Tag Archives: Nutrition

Down the rabbit hole

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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.

How to talk to your doc about nutrition

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Iatros (a patient) 480-470 BC. Good thing medicine has evolved since then.

Let’s say you have finally turned your back on the “calories in = calories out” drivel, donated the hearthealthywholegrains to the neighbourhood birds where they rightly belong and swapped your industrial seed oils, masquerading as vegetable derivatives, for good old-fashioned butter. You feel great, you are losing extra weight, you have reduced your medications and enjoying a healthy relationship with food for the first time in your life. Proud, you announce to your family doctor that you now eat like a caveman and in return you get a blank look with a hint of concern for your mental and physical wellbeing.

What do you do?

Disclaimer: I’m not a general practitioner, PCP or a specialist (yet!). I’ve spoken to many and been taught by a few. As a pre-intern and before, a medical student, I have been a part of the treating team in general practice, outpatients clinics and in the hospital setting. On that basis, I will take the liberty to draw some tentative observations and give some generic advice on this subject. Health professionals reading this, please feel free to chime in.

If you just want to rub it in to your doctor’s face because you have had a tough relationship with the medical profession in general, I get it. You can stop reading now ….

However, if you are intending to maintain a mutually respectful and useful relationship with your GP and even educate them about a couple of things, you might need a few hints.

1. Don’t make assumptions

This might sound obvious but you shouldn’t assume that all docs are stuck in the dark ages and will be naturally resistant to anything out of mainstream. If you are working yourself up for a confrontation you are going to get it. If you expect an open mind from your doc, you need to approach that conversation with an open mind yourself.

2. Don’t accuse the doctor of ignorance or incompetence

It mightn’t be a good idea to start the talk with: “You know nothing about nutrition, I read this blog from a medical student that says so”. May I also refer you to my other post where I point out how many years medical training actually takes.  It’s deplorable that nutrition is not part of the curriculum but it is hardly the fault of a person in front of you, who has studied 12+ years and might have x years of experience. Tread with caution.

3. Be careful with conspiracy theories

We all know about pharmaceutical, agricultural and political interests involved in the business of food supply. But as a conversation opener it really sucks.

“Doctor, I have stopped eating wheat because Monsanto’s unethical practices compromise the health of the planet”
“Riiiight… Erm, have you been under a lot of stress recently?”

4. Bring science to the table

Whether you are a science guru or a curious web wanderer you can use Evidence-Based Medicine to your advantage. If you have access to studies and a deep desire to educate your doctor in the error of his/her ways there are a couple of things you can do.

~ pick your battles: choose one area at a time, eg. Saturated fat is a necessary part of human diet, not a killer substance designed to punish us for our gluttony
~ find the evidence: doctors prefer randomised controlled trials and meta-analyses, like this one:
~ bring a hard copy to the consultation. Emails are less likely to be read as most GPs are very busy. Even better, highlight the abstract of the article and leave the paper for your doc to read. They might or they might not. A simple overview will go a long way to spike their interest:

“Hi, doc, I’ve come across a recent study you might be interested in. Looks like they analysed 21 prospective cohort studies with a total of almost 350 thousand people with a follow up between 5 and 23 years. They found that there was no link between saturated fat intake and risk of coronary heart disease, stroke and cardiovascular disease in general. Seems to be one of several studies in the last 10 years that exonerates saturated fat. Me, I’ve never liked that low fat yoghurt, they just replace fat with sugar. Here is copy if you want to check it out”

~It’s ok if you are not well-versed in the intricacies of Evidence-Based Medicine. Many bloggers out there pull out the latest studies and break them down for those less time/inclination/patience (PubMed…yawn) making a job easier for you.

5. N=1 is a great start

Your results are the best proof that your Paleo/primal/traditional/low carb lifestyle works. You will see the new respect in your doctor’s eyes when they see a drop in your blood sugar numbers if you are a diabetic. They will join you in rejoicing when your long-standing eczema, for which they have written countless steroid cream prescriptions, goes away. “MY irritable bowel syndrome is better now that I don’t eat bread or pasta” might even get your doc interested enough to read that study on gluten that you have printed out for them. Don’t underestimate the deep (sometimes very deep) desire of most doctors to help people and see them get better. They might even suggest a similar strategy to another patient of theirs with the same problem.

