Wednesday, December 7, 2011

The Nutrition Debate #33: Omental Adiposity

Dontcha love it? What I’m talking about here is the increasingly common “beer belly” on men of a certain age (mine) -- men who look nine months pregnant before the baby has “dropped;” You have a high, hard abdomen. Your jacket button doesn’t button any more. You can’t hug without first bumping into the huggee. I know. I was “there” once, before I lost 170 pounds.

I first came across the noun form “omentum” about six years ago in You on a Diet, a book by Dr. Michael Roizen, popularized by Oprah and later by a PBS series. The omentum is a sheet of fat that is covered by the peritoneum. The greater omentum is attached to the bottom edge of the stomach, and hangs down in front of the intestines. The other edge attaches to the transverse colon. The lesser omentum is attached to the top edge of the stomach, and extends to the undersurface of the liver. In humans, especially men who make bad choices about food (not necessarily beer), the omentum is a mass of fat around and especially in front of the stomach, liver, spleen, kidneys and intestines. It’s not healthy. There is a strong correlation between abdominal obesity, aka ‘central obesity,’ and cardiovascular disease.

This ‘visceral fat,’ also known as organ fat or intra-abdominal fat, is located inside the peritoneal cavity, packed in between internal organs and torso. It is differentiated from subcutaneous fat which is found underneath the skin, and intra-muscular fat which is found interspersed in skeletal muscle. Other distinctly different types of body fat include bone marrow fat and epicardial fat, deposited around the heart and found to be a metabolically active organ.

The immediate cause of obesity is a net energy imbalance. But the fundamental cause of obesity is not well understood, and many believe is a metabolic disorder of fat regulation. There is a growing consensus that, in humans, central obesity is related to the excessive consumption of fructose. It is also associated with elevated levels of the hormone insulin. In a large study (NHANES III), excessive waist circumference appears to be more of a risk factor for metabolic syndrome than BMI (Body Mass Index). The Index of Central Obesity is another measure more predictive of increased risk than BMI. See the Wikipedia entry or consult Medscape for more information on abdominal obesity, BMI and Central Obesity Index.

Central obesity is associated with a statistically higher risk of heart disease, hypertension, insulin resistance, and Type II diabetes. Belly fat is a symptom of metabolic syndrome (see, column #9).Central obesity is also associated with glucose intolerance and dyslipidemia (‘high cholesterol’), as well as a group of diseases that are either inherited or due to secondary causes (Cushing’s syndrome, PCOS, and treatment for AIDS).

There are numerous theories as to the exact cause and mechanism in Type II diabetes. Central obesity is known to predispose individuals for insulin resistance. Discoveries in recent decades have revealed that abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance. Central obesity seems to be the foremost type of fat deposit contributing to rising levels of serum resistin, one such hormone. Conversely, serum resistin levels have been found to decline with weight loss, especially decreased central obesity.

And if that ain’t enough, a study reported in the May 2010 Annals of Neurology examining over 700 adults found evidence to suggest higher volumes of visceral fat, regardless of overall weight, were associated with smaller brain volumes and increased risk of dementia, to wit, Alzheimer’s Disease.

Of course there are sex differences in fat accumulation. Female sex hormones cause fat to be stored in the buttocks, hips and thighs of women. Men are more likely to have fat stored in the belly. When women reach menopause and estrogen produced by the ovaries declines, fat migrates from the buttocks, hips and thighs to their waists and bellies.

So, what can be done about “omental adiposity”? Low fat and restricted calorie diets have not proven to be an effective long term intervention. Most people regain virtually all the weight that was lost and many regain still more. Spot exercises, such as sit-ups, crunches and other abdominal exercises are useful in building the abdominal muscles, but they have little effect, if any, on the adipose tissue located there. And, just for the record, there is little evidence that beer drinkers are more prone to abdominal adiposity than non-drinkers or drinkers of wine or spirits.

The best regimen for losing and keeping off excess omental weight – the pot belly – is a diet that provides satiety (a high fat diet), that digests slowly and restores skeletal muscle (moderate protein), and allows you to burn body fat for energy. See column #11 in my blog at That means low carbohydrates. After the body burns the “sugars” in the carbs for energy, it turns to fat for energy, that is, your body fat. I know. I’ve regained some of the 170 pounds that I lost, but I have lost my “beer belly” forever.

© Dan Brown 12/7/11

Sunday, November 20, 2011

The Nutrition Debate #32: Artificial Sweeteners

I’ve been avoiding this topic because I was afraid I was going to learn “the bitter truth” as I researched and studied synthetic sweeteners. You may feel the same way after learning about them. But increasing public awareness about human nutrition and health issues is why I write this column, so here goes.

An artificial sweetener is a food additive that is not natural and that duplicates the effect of sugar (sucrose) in taste, texture and “mouthfeel.” The primary compounds used as sugar substitutes in the United States are sucralose (e.g., Splenda), aspartame (e.g., Equal, NutraSweet), and saccharin (e.g., Sweet’n Low). The good news is none of these products contain any fructose. The bad news: 1) the little yellow, blue and pink packets all contain bulking agents which are mostly sugars, and 2) the effect on the body’s hormonal system of a high-intensity artificial sweetener is as bad or worse than “natural” sugar, as in refined sugar cane, even allowing that cane sugar is 50% fructose!

Not a big deal? You say it’s just a little. Not so. Splenda, for example, is usually just 5% high-intensity artificial sweetener (sucralose) and 95% bulking agents, specifically dextrose (D-glucose) and maltodextrin, a polysaccharide containing from 3 to 20 glucose molecules in a chain. The body easily and quickly metabolizes both of these sugars as energy, while most (85% to 95%) of the non-nutritive sucralose passes unchanged out of the body through the feces or, after some is absorbed into the blood, through the kidneys as urine. Reviewing then, that’s 5% non-nutritive sweetener and 95% nutritive sweeteners, all basically absorbed and metabolized as glucose.

