Sunday, September 25, 2011

Quote of the Day

"Nutrition advice is like porn- there is a lot of it, but most of it isn't good and some of it is just plan nasty."

Fructose vs. Your Liver: The Fight of the Century

Announcer: "In this corner.... weighing in at 3lbs., the reigning champion of detoxing and synthesis, give it up for... YOUR LIVER!!!

Audience cheers

Announcer: "Now meet his challenger.... weighing in with a molar mass of 180.16 g/mol, meet the lean, mean, monosaccharide... FRUCTOSE!!!

Audience boos

Referee: "Now I want a good clean fight... no low blows and you break when I tell you to."

Announcer: "And they are off... liver is defiently favored heavily in this battle... fructose just isn't big enough to take the liver down... and the first punches are thrown... fructose coming at liver with a flurry but liver easily defends [a low level (25g), acute fructose exposure] and BAM fructose takes a hit right in the hydroxymethyl. He has got to learn to protect methyl otherwise this match will be over quick.

And here comes fructose again but wow look at that power! Liver is just able to avoid injury there, that was close [a high level (+50g) acute fructose exposure or chronic medium-high (+30g) exposure for a month or so].

Now here comes liver in a fury! He takes fructose to the ground and this match seems to be all over!! [maintaining low levels (>30g) throughout life]

But wait! Fructose manages to get out from under the liver and is now back on his feet [temptation]. The round will go to liver but fructose isn't going down without a fight!

Now look at fructose go! Holy moly! Fructose is just knocking triglycerides [chronic high levels of exposure] out of liver left and right... just look at liver now! He's covered in them! [fatty liver disease] This looks like the end for liver... Liver takes a fall, he's down, he's down! Fructose is all over him and liver cannot fight him off any longer!!

The referee is stepping in now [doctor, if your lucky] to save liver from getting killed because he can no longer defend himself! It's all over... Fructose is the new champion!!"

The End

Case in point don't let fructose become a Cinderella story... keep fructose low, no more than 30g per day, and keep larger dosages of it as infrequent as possible.

Saturday, September 24, 2011

The Common Sense Manifesto

A family sits around the dinner table happily eating a meal of spaghetti and meatballs with garlic bread

Husband: "This sure is a swell meal you made honey"

Wife: "Why thank you George... and for dessert we have apple pie."

Husband: "Excellent!... my favorite."

Suddenly George holds his fist to his chest and makes a face of discomfort

Wife: "Is everything all right honey?"

Husband: "Yes, just a little bit of heartburn is all.... pass me a piece of garlic bread, would ya?"


I'm sure we all know people like this, those that are popping antacids or other over the counter drugs to alleviate the discomforts of "unimportant" symptoms such as acid re flux or heartburn. These people just pass them off as nothing and continue about their day as if all was fine in the world. Then a few years down the road these same people windup with some sort of severe condition and are shocked because they always felt "fine" before that. For this reason I have come up with the Common Sense Manifesto.

The Common Sense Manifesto:

1) If after eating a food, you feel worse than you did before eating it do not eat it.

2) If you believe that that food is good for you find an alternative that makes you feel good.

3) If you find all alternatives of this health food give you the same result consider the fact that it might not be a health food for you. (what is a health food if it makes you unhealthy?)

4) In the case of foods that you really like, but make you feel terrible, you must weigh whether those couple of minutes of bliss are worth the hours of agony following

5) Nobody is going to make you eat anything... it is always your choice

6) Does the food keep you satiated for long periods of time or do you find you need to constantly snack to maintain energy? Satiety= good ... Energy snacking= bad

If people followed these rules they would be making a big step in the right direction.

Wednesday, September 21, 2011

Terrible Journalism

Some days I feel a little masochistic and on those days I'll go to Yahoo! Health and poke around... this usually ends with me either banging my head on the desk or pulling some of my luxurious locks out. But today I'm going to be mildly productive and just write about one particularly bad article. And when I say bad I mean bad...