6. Admit it: you are a freak

If you think that it is normal to read 5 blog posts a day on nutrition, follow 200 health professionals on Twitter or know the difference between fructose and sucrose, I hate to break it to you. It isn’t. You are officially a part of 0.01% *of the population who a) care about their health b) seek out information c) use their brain d) dare to question the conventional advice. You are a rare breed.

*no actual statistics was used to determine this number. Please do not send emails requesting scientific references

The majority of patients are not like you. They want an instant result with little effort on their part. I do not blame them: they have been conditioned to believe that everything can be solved with a pill, a surgical procedure, a new face cream and an AbCirclePro.

Do you know what most doctors think about lifestyle change recommendations? It’s not that they don’t work. It’s that people don’t follow them.  The frustration leads to indifference. Like many patients, I have issues with the advice to “just eat less and move more”. But sometimes doctors have to deal with people unwilling to stop injecting IV drugs, smoking cigarettes, drinking a bottle of scotch before lunchtime and feeding KFC to their one-year olds. You might just rekindle a jaded doc’s belief in the power of good.

7. Go for the young’uns

Medical students and junior doctors get picked on. A lot. If you survived medical school with your ego intact, congratulations, you must have started at a higher baseline than me. Maybe this is why, in my experience, young doctors are much more likely to admit that they know nothing about nutrition. And why they tend to defer to government guidelines, dietitians and nutritionists. Another reason why the young docs are “an easy target” is because they are still relatively uninfluenced by the pharmaceutical propaganda. They are still naively excited by free Viagra pens. So don’t be afraid to share your experiences and ideas with medical students and hospital residents. Sure, you might get a funny look and a sneaky PRN order for haloperidol (sorry!). But one comment may be all it takes to plant a seed in someone who can look at the system with fresh eyes.

Adult circumcision. Wall painting from Ankhmahor, Sakkara. 2350-2000 BC The oldest known illustration of circumcision.

Doctor-bashing is practically a national sport nowadays. You can always count on an after-dinner horror story about corrupt GPs handing out antibiotics like candy, inept hospital interns missing blood vessels and arrogant surgeons leaving objects in body cavities. If you have decided to turn your back on the Western medicine you might have a good reason for doing so. But if it’s just a knee-jerk reaction born out of frustration with the system and a couple of bad apples, I might be able to convince you to reconsider. And at the end of the day, even if you cannot find the doctor who is willing to let go of the fat phobia or recommend kimchi for healthy gut, the next best thing is a doctor who treats you with respect, empathy and is prepared to listen.

Paleo Nutrition Seminar: Inner West CrossFIT

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Last night I had the greatest pleasure to present a Paleo/primal nutrition seminar to the folks from Inner West CrossFIT in Sydney. They are currently doing the 30day Paleo challenge and wanted somebody “sciency” to talk to them about the benefits of primal nutrition.

The 6pm WOD was cancelled (I don’t know how they survived without it), it was pouring rain outside and I had some good looking fit people sitting on wooden boxes and ab mats in front of me.

A high-tech girl that I am, I pulled out my butcher’s paper (thank goodness for Blu-Tac) and some textas and we were good to go.

What we discussed:

1. Low levels of Western disease in traditional populations
2. Western countries and the epidemic of chronic diseases in spite of the achievements of modern medicine.
3. (Very) brief nutritional history of humans
- from 2 million years ago till today
- the birth of diet-heart hypothesis 50 years ago and how it changed the way we eat forever
4. Paleo nutrition is not a re-enactment. We briefly touched on The Framework of Common Sense and how to use it.
5. Neolithic agents of disease
- wheat
- fructose
- industrial seed oils
- unfermented soy
6. Balanced food choices, including safe starches to last through their WODs and a few treats like dark chocolate and fruit
7. Dairy: why I believe that diary has a place in primal nutrition
8. Relying on hunger signals: when they are helpful and when they are not.
9. Meal frequency and how to unlearn the snacking habit.