How much energy are we talking about in the 95% part? Each 1 gram packet of Splenda contains almost a gram of carbohydrate (3.36 calories). That compares to 10.8 calories in a 2.8 gram packet of sugar, 15 calories in a level teaspoon of table sugar or 25 calories in a heaping teaspoon. The 5% sucralose part is non-nutritive (zero calories), but sucralose, the artificial “sugar,” is about 600 times sweeter than sucrose (table sugar). That’s a lot of sweetness.

Is this important? If you’re diabetic or pre-diabetic and need to limit or restrict sugars, then “sure.” We know that glucose induces an insulin response, and we are trying not to wear out our pancreas which produces insulin. There is in addition, however, also the well-established scientific fact that the taste of sweetness, perceived in the mouth by the salivary glands, induces an insulin response. As such, even a high-intensity artificial sweetener that contains no glucose (I know of none) would induce an insulin response. Chronic high insulin levels in the blood (hyperinsulinemia), which occurs when there is little glucose to transport, leads to insulin resistance, and eventually to Metabolic Syndrome and Type 2 diabetes. Wide use of artificial sweeteners, in this respect, could be worse for your health than real sugar.

An Equal packet, containing the artificial sweetener aspartame, is made with dextrose (D-glucose), acesulfame potassium, starch, silicon dioxide, maltodextrin and an unspecified flavoring. Equal tablets contain the sugar lactose.

Sweet’n Low is a compound of granulated saccharin, dextrose and cream of tartar. In Canada, Sweet’n Low is made from sodium cyclamate because saccharin has been banned there since the 70’s. In the U. S., cyclamate was banned in 1970.

A similar and closely related sugar substitute is a natural sweetener from the herb stevia. Four years ago Cargill and the Coca Cola Company introduced the stevia-based product Truvia. It is made from rebiana, an extract of stevia, pus erythritol, a sugar alcohol, and natural flavors. More recently, Pepsico and the Whole Earth Sweetener Company introduced PureVia. It contains the stevia extract, plus dextrose, cellulose powder and natural flavors. These extracts are relatively new to the market and are used both as tabletop sweeteners and as food ingredients, especially in beverages.

Other natural sweeteners include the sugar alcohols. Maltitol and sorbitol are often used in tooth paste, mouth wash, and in foods such as “no sugar added” ice cream. Erythritol is gaining momentum as a replacement for these other two sugar alcohols in foods as it is much less likely to produce gastrointestinal distress when consumed in large amounts. Xylitol is an especially non-fermentable sugar alcohol that is tooth friendly and is used in chewing gum. Possessing approximately 40% less food energy than sucrose, xylitol is another low-calorie alternative to table sugar.

So, the bitter truth is “there’s no such thing as a free lunch.” Bitter is better. (Butter is better too.) Weaning myself off Splenda isn’t going to be easy. I take it in my coffee and in my iced tea every day. But bitter will be better for my health.

© Dan Brown 11/20/11

Sunday, November 13, 2011

The Nutrition Debate #31: Carbohydrates and Sugars

Are all carbohydrates sugars? Are all sugars carbohydrates? What is a carbohydrate? And what is a sugar? This is not chemistry class, but I think we all need to know the answers to these basic questions if we are going to guard our health. So, I’ll try to keep it simple and interesting. After all, we all have to eat, and making wise choices requires us to be well informed. There’s a lot of misinformation going around so listen up.

All carbohydrates are saccharides. The word saccharide comes from the Greek word meaning sugar. Carbohydrates are divided into four types: monosaccharides, disaccharides, oligosaccharides, and polysaccharides. Monosaccharides and disaccharides are smaller compounds, composed of one or two molecules, and are commonly referred to as sugars. These compounds very often end in the suffix –ose. Examples include glucose (as in blood sugar), sucrose (as in table sugar), fructose (fruit sugar), and lactose (milk sugar).

Polysaccharides store energy (e.g. glycogen and starch) and as structural components (cellulose in plants). The term carbohydrate is often used to mean any food that is rich in complex carbohydrates such as cereals, bread, rice or pasta, or simple carbohydrates, such as candy, jams, jelly and ice cream.

Glucose, fructose and galactose are the three monosaccharides. They are the simplest carbohydrates in that they cannot be broken down into smaller molecules. They are the major source of fuel for metabolism, being used as an energy source (glucose being the most important). When not immediately needed for energy, they are converted into its storage form, glycogen, mainly in liver and muscle cells.

The disaccharides include sucrose (composed of one glucose and one fructose molecule), lactose (composed of one glucose and one galactose molecule) and maltose (two glucose molecules bonded in a special way). Oligosaccharides and polysaccharides are just longer chains of monosaccharides bound together. Oligosaccharides contain between three and ten monosaccharides and polysaccharides contain greater than ten monosaccharide units.

The human diet contains many foods high in carbohydrates: fruits, sweets, soft drinks, breads, pastas, beans, potatoes, rice and cereals. Carbohydrates are a common source of energy in living organisms; however, no carbohydrate is an essential nutrient in humans. Carbohydrates are not necessary building blocks of other molecules, and the body can obtain all its energy from protein and fats.

The brain and neurons generally cannot burn fat for energy, but use glucose or ketones. Humans can synthesize some glucose (in a process called gluconeogenesis) from specific amino acids, from the glycerol backbone in triglycerides, and in some cases from fatty acids. Glucose is a nearly universal, accessible and preferred source of calories. It is used first, either directly or indirectly from glycogen in storage. Polysaccharides are also a common source of energy. Many organisms can easily and quickly break down starches into glucose.

