance with your guidelines? (I wrote a post about one of the multi-million dollar lifestyle modification campaigns in Oz and the subsequent “non-adherence”.)

It all becomes clear when we see this statement in a table form.

Call me an optimist but looks like both men and women REDUCED their fat intake, INCREASED their fibre intake and INCREASED their carbohydrate intake.

Kiddies INCREASED their dietary fibre (somebody is actually eating their bran muffins!), INCREASED protein and INCREASED carbohydrate.

It also looks like reduction in fat didn’t result in reduction in total calories consumed. Bugger me! I thought fat being more calorie dense and all…

Does anybody need a reminder on how the obesity and overweight rates in Australia went while we were busy modifying our intakes “in the direction encouraged by previous dietary guidelines”?

“I don’t know why the sacrifice didn’t work.

The science was so solid.”

King Julien XIII, Madagascar 2

Down the rabbit hole

Many assume that because I critisise the conventional approach to nutrition that I am a rebel. An alternative, slightly nutty medical practitioner in flip flops, long tribal skirt and myriads of beads hanging from her neck: “So, you have a neck of femur fracture? I recommend this delicious broth from organic frog livers followed by cupping of your right buttock and acupuncture to your left testicle”. To add insult to injury, I also teach yoga. Victoria has kindly forwarded to me this entertaining representation of a yoga teacher. Thank you, Victoria, I suddenly feel the urge to buy more Lululemon.

I’m not a rebel at all. In fact, I like rules and do not reject them out of some vestigial teenage rebellious principles. My “problem” is that I like to know the reasoning behind the rules. So when the Australian National Health and Medical Research Council, a.k.a the NHMRC, comes out with a Draft of The Australian Dietary Guidelines I do not snigger resentfully. Sure, I find it hilarious that of all the species on the planet humans are the ones who need the leaders of their pack to tell them what to consume to survive. Can you imagine “Dietary Guidelines for Lemurs: reduce incidental consumption of red beetles and increase the portion of green crunchy leaves daily”?

That way! I think...

Tell me what to do and if I agree with it, I’ll follow like a lamb.

So what’s the story?

The last revision of the Australian Dietary Guidelines (ADG from here) and the accompanying Australian Guide to Healthy Eating (AGHE) occurred in 2003. Things clearly haven’t been going that well since we need a multi-million dollar revision 9 years later. But of course, we all know that.

The fact that caught my attention is that the Drafts to ADG and AGHE are available for public comment. That means that you and I can make an individual online submission to the NHMRC until February 29, 2012 (here is the submission page link).

The development of new guidelines is a serious business. The official website, eatforhealth.gov.au, states that more than 55,000 scientific journal articles were researched. In addition, various experts in food, nutrition and health, food industry representatives and the public (not me?) were already consulted. The information on the evidence which formed the scientific basis of the guidelines is outlined in the Evidence Report, formally known as a Review of the Evidence to Address Targeted Questions to Inform the Revision of the Australian Dietary Guidelines (you gotta give it to the government, they are always thorough). Interestingly, the literature review was limited to 2002-2008.  If you think that’s a little Gen Y (nobody before us had any idea about anything) don’t worry. They also used the previous 2003 guidelines as a blueprint. So if somebody stuffed up writing those it’s really nobody’s fault.

One of the major differences in this revision is the emphasis on foods and food groups recommendation rather than nutrients. I am an optimist and I see it as a major step forward. The recent trend towards “nutritionism“, as Michael Pollan called it, resulted in the overhaul of the way we traditionally view food. Food used to unite us, connect families and countries, make us happy and healthy. Food circa 2012 is a combination of “only a 100 calories”, fat free, no-sugar, high fibre, healthy wholegrains, high in antioxidants, reduces cholesterol, calcium fortified, plus vitamin D, low GI…

Any recommendation to step away from nutrients gets thumbs up in my books. A further look into the guidelines however seems to contradict that fine premise, more on that later.

I’m sure that now you are all dying to hear what we should and should not eat. Please be aware that if you are in the US, Canada, Europe or anywhere else in the world where people do not routinely say “you little rippa” and “she’ll be right mate”, none of this applies to you. Please refer to your own government’s advice. Because everybody knows that human metabolism is government-dependent.

Guideline 1:

Eat a wide variety of nutritious foods from these five groups every day:

 plenty of vegetables, including different types and colours, and legumes/beans

 fruit

 grain (cereal) foods, mostly wholegrain, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley

 lean meat and poultry, fish, eggs, nuts and seeds, and legumes/beans

 milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the age of 2 years).

And drink water.

Guideline 2:

a. Limit intake of foods and drinks containing saturated and trans fats

 Include small amounts of foods that contain unsaturated fats

 Low-fat diets are not suitable for infants.

b. Limit intake of foods and drinks containing added salt

 Read labels to choose lower sodium options among similar foods.

 Do not add salt to foods.

c. Limit intake of foods and drinks containing added sugars. In particular, limit sugar-sweetened drinks.

d. If you choose to drink alcohol, limit intake

Guideline 3:

To achieve and maintain a healthy weight you should be physically active and choose amounts of nutritious food and drinks to meet your energy needs.

 Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically active every day and their growth should be checked regularly.

 Older people should eat nutritious foods and keep physically active to help maintain muscle strength and a healthy weight.

Guideline 4

Encourage and support breastfeeding.

Guideline 5 

Care for your food; prepare and store it safely.

If you have read my blog before (or even had a look at my Start Here page) you might know that I have a slight problem with the Guidelines 1,2 and 3. Over the next few weeks I will be looking in finer detail into each of those guidelines and the evidence behind them with the aim to make an online submission. Feel free to join in the fun. Better still, send in your own thoughts on the Draft to the folks in NHMRC.