The discussion got pretty lively: “healthy” fruit juices, how many eggs, is quinoa ok, which soy products were safe, managing the energy slump in the first 2 weeks and even gluten-free beer.

I finished up with a plea not to get too obsessive about little things. Food should still be enjoyable and fun.

After finishing the presentation in 70 minutes (I consider this an achievement) we chatted about Paleo, crossfit, women’s health and fueling the crossfit body.

It was great to see a group of people so passionate about health and fitness. I hope they have learned something new from our talk. My other secret hope is that at the end of their 30 day Paleo challenge some will decide that they want to continue and reap the benefits of the new lifestyle. Good luck to you all!

Big picture, please

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No science today, folks. Just a good old rant.

It’s the evening rush in a city gym. A 20-something personal trainer with biceps bulging out of his sleeves is leading a middle-aged woman into a designated PT area. This is clearly her first time here. She is wearing the world’s biggest t-shirt, nervously tugging it down to the knees, looking flushed already from going up the stairs. The PT pulls out a funny-looking half ball and gestures her to come to a push up position. She obediently kneels down on the ground, places her hands on the flat part of the ball, hikes her hips high into the air, lifts her knees off the ground and promptly starts to shake all over. Two seconds later she collapses back down and the PT kindly encourages her to come up again. The second time she works out that she can take her feet wider and this time she stays up but her whole body is shaking uncontrollably from the wrists to the pelvis. I mentally shoo away the image of her falling flat on her face and breaking her nose. Her PT enthusiastically announces that she will be doing 3 sets of 12 push ups with one leg in the air and this is “great for her shoulder stability and core muscles”.

Oh my…

It’s a no-brainer that a 40-something overweight de-conditioned woman should be first building her base strength and fitness. Maybe wall push-ups and half-squats would be a good place to start. Seems like a common sense approach. Then again common sense is not very common.

Similar approach is used in health and nutrition on a regular basis. I love berries. But if I hear of another berry which has been found to reduce inflammation/fight cancer/bring about world peace, I swear I will lose it. A quick browse through a popular bodybuilding magazine reveals that apparently honey has antibacterial properties and lycopenes in tomatoes are good for prostate health. How many times have you seen a woman (not to be a sexist or anything, but it is normally a woman) standing near the fridge with a frozen meal in each hand earnestly comparing the nutrient composition? Hmmm… This one has more antioxidants, and this one has more protein. Which one of these highly processed refined carb-loaded artificial nutrient- fortified examples of food manufacturing science is better for me?

Talking about food manufacturers, they bit down on this concept very quickly. Every commercial is quick to point out that one magic ingredient which makes their product essential for health.

Food “reductionism” has been rife in health and nutrition for a long time. It’s as if the elusive search for gold in alchemy has morphed into its modern scientific equivalent.

Spag Bol is Italian. Italy is in the Mediterranean. The Mediterranean diet is healthy. Ergo: spag bol is healthy

The Mediterranean diet is a common example. After we have successfully promoted red wine into a health food category (no objections here) with resveratrol, we found another magic component which mitigates the unhealthy saturated fat levels in the diets of the a French, Spanish, Italians and Greeks: polyunsaturated fatty acids. Actually, the studies talked about omega-3 polyunsaturated fats but omega-6 is riding along on the wave of a sudden “omega” popularity. The market reacted instantaneously. Olive oil, being holier than thou, is now used in spreads, frozen meals, tuna cans, body butter and strangely enough, perfume. I will talk about the Mediterranean diet another day but Stephan from Whole Health Source did a good analysis of the famous Lyon Diet-Heart Study which started the whole craze.