A commonly held belief among the general public, and even among nutritionists, is that complex carbohydrates (polysaccharides, e.g. starches) are digested more slowly than simple carbohydrates (sugars) and thus are healthier. However, there appears to be no significant difference between simple and complex carbohydrates in terms of their effect on blood sugar. Some simple carbohydrates (e.g. fructose) are digested very slowly (and very differently from glucose), while some complex carbohydrates (starches), especially that in processed food, raise blood sugar rapidly.

It is not sufficient, therefore, to buy foods that trumpet “whole grain ingredients.” The primary ingredients of these foods (those listed first) may be “bleached all purpose flour” (a highly processed food), sugar, dextrose, molasses, sucrose or HFCS (all highly processed sugars), before any “whole grains” are added. When you see grain sprinkled on the surface of that loaf of bread, just realize that it’s been brushed with HFCS to give it a nice brown color and make it sticky.

Always a wiser choice is to choose whole, unadulterated foods from the meat, dairy and produce aisles. Avoid the center of the store; shop the perimeter. Avoid food sold in a box or a bag, except perhaps flash frozen fish and veggies, in which case always check the ingredients list. Avoid anything refined or heavily processed. In other words, eat real food.

N.B.: For the record and for those who would doubt my authority of make some of the claims herein, this column has been largely cribbed – much of it lifted verbatim – from the Wikipedia entry “Carbohydrate.” Credit them. Check it out.

© Dan Brown 11/13/11

Sunday, November 6, 2011

The Nutrition Debate #30: Is Fructose a Liver Toxin? Is it Really Poison?

Fructose is ubiquitous in the food supply. It is 67% of the natural sugar found in an apple as well as 50% of table sugar (sucrose), 55% of high fructose corn syrup (HFCS) in sweetened soft drinks, and 42% of the HFCS used in many baked goods, For a fuller exposé, take a look at the last column, #29, “Fructose: Formerly Known as Fruit Sugar,” also archived on my blog at www://

The amount of all sugars is increasing each year in the American diet. Since 2000, however, the amount of fructose has leveled off and even declined slightly, precipitating the Corn Refiners’ Association recent TV ad campaign to repair the image of HFCS. In it, a pretty young woman says, “I learned, whether it’s corn sugar or cane sugar, your body can’t tell the difference. Sugar is sugar.” I agree. HFCS is essentially not much worse than (table) sugar made from sugar cane or beet sugar. HFCS and sucrose are basically the same, and both are equally bad for you.

The problem is not with the glucose component of sucrose. Once absorbed through the wall of the small intestine, glucose goes to virtually all the cells of the body and is used for energy or it is stored mostly in the muscles and liver as glycogen, a ready form of quick energy. Either way – used quickly or stored and used later – it is metabolized (broken down and “burned”). Glucose is the preferred and most commonly and readily used form of energy.

Fructose is different. It cannot be metabolized by the body for quick energy. Once it enters the bloodstream it goes directly through the portal vein to the liver and is stored there. Scientists, noting that the liver’s function is to filter out toxins, think that fructose is toxic. Remember, before modern agriculture, fruits were available seasonally and were far less sweet because they had not been hybridized. In addition, refined processed sugars were nonexistent. When we eat large doses of sugar the liver becomes overloaded with fructose. Is fructose toxic to the liver? Not in the sense of an acute toxin. It is, these scientists claim, a “chronic hepatotoxin.” In the words of Robert H. Lustig, MD, presenter of UCSF’s YouTube video, “Sugar: The Bitter Truth” in their Mini Med School for the Public series, fructose is “alcohol without the buzz.” No wonder that excess fructose consumption over a long period of time is frequently thought to be a cause, and is certainly associated with, non-alcoholic fatty liver disease (NAFLD), also on the rise.

Lustig adds: “Fructose increases de novo lipogenesis (fat formation), triglycerides and free fatty acids in most adults.” Fructose is a carbohydrate, but “it is metabolized like fat,” he says; therefore, “a high sugar diet is a high fat diet”.

In addition to Dr Lustig’s work, a 2005 a scientific paper titled “Fructose, insulin resistance and metabolic dyslipidemia,” from the Clinical Biochemistry Division, Department of Laboratory Medicine and Pathobiology, Hospital for Sick Children, University of Toronto, Toronto, Canada, concludes: “An important but not well-appreciated dietary change has been the substantial increase in the amount of dietary fructose consumption from high intake of sucrose and high fructose corn syrup...” A high flux of fructose to the liver, the main organ capable of metabolizing this simple carbohydrate, perturbs glucose metabolism and glucose uptake pathways, and leads to a significantly enhanced rate of de novo lipogenesis and triglyceride (TG) synthesis...” Fructose-induced insulin resistant states are commonly characterized by a profound metabolic dyslipidemia... Thus, emerging evidence from recent epidemiological and biochemical studies clearly suggests that the high dietary intake of fructose has rapidly become an important causative factor in the development of the metabolic syndrome. There is an urgent need for increased public awareness of the risks associated with high fructose consumption...”

Dr. Lustig’s video presentation includes a slide entitled “Fructose is Not Glucose,” with five bullets, summarized here:

1. Fructose is 7 times more likely than glucose to form Advanced Glycation End Products (AGE’s).
2. Fructose does not suppress Ghrelin, the hunger hormone.
3. Acute fructose does not stimulate Insulin (or Leptin: The brain doesn’t see that you ate, so you eat more).
4. Hepatic fructose metabolism is different. (rather than forming glycogen, de novo lipogenesis occurs).
5. Chronic fructose exposure promotes the Metabolic Syndrome.

But Dr. Lustig says that because fructose is a chronic toxin, not an acute toxin, the USDA/FDA “won’t touch it.” That may be, but personally I think Cargill and Archer Daniels Midland may have some influence in Washington as well.