Lessons from history

Dairy products – foodstuffs made from mammalian milk.
Food Standards Agency UK

Cute child - check, sexist humour - check, false health claims - double check.

I hope you don’t eat margarine. Just like I hope you don’t smoke, drink alcohol excessively or do illicit drugs. Since margarine hasn’t been on my shopping radar for a while I just walk right past the brightly lit refrigerated shelves with hundreds of colourful tubs and packages straight to the “naughty corner” where a few lonely packs of butter have found refuge.

But recently a thought struck me as I was passing all that splendour: what is margarine doing in the dairy section of the supermarket? Or listed as “dairy” on the supermarket websites?

I will not bore you with the debunking of the so-called health claims of margarine. They all go along the lines of “we will save you from a certain death caused by the saturated fat in butter clogging your arteries”. Yawn. You can read  about the saturated fats here (Gary Taubes “What if It’s All Been a Big Fat Lie?”), here (Stephan Guyenet “Butter, Margarine and Heart Disease”) and here (Sylvan Lee Weinberg “The Diet-Heart Hypothesis: a Critique”).

Instead, I want to step away from the health conundrum to explore the history of margarine and its amazing rise from a lab-created inferior butter substitute to a major item in our shopping carts. I found myself more and more intrigued by the history (of food) as I get older which is scary because I find myself turning into my father: “Back in the days of the Empress Catherine the Great…” If you are under 30 and you are already bored come back in a few years.

History of margarine

Surprisingly enough, we can actually blame the French for the birth of margarine. The shortages of butter were crippling for the fat-loving nation in the middle of the 19th century. The war with Prussia was on the horizon and everyone knows you can’t feed cereal to soldiers. At the Paris World Exhibition in 1966 Louis Napoleon III announced a contest for the development of an acceptable butter substitute. In 1869 a French chemist by the name of Hippolyte Mège-Mouriés applied for a patent for a substance made from beef tallow emulsified with skim milk. He called it margarine, after a margaric fatty acid (considered a separate fatty acid at the time), and was subsequently awarded the government prize. The food industry began mass production but the product never took off. We can only imagine what the French public thought of spreading a colourless derivative of beef fat onto their morning croissants. My sympathies are entirely with them.

The Dutch firm Jurgen, one of the founding firms of Unilever (aha!),  bought the patent in 1870 and made a few improvements on the taste and the marketing. Other Northern European countries got in on the act, realising the potential of the new product.  It took awhile for the dairy industry to see the looming danger but by the end of the 19th century several countries had legislation in place to protect butter from the new kid on the block. The most bizarre of the margarine regulation laws was to have it coloured unappetising pink. Not surprisingly, it didn’t last.

As you can see at this point margarine is still largely an animal product. But with the growing shortages around the time of World War I and the development of food science new raw materials were required. The solution came in form of “vegetable” oils: soybean, cottonseed, canola, corn.

Quotation marks around “vegetable” are my little act of defiance against the food  industry which wants us to believe that these are vegetables because it makes it sound oh so wholesome. Until I see a potato oil on the shelf they are not vegetable oils (not even corn which is, of course, a grain)

The problem with oils is that they are, well, oily. But turns out that if you push hydrogen atoms through the oil under pressure in the presence of a metal catalyst such as nickel or palladium, you can solidify the oil. This basic biochemistry site gives a good description of what happens with unsaturated acids during hydrogenation.

Partial hydrogenation of unsaturated fatty acids leads to the formation of trans-fatty acids. Yep, we all know they are the real bad guys. Oops.

Over the next few decades margarine continued to develop as a combination of animal fats and seed oils. World War II brought the food rationing, relaxed legislation, (some might say more money behind the margarine manufacturers) which led to the margarine taking over the spread role from butter for the first time. The dairy industry was running out of ideas; their last resort was the colour advantage. Margarine companies were not allowed by law to mix yellow colouring into their product however they successfully circumvented that difficulty by selling a separate colouring which a housewife could mix with the margarine and serve to the unsuspecting dinner guests. The animal fat portion all but disappeared as the grain industries swelled up with government subsidies, especially in the US.

In the post war 1950 the diet-heart hypothesis started to make waves in the scientific and nutrition world and all of a sudden margarine went from a inferior and apologetic butter substitute for the poor to a heavily marketed health product. Housewives did not have to be ashamed of serving margarine in a butter dish any longer. Dr Ancel Keys said it was ok.

The rest, as they say, is history.  The word “margarine” is not even used very much anymore. Now we buy “spreads“, some of them are a combination of dairy and seed oils, some are pure seed oils promoted for their “heart healthy” polyunsaturated fat content. It is practically impossible to tease out which is which.

"When school is out each child needs their sandwich with Jurgen's Planta" 1916-1917. Run, kiddies, run!

Manufacturers still have to tread a thin marketing line between taste (the smooth softness and dairy aroma of butter) and the perceived unhealthfulness of saturated fats. Oh, how the tables have turned.  Now they apologise for butter. The fundamental difference between two products has been carefully ironed out and nowadays the terms “butter” and “margarine” are mostly interchangeable in the eyes of general public. So much so that if you ask for “butter” in a restaurant you are just as likely to get margarine.  If you attempt to raise the issue with an unsuspecting young waitress (poor thing,  she had no idea what she was in for when she was approaching my table), you’d be met with a blank look. Isn’t it the same thing? No, my dear, they are not. Just like when I order a piece of steak I don’t expect you to bring out a slab of tofu coloured red.

When can we restart calling these “foods” what they actually are? Imitation products,  lab-created and mass-produced to utilise agrarian commodities and chemically manipulated to suit the nutritional fad of the month.

And here is a little video on how to make butter.

How to make butter