The article is entitled "5 Foods That Can Trigger a Stroke" and was written by Melanie Haiken, from; you can read the article here. Just doing a quick search brings here personal page up, seen here, and it turns out she has no health credentials at all... according to here site she is: "writer, editor, Web project manager, and national magazine journalist". That being said I am not abject to journalists writing health articles... but in this case her lack of... let's call it reading ability... is why journalists get ripped on when reporting in a specialized field.

So on to the study... I only want to focus on one of the five foods that she lists because it's the one I have the biggest beef with (pun intended). That is number four: red meat. I don't know why but red meat seems to be a standard in the list of foods that we shouldn't eat... I don't recall ever seeing a widely circulating article like this that doesn't mention red meat in some way. Even articles where you wouldn't think they could possibly sneak it in they somehow manage to.

The first half of the red meat section discusses a study in the medical journal Stroke in which Melanie states that the researches followed 35,000 women for 10 years and they found that women who consumed a large portion of red meat each day had a 42-percent higher incidence of stroke. This is what Melanie says.

Now let's look at the actual study... You cannot actually see the whole study unless you are a member or you pay (which I'm not going to do... I wonder did Melanie?) but you can see the abstract here. But even reading the abstract is enough to see that Melanie's damning of red meat is unsound. First off this study only followed women so this study CANNOT even draw a correlation for men. Secondly this was an epidemiology study of Swedish women, so now all your results only apply to Swedish women. Third this was a survey study and as I hope you know they are useless because of the wild inaccuracies that occur (at best surveys will establish a weak correlation, which does not imply causation). So now just based on the type of study this is and the general method we know that at best this study can show a weak correlation between stroke and red meat in Swedish women.

Let's mosey over to the results shall we? The results being scant as they are there is not a whole lot to say except that what is considered unprocessed meat? Can't red meat be unprocessed? I recall this place called a butcher shop that sells lots of red meat that seems unprocessed to me... seeing how it still looks like a cow when you buy it. So what if your a Swedish women who worries about weak correlations... can you buy a cow from your butcher because its unprocessed or will your weakly corrilated risk of stroke rise because its red meat. This vagueness disturbs me... and unless Melanie bought the article I wonder if she even read the results or skipped right to the concluesion...

So that's the study...

And from that Melanie determines (using all her medical training) that we should all eat less red meat and replace it with some poultry and fish, but be sure to emphasize beans, legumes, nuts, tofu, and nonfat dairy (because those are high quality proteins that are easily used by the body... cue eye roll).

As for the hemoglobin tidbit she adds... she gives no studies to support that claim so I feel no need to refute it... making a claim like that without providing any data is stupid and confusing to the reader who may be taking her words to heart.

And if you want to see what saturated fat really does go here.

But since Melanie is making claims without giving data I'm gonna make one to, and here it is: "Researchers are currently investigating a promising lead where infusing pig bile directly into the cerebral cortex allows humans to fly."

Isn't main stream nutrition wonderful!?


So by now most people know what atherosclerosis is, we've heard about in the news, on the internet, and in our households. But just to cover my bases here is what it is: it is the hardening of the arteries via accumulation of oxidized fat, cholesterol, and lipid material. Note the word oxidized, it will be important starting... now.

The 1 Easy Steps to Atherosclerosis:
1) Become chronically inflamed

Congrats!! You are now on your way to getting all the great benefits that atherosclerosis provides such as the heart attack, chronic heart disease, and much much more!!!

Chronic inflammation is the catalyst for everything that happens afterward that leads up to atherosclerosis.

So first let's look at why we become inflamed....

Inflammation is the bodies immune response to internal and external stressors. If you get a cut the area around the damage will inflame which says "Hey we need help over here!" and this allows the healing process to begin. If inflammation didn't exist then that cut would stay wide open and your body would go about its normal business. That would be pretty bad and so we must be able to become inflamed when necessary.

But now image that you are constantly getting small cuts all over your body all day, everyday of the week... apart from being a really crummy week and a lot of pain your immune system is being taxed beyond what it is comfortable operating at. The body is constantly calling for more help but never seems to have enough.

So what's this got to do with atherosclerosis? Patience, we're getting there... a complex process deserves at least a semi-complex answer.