© Dan Brown 11/6/11

Sunday, October 30, 2011

The Nutrition Debate #29: Fructose, Formerly Known as Fruit Sugar

What is fructose? Fruit sugar, right? Well, yes and no. It is found in copious amounts in fruit, of course, but so are other sugars. Free fructose, the monosaccharide form, is 57% of the total sugars found in an average apple, but free glucose, another monosaccharide, is 23% of the total sugar. Sucrose, a disaccharide composed of equal parts fructose and glucose, is the remaining 20% of the sugar. So, combining the free fructose with the fructose bound up in sucrose, the total fructose in an apple is 67% of the sugars. (Trust me on the math here.) The remaining one-third is glucose.

Apples and pears are on the high end of the fructose scale. Apricots, at 39%, are at the low end. The sugar in bananas is 50% fructose, grapes 53%, and peaches 46%. Honey is 50.5% fructose (free and combined). Besides tree and vine fruits, fructose is also found in other foods found in nature, for example, berries, sweet corn and sweet red peppers and most root vegetables (e.g., red beets, carrots, onions and sweet potatoes).Generally, most of the fructose is bound up in sucrose (equal parts fructose and glucose).

Sucrose in its processed form is what we know as table sugar, which is made from refining sugar cane or sugar beets. Table sugar is therefore 50% fructose. So is the sucrose, or simply “sugar,” listed near the top in the ingredients list of more and more processed foods.

According to Wikipedia, “Commercially, fructose is usually derived from sugar cane, sugar beets and corn, and there are 3 commercially important forms:” 1) processed crystalline fructose, 2) high-fructose corn syrup (HFCS), as a mixture of both glucose and fructose as monosaccharides, and 3) sucrose. All forms of fructose, according to Wiki, are commonly added to foods and drinks for palatability, taste enhancement and improved browning of foods such as baked goods.

Starting in the early 70’s, as total consumption of sugar rose in the U.S., HFCS eroded the sucrose market. By 2000 they were consumed in the U.S. in equal amounts. HFCS is commonly found in food and drink in two forms: The 55% fructose/41% glucose form is in use in the U.S. in non-dietary soft drinks. The 42% fructose/53% glucose formulation is used primarily in processed foods and baked goods. (The balances in both forms are “other sugars.”)

“The primary reason fructose is used commercially in foods and beverages, besides its low cost, is its high relative sweetness. It is the sweetest of all naturally occurring carbohydrates; at room temperature it is 1.73 times as sweet as sucrose,” but when heated it loses this advantage, again according to Wiki. The sweetness of fructose is “perceived earlier,” has a “higher peak,” “exhibits a synergy effect when used in combination with other sweeteners,” has “greater solubility,” “increases starch viscosity more rapidly and achieves a higher final viscosity than sucrose,” “retains moisture for a long period of time even at low relative humidity,” and therefore “can contribute to improved quality, better texture, and longer shelf life to the food products in which it is used,” all as reported in the Wiki entry. Ever wonder why a Twinkie or a Devil Dog stays soft forever? It’s the HFCS!

If you haven’t noticed how ubiquitous HFCS has become in the processed food supply, let me give you a snapshot. In the bread aisle at my local supermarket I found it in most of the “soft” goods and long shelf life items: Devil Dogs and Twinkies, of course, and fruit pies and muffins; also in hot dog and hamburger rolls and, naturally, in Wonder Bread. I also found it listed as 4th ingredient in Weight Watchers 100% Whole Wheat bread, just before molasses!

Fundamentally, however, regardless of whether the formulation of fructose you consume is 55%, 42%, or 50% fructose as in table sugar (sucrose), we all consume ever increasing amounts of fructose each year, whether we know it or not. We eat much more fructose than we think, and much more than the amount that is found in fresh fruit. Sugar -- ordinary table sugar, made from sugar cane -- remember, is half fructose.

So, why does it matter? Because fructose, in the words of Robert H. Lustig, MD, is “poison.” Dr. Lustig is professor of Clinical Pediatrics in the Division of Endocrinology at the University of California San Francisco. His research focuses on childhood obesity. He contends that, in the amounts we are eating it, fructose is toxic to the liver.

Want to know why? You can watch his 90 minute 2009 video, “Sugar: The Bitter Truth,” from UCSF’s “Mini Med School for the Public” on YouTube. Or stay tuned. In the next installment I will present my ‘Executive Summary’ of his evidence.

By the way, all of my columns are archived on my blog: www://
© Dan Brown 10/30/11

Sunday, October 23, 2011

The Nutrition Debate #28: Sugar in the Diet: What does it mean?

I ran into a friend at the supermarket the other day and asked her how she was. She replied, “Fine,” but “tired a lot.” Not wanting to miss an opportunity to proselytize, I suggested, “sugar crash.” She protested, “I don’t eat sugar!” So, I asked her what she ate for breakfast. Therein lies a tale of folly that deserves to be more widely known and understood.

Sugar, as she and virtually the “whole world” thinks of it, is table sugar, as in “added sugar” such as that sprinkled on cereal. It is also an ingredient in candy and ice cream. Soft drinks usually are sweetened with high fructose corn syrup.

Table sugar, the “added” sugar, is cane sugar and chemically is known as sucrose. It is a disaccharide, meaning it is composed of two simple sugar molecules. One of those molecules is fructose and the other is glucose. All chemical compounds ending in “ose” are sugars. Most break down in the digestion process to glucose, some to fructose, and a few to galactose, the third monosaccharide, before entering the blood stream through the wall of the small intestine.

Sugars in this “whole-world” sense do not include those found in fruits, which are a combination of free fructose, free glucose and sucrose. Fruit sugars are regarded in this “whole-world” view as good for you, because they are an inherent component of this “real” or whole food. Forget that for centuries hybridizers have been making fruits sweeter than those found in nature to appeal to our sweet tooth.

Carbohydrates, one of the three basic elements of nutrition (the other two being protein and fat), are all saccharides. Carbohydrates, including fruits, cereals, bread, potatoes, rice and pasta, are somewhat more complex compounds, meaning composed of many molecules. Nevertheless, they virtually all break down in the digestion process to the simple sugars glucose and fructose. Glucose goes to the cells for quick energy. Fructose goes directly to the liver and is stored.