I am sorry to say it but even some well educated people in the primal/Paleo community fall into this trap. I have read many a forum where a question from a newbie turns into a heated discussion: is white potato Paleo? What about nectarines, since they are technically a new breed of fruit? What’s the best ratio of DHA/EPA in my fish oil? Am I doomed if I can’t source grass-fed beef?

There is nothing wrong with wanting perfection in your diet. And if you have that much time and energy to devote to your diet, that’s great. If you choose to count your calories, I think you are wasting precious brain power, but whatever floats your boat. However, let’s not forget that the majority of people are still buying banana bread because it contains fruit. And if you are one of them, no amount of blueberries is going to fix that damage.

I’m a visual kind of person so to make things easy I’ve designed a little pie chart representing how the majority of the community (as I know it) sees nutrition.

Food attitudes in modern society. Source: Anastasia's extensive life experience

“Disinterested Rebels” are the ones who are happily chugging away the pizzas and the burgers washed down by liters of Coke. They don’t care about heart disease, cholesterol or getting a beer gut. I nominated the 20% figure because the smoking prevalence in Australia is 19%. And if you are still smoking it’s pretty safe to say you are not terribly concerned about living.

“Endeavouring Hopefuls” are the concerned consumers, representing the majority of the population. They listen to the nutrition guidelines, buy diet magazines and are the main marketing targets for low-fat muffins and diet sodas.

“Major Healthnuts” take their health and diet very seriously. They painstakingly research the nutritional benefits of every mouthful. They are the organics, the fruitarians, paleos, vegans, raw foodists…They also tend to have a firm unwavering belief that their way is the only right way and they will fight for it foaming at the mouth. If you receive this via an email subscription and follow numerous bloggers on Twitter and Facebook, congratulations, you belong to the last group. Welcome to the club.

The common term Standard American Diet can probably encompass the first 2 groups. And by the way, my American friends, you don’t have a patent on crap food, I think it’s time to change the term to SWD (Standard Western Diet). It doesn’t have the same punch as SAD but it accurately portrays that here is Australia we like our bagels and soda (aka soft drinks) too.

Bottom line: before splitting hairs about your macronutrient ratios and decanting cod liver oil by the millilitre, fix the BIG things that are wrong with your diet. Get rid of processed food. Period. Anything that comes in a box and has a Heart foundation tick should also be burned, just in case. I’m sorry, boys, protein shakes are never Paleo. If you need them, have them, just don’t lie to yourself.

Many smart people before me have identified 4 major components of the SWD which cause the most damage. Dr Kurt Harris has succinctly named them NADs (Neolithic Agents of Disease). They are wheat, fructose, industrial seed oils and soy. Until you eliminate these 4 you can stop worrying about dairy, legumes, nuts and rice. These are the only agents which truly fail the Framework of Common Sense.

And a word of advice: when your truck driver uncle Harry comes home from the doctor dejected because he was told to lose 20 kilos, don’t start a conversation about medium chain fatty acids. That would be the nutritional equivalent of one-legged BOSU ball push ups. Let’s get the “Disinterested Rebels” and “Endeavouring Hopefuls” off the NADs first.

In the world we live in, THIS is a healthy afternoon snack.

The Framework of Common Sense

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For something as mundane as fuel for our bodies, food and our relationship with it are extremely complicated. Our nutritional knowledge is molded from birth. First, from our parents: Eat your greens! Drink milk for strong bones! No dessert until you clean your plate! In the tempestuous years of teenage rebellion, we do a 180 and discard the well-meaning advice of our elders and embrace the “coolness” of junk food and alcohol. At least I did. Some “Peter Pans” remain in the grips of the party food (pizza, sausage rolls, lemonade) beyond adolescence. Others make a transition to responsible adulthood by becoming your typical health conscious consumer. But most still continue to seek some authority to take on a parent role: government guidelines, scientists (as a vague joint body supposedly united by a common purpose and understanding), doctors, newspapers, weight loss shows, personal trainers, Sharon from next door because she has lost 7 kilos on the Lemon Detox diet. Once the authority figure is established, everything they say equals gospel and every decision you make is referred to their wisdom.