So now image that all those small cuts are occurring inside your body, in your veins and arteries, all day, everyday... this is what it means to be chronically inflamed, you are not inflamed as much as you would be during an illness and so you have few symptoms at the start, but instead you suffer from a low level of inflammation all the time. So your immune system is constantly sending help to the area of inflammation, trying to return to its homeostatic environment.

What foods cause inflammation you might ask?

Most pro-inflammatory foods are those that either cause an allergic reaction (of any degree), a spike in insulin, contain synthetic trans-fats, or contain high levels of arachidonic acid (omega-6). I'm sure there are others but these are the biggies.

When I say allergic reaction of any degree I mean that you may not even notice the reaction if you are used to eating the food. Dairy protein and gluten are two very common allergens that people are not even aware that they are sensitive to unless they avoid them for an extended period of time. That's why you see people like Robb Wolf advocating the idea to go grains, legumes, and dairy free for a month, see how you feel, and then, if you desire, slowly add them back in and see how you respond.

A spike in insulin occurs whenever we eat protein or carbohydrate, but in the case of inflammation we are really only concerned with foods that cause insulin to rapidly increase. The common measurement for speed of insulin release is the glycemic index, where a solution of pure glucose is given a level of 100 and everything else is based around that.

So what's highly glycemic? Processed carbs (like cereal, bread, pasta), some fruits, and other things... see a listing here.

Synthetic trans-fats, which are by-products of hydrogenated oils, are probably one of the few things that everyone agrees are pretty bad for you. Study after study (see a few below) show that trans-fat decrease HDL and increase inflammation. Do not confuse synthetic trans-fats with natural trans-fats found in meat and diary, such as conjugated linolenic acid, as these fats have been found to have similar effects as saturated fats.

Arachidonic acid, commonly know as omega-6, is pro-inflammatory by its very nature. It is an essential polyunsaturated fat commonly found in vegetable and seed oils, nuts and seeds, grain-fed meats, and high fat processed foods. Even though it is an essential fat the average person is getting far to much omega-6 and not enough omega-3 (which is anti-inflammatory) to counteract the omega-6's effect.

Are you asleep yet?

Next up... Oxidation

Ever see a rusty beat up car and think what a piece of junk? Well that rust is just oxidized ferrous material... and the same thing happens inside your body all the time. Oxidation is the interaction of oxygen with any other material and is very important for our daily function, but once again too much of it can be detrimental to health.

Recall that if you are chronically inflamed help will constantly be coming to the inflammation area to try and heal it. Now who exactly is this help? Well a major one is LDL which shuttle lipid material to the trouble area. But I thought LDL was bad!? Well, no, its actually one of the most important molecules in the body.

Image a world with no cars. It would take a really long time to get anywhere and you'll probably wind up getting mugged, losing something, or just wind up disheveled. This is what would happen to cholesterol, fat, and other lipid materials if it weren't for lipo-proteins (the last L in LDL)

Ok, so the LDL is at the inflammation site doing its thing and all is good (except your chronically inflamed!). But now imagine that on its way to the site in ran into a oxygen free-radical and reacted with it. Now we have an oxidized LDL particle and now we are in trouble. This oxidized particle still goes to the inflammation site but now it burrows itself behind the epithelial tissue, which is the protective tissue in the vessels and is not very think in most vessel locations, and there you have it.... the dreaded plaque buildup and the start of atherosclerosis. The worst part is that this is a positive feed-back loop in that once you have oxidized molecules inflammation increases and vis versa and they keep building on each other.

So how do we reduce these nasty oxidizing agents?

The best way to reduce these agents are to:
1) Eat foods with anti-oxidant nutrients. Common anti-oxidants are vitamin C, vitamin E, vitamin A, selenium, and astaxanthin (found in krill oil). There are lots more, but these are rather well know ones that are easy to get from whole foods.

2) Eat little unsaturated fat. Because the fat is unsaturated (it has one or more double bonds) it is much more prone to react with oxygen and become oxidized (often times before you even consume it). If you do have any have it cold, as heating unsaturated fat (like olive oil) will just about guarantee that the oil becomes oxidized. Do any cooking with saturated fat, my favorite is coconut oil.