Back to the question I asked of my friend: “What did you eat for breakfast?” Her answer: “A glass of orange juice, a whole grain cereal ‘with 3 grams of protein’ [in reduced-fat milk, I assumed], toast and jelly.” “All sugar,” I exclaimed! Obnoxiously, I said, “if you eat a lot of ‘sugar’ – read any food except fat and protein -- all at once, your blood stream will be flooded with sugar (glucose) sooner or later (up to a few hours, depending on the food and the condition of your metabolism), and insulin pumped from the pancreas (if it is still working well). And then, after the ‘sugar’ gets delivered to the muscles and organs by the insulin, your blood sugar level will crash and you will ‘feel tired’ (and hungry) again.”

You will feel hungry again because another hormone, ghrelin (first reported in Nature in 1999!), will send a signal from cells lining the fundus of the stomach to the hypothalamus in the center of your brain, that the “quick energy” in your blood (glucose) is low again. So, when your “all sugar” breakfast is digested, in mid-morning your body will again crave “sugar” (anything that will break down to glucose) to “feed the beast.” “Sugary snack” doesn’t mean a candy bar. It means any carbohydrate, including fruit, or a glass of milk (lactose), all of which will break down to glucose and again raise the level of sugar in the blood. It will also overwork the pancreas again to produce more insulin. A vicious cycle.

Over a course of years the cell wall of the destination cells in many people will develop insulin resistance, requiring more insulin to get the job of delivering glucose energy to our muscles done. Eventually, in many of these people, the pancreas will slowly burn out. The islets of langerhans that produce the beta cells in the pancreas will stop working. They will die. By the time your doctor discovers this, up to 80% of your pancreatic function will probably already have been lost. That was the stunning conjecture made by Dr. Ralph DeFronzo, American Diabetes Association keynote speaker at their annual meeting in San Francisco in 2008. You will be diagnosed with full-blown Type 2 Diabetes. You will be drug dependent for the rest of your life. You will then be watchful for, or worse, diagnosed with the “dreaded complications.”

As a result, in recent years the standards and methodology for diagnosing Metabolic Syndrome and Type 2 diabetes has evolved. The old standard was two consecutive elevated plasma blood glucose tests above 140mg/dl, lowered to 126 in 1997, where it remains today. Fasting blood glucose between 100 and 125mg/dl is now regarded as pre-diabetes.

The new diagnostic standard for T2 diabetes is the Hemoglobin (Hb) A1c test. The diagnostic standard was formerly 7.0%. A few years ago it was lowered to 6.5%, and a 6.0% level added for pre-diabetes. Some activist endocrinologists, such as Dr. Richard K. Bernstein, use a much lower standard, regarding an A1c of 5.8% as indicating full-blown Type 2.

So, to stay healthy, watch your total sugars and remember: All carbohydrates are sugars. Your body breaks sugars down into glucose, the simplest sugar. Glucose induces insulin secretion. If you still think you don’t eat sugar, read this again!
© Dan Brown 10/23/11

Sunday, October 9, 2011

The Nutrition Debate #27: “…the strongest predictor of a heart attack”

The contemporary medical literature is replete with macro and other large studies that attempt to extrapolate a correlation between heart attack risk and blood lipids. The last two columns, “Understanding Your Lipid Panel” and “The Cause and Treatment of Heart Disease” address this issue from different directions. In this column we will attempt to put a fine point on the critical matter of lipid ratios.

In the 1960’s Total Cholesterol (TC) became a common and inexpensive test. As the principal metric of “the Lipid Hypothesis” popularized by Ancel Keys and then the American Heart Association, it became the universal marker for predicting heart disease risk. But that was more than half a century ago. We’ve come a long way since then.

The “treatment,” i. e. medical advice, then and now for high TC was to eat less saturated fat and other animal foods with high cholesterol content. This was the modality even though the body needs cholesterol for many essential purposes and makes up what we don’t eat by manufacturing it as needed. The threshold for TC was and remains today 200mg/dl.

Low density lipoprotein (LDL) is a component of TC. Even though the common test used to determine LDL was and is a calculated value, not a direct measurement, it became a popular target in the 80’s when big pharma developed drugs – statins – that lowered it. By lowering LDL, statins also lowered total cholesterol. So, doctors prescribed statins to anyone and everyone whose TC was over 200. Today, Lipitor, Crestor, Zocor, and its generic Simvastatin, account for $20 billion in world-wide annual sales.

In recent decades the other components of the Lipid Panel – High Density Lipoproteins (HDL) and Triglycerides (TG) – have taken on increased importance in understanding Cardio Vascular Disease (CVD) risk.Unfortunately, these developments have garnered little attention since the pharmaceutical industry has not yet developed blockbuster drugs to influence them. Fish oil lowers Triglycerides, but fish oil cannot be patented.

Most lipid panel lab results these days do however include a ratio of TC to HDL with a recommendation that it should be less than 5.0. In other words, if TC is 200, then HDL should not be less than 40. While this at least recognizes the importance of HDL, it is hardly a standard to be emulated. It is, in fact, borderline dangerous. Optimal is ≤3.5.

A somewhat higher standard coming into wider use is the inverse of this fraction, i.e. HDL/TC. However, the standard for this fraction is ≥0.24 = ideal. Translated, that is closer to a ratio of 4.0, versus 5.0 in the TC to HDL ratio cited above.

Many enlightened practitioners today, however, use the ratio of Triglycerides to HDL (TG/HDL) as “the single most powerful predictor of extensive coronary heart disease among all the lipid variables examined,” according to just one of many articles in the literature. The study I quote is in Clinics at PubMed Central 2008 August 63(4) 427-432. Note, by the way, that neither TC nor LDL is a factor in this formula. This ratio is considered by informed clinicians today as more reliable than LDL, or TC/HDL, or high sensitivity (hs) C-reactive protein (CRP), the marker my internist/cardiologist uses.