Here is a radical concept. You have a brain. So do I. I propose a framework. I will call it The Framework of Common Sense. Every time you hear of a new diet, new pill, new exercise regime, new wonder berry from Tibet, you apply the FCS and voila! Your rusty neurons spring into action. A word of warning though. FCS requires applying critical thinking to every new concept. Always. You can never turn your brain off and just go with the flow. If your attention is already starting to drift I suggest you go back to this.

Good, you are still here. Let’s get started.

STEP 1: The laws of metabolism

This is where you ask yourself: does it make sense from physiological point of view? This one has a caveat: you have to know the basics of human biochemistry. Sorry.
Important things to know here:
A. Availability of mechanisms for digestion and absorption: is human body actually designed to process this food?
B. Nutrient density: does the diet in question provide enough vital nutrients for health without the need for supplementation?
C. Hormonal response: does the diet produce the hormonal environment necessary for everyday functioning and for special circumstances like growth, pregnancy, menopause, old age?
D. Inherent harm: can the diet cause damage to the body as suggested by biochemical mechanisms ?(note: do not confuse with Implied harm which is suggested by scientific evidence. It is further down the list)

STEP 2: Evolutionary environment

Is there evidence that people have consumed this food for a sizable chunk of human history? If yes, is there evidence that humans thrived on it?

Do not make your step 2 more important than step 1. Just because the food is ancient, it doesn’t mean it is automatically “good”. Australian Aborigines have been eating grubs and insects for thousands of years. I’m pretty sure that even if it turns out that cockroaches can cure cancer, they would never become a delicacy in the Western world. On the other hand, just because the food is modern doesn’t make it “bad”. Cheese is a modern food (and therefore off limits for the hardcore Paleo crowd). But step 1 tells you that cheese is A. Easily digested (unless people have specific issues with casein) B. High in essential fats, vitamin K, calcium etc. C. Has little effect on hormone levels D. Doesn’t cause inherent harm.

STEP 3. Scientific evidence

A. Implied harm: is there scientific evidence that the food or diet results in long term harm?
B. Implied benefit: is there scientific evidence that it is beneficial for health and longevity?

In science, the top level of evidence is a double-blinded multi-centre long term Randomised Controlled Trial (RCT). Two groups of people, similar in major demographics (age, gender, race, health status). The intervention allocated (in this case, a diet) is identical but for one variable. Neither investigators nor participants know the group allocation of an individual participant. Participants are followed up regularly and for a long time to assess risk and efficacy. You tell me if it is possible to test a diet using this principles.

The second tier in scientific evidence is observational studies. You select a group of people and observe their eating habits for some years and then record how many heart attacks, cancer, strokes etc. they get over the years. Or you ask heart disease patients about their dietary habits and then compare to healthy people. Or you do a national dietary survey and compare it to national disease statistics. Lots of loopholes in all of the above. Therefore…

Do not give step 3 higher priority than steps 1 and 2. Recognise limitations of scientific studies. For those who only trust scientific evidence, here is a nice review of the available evidence that the use of parachutes improves the outcomes of jumping off an airplane. Enjoy.

Now let’s apply the FCS to the Heart Foundation recommended diet (HFD)

STEP 1 Metabolism
A. Digestion and absorption
Major issue here is the massive content of so-called heart healthy whole grains. Your intestine is not a blocked pipe, it doesn’t appreciate being “scrubbed”. And to put it simply, if it comes out the other end in the same form as it goes into your mouth, it wasn’t meant to be digested.
B. Nutrient density
HFD is based on the concept that you can decrease the nutrient density as long as you have the same food volume. As a result you get skim milk, skinless chicken breasts, steamed watery vegetables and cardboard-tasting biscuits. Let alone a total lack of taste, how about the fact that cereals, breads, skim milk are so obviously devoid of nutrients that they have to be artificially fortified with thiamine, vitamin D, zinc, iron, etc.?
C. Hormonal response
55-65% carbohydrates? I don’t care whether you eat them on the form of sweet potato or Caramello Koalas, that’s a lot of insulin. If you are happy to pound the pavement for 10 kms daily and ruin your joints in the process just to control the fat-storing inclinations of that hormone, be my guest. And, guys, be prepared to do weight training every morning too, since insulin decreases testosterone concentration.
D. Inherent harm
3 words: wheat, fructose, hearthealthyindustrialvegetableoils (by the way, since when did canola and sunflower seeds get reclassified as vegetables?)