3) Consume just enough omega-3 to balance the omega-6. This is similar to number two but deserves special attention because of all the hype the omega's get these days. Ideally you want your ratio of omega-3:omega-6 to be between 1:1 and like 1:5. You really don't want to go higher than 1:1 or lower than 1:5... and if your eating a good (by my definition good means grass-fed beef, free-range chicken, pasture lamb, pastured eggs, coconut oil for cooking, lots of leafy greens) diet and are in good health you should hit this ratio without any supplementation or very little.

4) Avoiding common allergy foods like gluten and dairy protein until you know that you don't have an adverse reaction to it; which is achieved by staying off the stuff for at least a month and then very carefully watching yourself as you add it back in.

5) Stay low carb. If you have an abundance of glucose swimming in your blood your body is going to start building new molecules and that means more reactions and more free-radical bi-products. If instead you eat low carb, less than 100g per day, you are allowing your body to repair what it already has, which means less growth and less chance for bi-product and mutations.

So there you have it... the main cause of atherosclerosis.


--Atherosclerosis and Lipoproteins

--Hypertension and the Pathogenesis of Atherosclerosis

--Anti-inflammatory HDL Becomes Pro-inflammatory during the Acute Phase Response

--Atherosclerosis -- An Inflammatory Disease

--Triggering of inflammatory response by myeloperoxidase-oxidized LDL

--Replacement of dietary saturated fat with trans fat reduces serum paraoxonase activity in healthy men and women

--Consumption of Trans Fatty Acids Is Related to Plasma Biomarkers of Inflammation and Endothelial Dysfunction

Tuesday, September 20, 2011

Measuring LDL Cholesterol

How do we do it?: LDL cholesterol is measured indirectly using the Friedewald Equation.
The Friedewald Equation:

Where LDL is low-density lipoprotein, TC is total cholesterol, HDL is high-density lipoprotein, and T is triglycerides measured in mg/dl. (1)

We use this equation because measuring LDL directly is difficult so unless deemed necessary or if your willing to pay; your standard lipid profile uses the equation. 

Friedewald states that the formula is inaccurate for patients with triglycerides over 400mg/100ml (1)

But upon looking at his data set the majority (~75%) of the patients had triglycerides over 100 which makes me wonder if the formula is incorrect when triglycerides get very low (50-70), as suggested in study 2. This is important because many people who enbark on a high fat diet see their LDL go up and despite everything else getting better (triglycerides are down, HDL is up, body composition is better, etc...) they (or their doctor) pick this one thing out and proceed to freak out.

Doctor Reviewing High-Fat Diet Patient's Blood Results:

Patient sitting waiting for doctor to come in. Looks at watch. Doctor enters.

Doctor: "Sorry about the wait I was busy reading the ADA's website so I can stay up to date with the best, most current, unbiased data."

Audience laughs.

Patient: "That's alright... Did you look at my blood results?"

Doctor: "Yes I did and I must say that it all looks good, your HDL, triglycerides, thyroid, and general chemistry are absolutely perfect. The only problem is your LDL cholesterol."

Patient: "What's wrong with it?"

Doctor: "Well it's just slightly higher then I'd like to see it."

Patient: "Well since the LDL was measured indirectly, couldn't all the LDL be the harmless large and puffy ones? Shouldn't I have a direct test and have the prominent type of LDL determined before worrying?"

Doctor: "Hmmmm... Well I... uhhh... Let's just see if we can get it down. Tell me, what do you eat in a typical day?"

Patient: "Well I usually have six over easy eggs and 1/2lb of grass fed beef for breakfast, then I have 1lb of grass-fed beef, or free-range chicken, or lamb for dinner along with a heaping of lightly steamed leafy greens. Oh and all my eggs and meat are cooked in coconut oil." [this is my typical daily diet]


 Patient: "I've been eating this way for 5 years"

Doctor: "Well if want to live past 50 you'll throw out that diet and follow a 10% fat diet with all fat coming from vegetable sources, eat lots of fruit, veggies, and whole grains and no meat except fish."

Patient: "What happened to the LDL only be slightly elevated and not that big of a deal?"