Using this new gold standard, a TG/HDL ≤ 1.0 is considered ideal, a ratio of ≤2.0 is good, a ratio of 4.0 is considered high and 6.0 much too high. My recent TG/HDL = 0.35, which is interpreted to mean a very low probability of heart attack.

As the patent on Lipitor is about to expire, and the other name-brand statin drug patent expirations are not too far behind, big pharma is hard at work looking for the next blockbuster drug to lower Triglycerides or raise HDL. Alas, so far, diet -- that is, our dietary intake (as in, “we are what we eat”) -- is the only thing that seems to work, and big pharma isn’t in that business.

Agribusiness, however, has seen the potential for a big piece of the action here. Unfortunately, there isn’t much profit in “real food.” Ask your local farmer. The increasingly popular processed foods -- the so-called “heart healthy” foods we are being encouraged to eat in large quantities -- do not improve the TG/HDL ratio. They make it worse!

In the coming weeks we will return to the subject of healthy eating. Subjects will include “Sugar: What do we mean?” “Fructose: Where and what is it?,” “Intermittent Fasting: Is it a good idea?,” “Ketosis and Autophagy,” and “Cooking with Oils: good and bad choices,” Our goal will be to help the reader improve their TG/HDL ratio. Of course, to do that, you will need to have a baseline Lipid Profile. If you haven’t had a Lipid Panel done, or don’t know yours, ask your doctor to do one. And ask him to see how yours shapes up using the new gold standard for CVD risk: the TG/HDL ratio.

© Dan Brown 10/9/11

Monday, September 5, 2011

The Nutrition Debate #26: The Cause and Treatment of Heart Disease

Just in case the publisher is on vacation this week, let me be the one to state here and again, unequivocally, that I am not a doctor. In fact I have no medical training whatsoever and only took four years of both high school science and high school math on my way to becoming an architect. So, nothing in my columns is intended nor should be construed as medical advice. I offer only my opinions and the opinions of those medical doctors and scientists cited with attribution.

This is the fifth and last in the mini-series on “knowing your fats.” In this series I have quoted extensively, from “The Skinny on Fats,” originally published in 2000 by the Weston A. Price Foundation and then incorporated into a cookbook, “Nourishing Traditions”, by Mary Enig, PhD. and Sally Fallon, president of the Foundation. The quotation that follows is from “The Skinny on Fats.” It is titled, “The Cause and Treatment of Heart Disease.”

“The cause of heart disease is not animal fats and cholesterol but rather a number of factors inherent in modern diets, including excess consumption of vegetables oils and hydrogenated [read “trans”] fats; excess consumption of refined carbohydrates in the form of sugar and white flour; mineral deficiencies, particularly low levels of protective magnesium and iodine; deficiencies of vitamins, particularly of vitamin C, needed for the integrity of the blood vessel walls, and of antioxidants like selenium and vitamin E, which protect us from free radicals; and, finally, the disappearance of antimicrobial fats from the food supply, namely, animal fats and tropical oils.52 These once protected us against the kinds of viruses and bacteria that have been associated with the onset of pathogenic plaque leading to heart disease.

While serum cholesterol levels provide an inaccurate indication of future heart disease, a high level of a substance called homocysteine in the blood has been positively correlated with pathological buildup of plaque in the arteries and the tendency to form clots—a deadly combination. Folic acid, vitamin B6, vitamin B12 and choline are nutrients that lower serum homocysteine levels.53 These nutrients are found mostly in animal foods.

The best way to treat heart disease, then, is not to focus on lowering cholesterol—either by drugs or diet—but to consume a diet that provides animal foods rich in vitamins B6 and B12; to bolster thyroid function by daily use of natural sea salt, a good source of usable iodine; to avoid vitamin and mineral deficiencies that make the artery walls more prone to ruptures and the buildup of plaque; to include the antimicrobial fats in the diet; and to eliminate processed foods containing refined carbohydrates, oxidized cholesterol and free-radical-containing vegetable oils that cause the body to need constant repair.” End of quote. Please see the Foundation website referred to above for the footnote references.

While there is not perfect concordance among the various leaders in the medical and scientific community (and even popular authors like Michael Pollan) on what to eat to avoid the Diseases of Civilization, there are remarkable similarities. Gary Taubes, and Kurt Harris, M. D., and Mary Enig, PhD, are among my favorites, but they are just a few of hundreds of authoritative resources in this emerging field. If we keep an open mind, we should all benefit from the knowledge that is becoming available. But, sad to say, it is difficult to turn the ship of state from its present course.

This is especially true 1) when convenience dictates labor-saving prepared foods, and fast-food solutions, 2) when cost is the primary driver of decisions we make at the supermarket, 3) when deceptive, misleading advertising influences the food choices we make, and 4) when agri-business has so much at stake in promoting the sale of new versions of processed foods. The result: the very foods that are billed as “heart-healthy” are in fact the ones that will lead us down the path to the modern Diseases of Civilization: metabolic syndrome, type 2 diabetes, hypertension and heart disease.

To avoid these outcomes, we need to take control of our own health. We have to learn how to “eat healthy.” And then we have to do it. In upcoming columns, we will continue to explore real food: What to eat, what not to eat, and why.

To get started and to monitor your progress, you should have a baseline lipid profile. I urge you to ask your doctor for a copy of your most recent lipid panel, or order one for you. Then show him column #25 in this series: “Understanding Your Lipid Profile” and discuss your profile in that context. Ask your doctor is he agrees with the analysis I offered. And ask if it would matter to him what you ate so long as you achieved that kind of turnaround in the course of say a year. I did, and you could too, if you change what you eat and follow that way of eating carefully.