According to our algorithm we can stop right here. But let’s humour the zealots of conventional wisdom and work down the list.

STEP 2. Evolutionary evidence
7 million years of hominans. 2 million years of humans. 10 thousand years since some agriculture. 200 years of sugar. 50 years of industrial vegetable oils. Do the math.

STEP 3. Scientific evidence
Let’s face it: it’s very shaky. For a comprehensive analysis i.e. debunking of the lipid hypothesis (saturated fat raises your cholesterol, high cholesterol causes heart disease) please read this and this and this.

This algorithm can be applied to any nutrition plan: low-fat, low-carb, vegetarian, Paleo, vegan (horse-strength doses of vitamin B12 pills, anyone?), Jenny Craig and Raw food. I would love to hear some of you having a go at this algorithm. Or let me take on a diet or a food group of your choice.

The upside of using your own brain to make your own decisions is that you are in control of how you live your life. The downside is that you lose that wonderful sense of certainty that tends to come with ignorance. You will no longer be able just to trust media reports that start with the words “in the latest study the scientists have discovered…”. You will not be able to just accept your doctor’s advice to take the fat, salt and taste out of your food without asking WHY. You will have to know more about basic sciences, metabolism, anthropology, endocrinology, statistics and evidence-based medicine. You will have nagging doubts and constantly question yourself and others.

And if any of this is making you uncomfortable (quite understandable) it is never too late to turn back.

Consider yourself a nutrition expert? Take a quiz and find out!

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When it comes to nutrition and weight loss, we are all experts. Thanks to Women’s Day, Men’s Health, body building sites and your Sunday paper, everyone has an opinion. Now is your chance to find out how much you actually know. The questions are based on basic biochemistry of human metabolism and therefore are not somebody’s point of view. They are simple hard facts you can find in any biochemistry or endocrinology textbook. Good luck!

1. The predominant fat in lard (pork fat) is:
A. Saturated
B. Monounsaturated
C. Polyunsaturated
D. I only buy margarine

2. Saturated fat consumption in the 20th century has:
A. Increased
B. Decreased
C. Unchanged
D. I haven’t seen saturated fat since I was 5

3. What component of the diet raises blood triglycerides the most?
A. Carbohydrates
B. Fat
C. Protein
D. I have never had a cholesterol/lipid blood test and have no idea what you are talking about

4. What is the effect of low-carb diet on HDL (“good cholesterol”)?
A. Increases HDL
B. Decreases HDL
C. No change
D. Low-carb diets are a fad and I will never try one

5. Estimate the glycemic index of the following foods (guess to the nearest 10 or choose low/medium/high):
A. ”Frosties” breakfast cereal
B. Boiled potato
C. Eggs
D. Peanut M&M’s
E. Muesli bar with dried fruit
F. Super supreme pan pizza

6. Most of the blood cholesterol comes from your diet:
True
False

7. What is the preferred fuel for the heart?
A. Carbohydrates
B. Fat
C. Protein
D. Love

8. Which foods contain the most Vitamin A:
A. Carrots
B. Milk
C. Eggs
D. Liver

9. What happens in your body if you don’t get a carbohydrate fix 4 hours after your last meal? (in a healthy individual)
A. You go delirious and slip into a coma
B. You start burning your hard-earned muscle undoing all the work in the gym
C. Your body activates hormones which start burning body fat for energy sparing muscle proteins
D. This travesty has never occurred since you always carry a cereal bar for such occasions

10. What is the difference between saturated and trans fats?
A. There is no difference, they both cause heart attacks
B. There is no difference as they are both solid
C. Trans fats are man-made by hydrogenation, saturated fats are abundant in nature
D. I don’t know but this quiz has made me hungry

Answers in the next post!