Doctor: "That was before I knew you were eating a diet designed to kill you. Tell me are you suicidal? There is a good psychologist upstairs that I want you to see because no one in their right mind would eat this way"

Case in point: Don't flip if LDL goes up on a high-fat (especially high saturated) diet, look at you HDL and triglycerides. If you are still concerned get you LDL directly tested and have the lab determine the type of LDL that is most prominent. (full post on the LDL types coming soon)

1) Estimation of the Concentration of Low-Density Lipoprotein Cholesterol in Plasma,Without Use of the Preparative Ultracentrifuge

2) The Impact of Low Serum Triglyceride on LDL-Cholesterol Estimation

Monday, September 19, 2011

Alpha Linolenic Acid

What is it?: Alpha-linolenic acid is the main type of omega-3 fatty acid found in plants. It is similar to the omega-3 fatty acids that are in fish oil which are: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is not a usable form of omega-3 and the body must convert it into EPA or DHA.

Most Likely:

1) Alpha linolenic acid is poorly converted into EPA (1) (2) (6)

2) Alpha linolenic acid is not measurable converted into DHA (1) (2) (6)

1) High levels of consumed linolenic acid (EPA/DHA) compared to ALA reduce the amount of ALA converted into EPA/DHA (2) (6)

2) ALA does not provide the same level of protection against disease compared to EPA/DHA (4) (5)

1) Consumption of whole flax seed results in little ALA absorption; whereas ground flax seed results in high levels of absorption (3)

2) Consuming whole flax seed can lead to GI distress (3)

Studies that contributed:
1) Alpha-Linolenic Acid: Is It Essential to Cardiovascular Health?

2) α-Linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans

3) Bioavailability of Alpha-Linolenic Acid in Subjects after Ingestion of Three Different Forms of Flaxseed

4) n–3 Fatty acids from fish or fish-oil supplements, but not α-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review

5) Dietary α-Linolenic Acid, EPA, and DHA Have Differential Effects on LDL Fatty Acid Composition but Similar Effects on Serum Lipid Profiles in Normolipidemic Humans

6) Decreasing Linoleic Acid with Constant α-Linolenic Acid in Dietary Fats Increases (n-3) Eicosapentaenoic Acid in Plasma Phospholipids in Healthy Men

Studies that didn't contribute (but still worth reading):
--Agonism with the omega-3 fatty acids a-linolenic acid and docosahexaenoic acid mediates phosphorylation of both the short and long isoforms of the human GPR120 receptor

--The use of alpha-lipoic acid (ALA), gamma linolenic acid (GLA) and rehabilitation in the treatment of back pain: effect on health-related quality of life

--Hypertension induced by ω-3 polyunsaturated fatty acid deficiency is alleviated by α-linolenic acid regardless of dietary source

--An α-linolenic acid-rich formula reduces oxidative stress and inflammation by regulating NF-κB in rats with TNBS-induced colitis

--Alpha-linolenic acid supplementation and resistance training in older adults

--Dietary chia seed (Salvia hispanica L.) rich in alpha-linolenic acid improves adiposity and normalises hypertriacylglycerolaemia and insulin resistance in dyslipaemic rats

--Prospective studies of dietary alpha-linolenic acid intake and prostate cancer risk: a meta-analysis

--Subchronic Alpha-Linolenic Acid Treatment Enhances Brain Plasticity and Exerts an Antidepressant Effect: A Versatile Potential Therapy for Stroke

--Differential effect of maternal diet supplementation with α-Linolenic adcid or n-3 long-chain polyunsaturated fatty acids on glial cell phosphatidylethanolamine and phosphatidylserine fatty acid profile in neonate rat brains

--Dietary supplementation of alpha-linolenic acid in an enriched rapeseed oil diet protects from stroke

--Bioavailability of α-linolenic acid from flaxseed diets as a function of the age of the subject

--High habitual dietary α-linolenic acid intake is associated with decreased plasma soluble interleukin-6 receptor concentrations in male twins

--Dietary intake and status of n−3 polyunsaturated fatty acids in a population of fish-eating and non-fish-eating meat-eaters, vegetarians, and vegans and the precursor-product ratio of α-linolenic acid to long-chain n−3 polyunsaturated fatty acids: results from the EPIC-Norfolk cohort