Did cavemen have “Special K”?

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Paleo is a buzz word in nutrition. I first heard a concept of “eating like cavemen” a few years ago. I vividly remember a picture in my mind: scruffy lean Neanderthal (or is it Cromanian???) ripping apart an animal carcass with his teeth, digging in the dirt for edible plants and shivering in his cave. Why would i want THAT? (You can tell I know nothing about anthropology!)
If you punch the words “Paleo diet” into Google, you will be introduced to a whole community. You will see words like “hunter-gatherer”, “primal”, “animalistic”.
 
The basic idea is humans evolved for millions of years to eat a certain diet. The advent of agriculture and consequent introduction of grains and dairy approximately 10 thousand years ago is a very recent event in evolutionary terms. Our genes have not adapted to this radical change in our food supply. Humans had been eating a diet high in animal protein and meat for almost 2 million years prior to that.
 
As in every other nutritional community, confusion reigns. Some followers eschew grains only, some don’t consume dairy, others attempt to re-enact their own romantic idea of hunter-gatherer lifestyle. One concept that unites them all is the desire to return to natural nutritious food, free of additives, modifications, fads, chemicals, preservatives, enhancers and fortified ingredients.
 
I am not strictly Paleo. I enjoy full-fat dairy, like delicious thick cream in my coffee or aged cheddar in my omelette. I sometimes (gasp!) give in to a piece of sourdough bread. But I do believe that we lost our way with nutrition. Somehow our food turned into “stuff with stuff in it”. How many calories are in an average muffin? How much fat is in your favorite yoghurt? How much protein is added to your cereal? I bet you know the answers to these questions. If your highly processed chocolate-flavoured skim milk happens to lack vitamin D, never fear! The good manufacturer is going to improve their deficient product by adding extra vitamin D. Regardless of the fact that you need fat for vitamin D absorption. Oops! Looks like Mother Nature knew what she was doing after all!
 
I have a challenge for you today. Open your pantry. Don’t worry, I am not going to pick on you for a box of Tim Tams (in case of unexpected guests, of course) or a packet of crisps. You and I know that it’s junk. Instead, pick up a box of your cereal. The one with a Heart Foundation tick on it. Go down to ingredients. How many of these do you recognize? How many can you pronounce?  Do you know what they are for? Finally, are any of these FOOD in their own right???
I didn’t think so.
 

Welcome to primalmeded

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I am a final year medical student and I have a confession: I know precious little about health.

 
I have been taught about the mechanisms of heart attacks. I know how to diagnose one, what medications to prescribe, what complications to expect and how to look after my patient on the cardiac ward. The patient gets better, I discharge them home with a list of medications, a referral to a cardiologist and strong advice to “address lifestyle factors”. This is where things get a bit tricky.
 
I used to know what to say: avoid saturated fat, exercise up to 150 minutes a week, reduce your cholesterol, avoid salt, eat plenty of whole grains… But somehow “lifestyle modification” remained this vague elusive concept. Doubt made me get off my butt and do my own research.
 
My partner says that after I read Gary Taubes “Diet Delusion” (“Good Calories Bad Calories” as it is published in the US) I went quiet for a week. I hated the way that book made me question everything I thought I knew. I struggled through it and then promptly read it again. I began ferociously searching for information on nutrition and exercise. I still am.
 
There are people out there who are much smarter than me. They refuse to accept the nutritional dogma of the last 50-100 years which led us to be the fattest and unhealthiest generation yet. I will endeavour to follow their example and take charge of my medical education.
 
This blog is to share my ideas with you: my friends, family and anybody else who is tired of the latest gimmick and the newest fad. And to put my money where my mouth is, I promise to share my personal journey to health and fitness. Please do not expect “before and after” bikini shots, it ain’t gonna happen.
 
Drop me a line if you like what you see, or maybe two lines if you hate it.
 
Thanks,
Anastasia