© Dan Brown 9/5/11

Wednesday, August 31, 2011

The Nutrition Debate #25: Understanding Your Lipid Panel

As has been pointed out with each column, I am not a doctor or a health care professional, and I do not offer dietary or health-related advice. You must draw your own conclusions from my ramblings, and of course you do so at your own risk. Here comes the “however”: I can do simple math and read a lab report, especially one that gives an “IN range,” “OUT range,” and “Reference Range,” plus other guidance, for each test ordered.

At each office visit, my doctor always orders a complete blood count and a comprehensive metabolic panel, including a lipid panel and an Hb A1c, plus, from time to time, other specialty tests (Cardio High Sensitivity CRP, etc.). This column is going to be about understanding the lipid panel. That includes Total Cholesterol, HDL Cholesterol, LDL Cholesterol (calculated), Triglycerides, and the (total) Cholesterol/HDL Ratio. Some panels also include VLDL.

Most people know the drill: “high” total cholesterol is not a good thing, that there is “good” cholesterol (HDL) and “bad” cholesterol (LDL), and that we should try to get our circulating triglyceride levels down. If we aren’t successful at doing this through dietary restriction of saturated fat and cholesterol containing foods (per our doctor’s advice), he is going to prescribe a pharmacological solution to lower our LDL, and thereby our Total Cholesterol as well. We are going to be asked to support the $20 billion dollar annual statin market by taking Crestor, Lipitor, or Zocor (or Simvastatin, its generic equivalent). These are listed with the most recent and most effective first. But, is it that simple?

We shall ignore the efficacy of the dietary advice for purposes of this example, but I want it to be clear that I totally and completely disagree with that advice, based on all the science I am reading and on my own personal (n = 1) experience. Nevertheless, let us suppose that two people (or the same person, in two “snapshots” of lipid panels taken a few years apart) have identical Total Cholesterol, to wit: 200mg/dl (milligrams per deciliter). One has an HDL of 40mg/dl, an LDL of 130mg/dl (calculated), a Triglyceride count of 150mg/dl, and a Total Cholesterol/HDL ratio of 5.0. ALL FIVE OF THESE VALUES ARE BORDERLINE OUT OF RANGE. They would appear in bold in the “OUT range” column on your lab report. Your doctor would tell you, according to my understanding of the “Standards of Practice,” to cut down on all those saturated fat and dietary cholesterol containing foods, and probably to exercise more as well. BAD ADVICE, IMHO.

Now let’s look at another lipid panel: Total Cholesterol also 200mg/dl, HDL = 80mg/dl, LDL = 110mg/dl (calculated), Triglycerides = 50mg/dl, and a Total Cholesterol/HDL ratio of 2.5. The only value that is borderline high in this panel is Total Cholesterol at 200mg/dl. Everything else is textbook WUNDERBAR! It’s true, the LDL is above optimal (<100mg/dl), but remember LDL is a derived (calculated), not a measured value. The formula for LDL in the simple lipid panel is LDL = Total Cholesterol – HDL – Triglycerides/5. And, if your doctor was worried about your less than optimal LDL’s (because of existing heart disease, other cardiac risk factors such as hypertension, obesity, metabolic syndrome or higher than “normal” fasting plasma glucose or Hb A1c scores) he could order the VLDL test, or an even more sophisticated VAP test of LDL particle size (“A”= “large and buoyant” or “B” =“small and dense.”) Regardless, this lipid panel would NOT lead your doctor to prescribe statins or require dietary change. He would tell you to “continue with whatever you are doing.”

Bottom line: a Total Cholesterol test score of 200mg/dl on your lipid panel, with the first subset of values, can put you in the “dog house,” on dietary restrictions, and soon thereafter when dietary changes don’t work, on a diet of statins.

Or, you could have a lipid panel similar to the second example* and become your doctor’s poster boy, as I did after I’d been on a very low carb, high fat and moderate protein way of eating for a year or so. My doctor (a cardiologist) just tells me to keep on doing what I’m doing. Even though he started me on this program, he doesn’t want to know what I eat. For him, it’s no more lectures, just smiles, and when the test results come in, a congratulatory phone call.

For my doctor, my office visit is one of the “high points” of his day, he says. I can believe it. No stress (for him). No more arguments (from me). No latent suspicions or overt charges of “non-compliance” (cheating) with the dietary restrictions he imposed. And, above all, no hypocrisy for having to preach the baloney -- excuse me -- the bad medical advice that the public health, big pharma, media and the medical establishment continue to dish out to the lemmings who put their trust, and their lives, in the hands of “big brother,” the dietary Dictocrats, our nanny state. Sorry – I just had to vent, (and crow, of course)

* My most recent (8/15/11) lipid panel: TC = 209, HDL = 92, LDL (calc.) = 111, TC/HDL = 2.3, Triglycerides = 32

© Dan Brown 8/28/11

Thursday, August 18, 2011

The Nutrition Debate #24: What About Cholesterol?

And what about dietary cholesterol? Again, quoting from Mary Enig, PhD, and Sally Fallon, authors of “The Skinny on Fats, “Here, too, the public has been misinformed. Our blood vessels can become damaged in a number of ways—through irritations caused by free radicals or viruses, or because they are structurally weak—and when this happens, the body's natural healing substance steps in to repair the damage. That substance is cholesterol. Cholesterol is a high-molecular-weight alcohol that is manufactured in the liver and in most human cells. Like saturated fats, the cholesterol we make and consume plays many vital roles:

• Along with saturated fats, cholesterol in the cell membrane gives our cells necessary stiffness and stability. When the diet contains an excess of polyunsaturated fatty acids, these replace saturated fatty acids in the cell membrane, so that the cell walls actually become flabby. When this happens, cholesterol from the blood is "driven" into the tissues to give them structural integrity. This is why serum cholesterol levels may go down temporarily when we replace saturated fats with polyunsaturated oils in the diet.46
• Cholesterol acts as a precursor to vital corticosteroids, hormones that help us deal with stress and protect the body against heart disease and cancer; and to the sex hormones like androgen, testosterone, estrogen and progesterone.
• Cholesterol is a precursor to vitamin D, a very important fat-soluble vitamin needed for healthy bones and nervous system, proper growth, mineral metabolism, muscle tone, insulin production, reproduction and immune system function.
• The bile salts are made from cholesterol. Bile is vital for digestion and assimilation of fats in the diet.
• Recent research shows that cholesterol acts as an antioxidant.47 This is the likely explanation for the fact that cholesterol levels go up with age. As an antioxidant, cholesterol protects us against free radical damage that leads to heart disease and cancer.
• Cholesterol is needed for proper function of serotonin receptors in the brain.48 Serotonin is the body's natural "feel-good" chemical. Low cholesterol levels have been linked to aggressive and violent behavior, depression and suicidal tendencies.
• Mother's milk is especially rich in cholesterol and contains a special enzyme that helps the baby utilize this nutrient. Babies and children need cholesterol-rich foods throughout their growing years to ensure proper development of the brain and nervous system.
• Dietary cholesterol plays an important role in maintaining the health of the intestinal wall.49 This is why low-cholesterol vegetarian diets can lead to leaky gut syndrome and other intestinal disorders.

Cholesterol is not the cause of heart disease but rather a potent antioxidant weapon against free radicals in the blood, and a repair substance that helps heal arterial damage (although the arterial plaques themselves contain very little cholesterol.) However, like fats, cholesterol may be damaged by exposure to heat and oxygen. This damaged or oxidized cholesterol seems to promote both injury to the arterial cells as well as a pathological buildup of plaque in the arteries.50

Damaged cholesterol is found in powdered eggs, in powdered milk (added to reduced-fat milks to give them body) and in meats and fats that have been heated to high temperatures in frying and other high-temperature processes. High serum cholesterol levels often indicate that the body needs cholesterol to protect itself from high levels of altered, free-radical-containing fats. Just as a large police force is needed in a locality where crime occurs frequently, so cholesterol is needed in a poorly nourished body to protect the individual from a tendency to heart disease and cancer. Blaming coronary heart disease on cholesterol is like blaming the police for murder and theft in a high crime area.” End of long quote. Note all the footnotes are in the Weston A. Price website article, “The Skinny on Fats.”

To add insult to injury, remember that we make, i.e. our liver and cells make, cholesterol to “make up” for all those good foods (eggs, butter, cream, marbled beef, shrimp, liver, etc.) that we avoid eating to follow doctor’s orders. It has too. It needs cholesterol to do all the things described above, and it works holistically to get what it needs. It’s a good thing too. Just imagine if the human race were dependent for survival on the vagaries of current government public health policy. I’ll take autonomic homeostatic regulation over Obamacare and Congressional regulation any day. It doesn’t shut down.

© Dan Brown 8/14/11

Sunday, August 7, 2011

The Nutrition Debate #23: The Benefits of Saturated Fats

The benefits of saturated fat? To admit to such a belief is surely heretical, so I do not expect my reader(s) to commit such apostasy “on faith.” But, purely as an observer of another’s fall from grace, you may want to read further to see how this idea develops and is supported by science. If this sounds like a classic battle of orthodoxy vs. the enlightened, you’re right. You certainly won’t hear it spoken of by any of the usual sources of information in our modern society: Government, Agri-Business, and the Mass Media. Who but the small grass-fed beef or pastured chicken egg purveyor would benefit, besides you?

As you already know, one of the apostles of human nutrition that I follow is Mary Enig, PhD, a Director Emeritus of the Weston A. Price Foundation, who with Sally Fallon, President of the Foundation, wrote “The Skinny on Fats.” This really is a “must read” for anyone interested in eating in a healthy way and living a long life. Do yourself a favor and google it.

Because it is more technical than I am qualified to write about, and cites many sources as references, I quote from it directly again here: Note that each of the 8 references are provided at the Foundation “hit” on “The Skinny on Fats.”

“The much-maligned saturated fats—which Americans are trying to avoid—are not the cause of our modern diseases. In fact, they play many important roles in the body chemistry:

• Saturated fatty acids constitute at least 50% of the cell membranes. They are what give our cells necessary stiffness and integrity.
• They play a vital role in the health of our bones. For calcium to be effectively incorporated into the skeletal structure, at least 50% of the dietary fats should be saturated.38
• They lower Lp(a), a substance in the blood that indicates proneness to heart disease.39 They protect the liver from alcohol and other toxins, such as Tylenol.40
• They enhance the immune system.41
• They are needed for the proper utilization of essential fatty acids.
Elongated omega-3 fatty acids are better retained in the tissues when the diet is rich in saturated fats. 42
• Saturated 18-carbon stearic acid and 16-carbon palmitic acid are the preferred foods for the heart, which is why the fat around the heart muscle is highly saturated.43 The heart draws on this reserve of fat in times of stress.
• Short- and medium-chain saturated fatty acids have important antimicrobial properties. They protect us against harmful microorganisms in the digestive tract.

The scientific evidence, honestly evaluated, does not support the assertion that "artery-clogging" saturated fats cause heart disease.44 Actually, evaluation of the fat in artery clogs reveals that only about 26% is saturated. The rest is unsaturated, of which more than half is polyunsaturated.45 “(end of quote)

Among the most vilified of animal foods high in saturated fats has been butter. As noted previously it is now enjoying a comeback, while margarine, made from partially hydrogenated vegetable oil (trans fat), has suffered a sharp decline.

In 2000, before her more than 20 year campaign to bring trans fats to the public’s attention had reached full fruition (she had testified on it at the 1977 McGovern Commission), Dr. Enig wrote (again, in “The Skinny on Fats”), “The Diet Dictocrats have succeeded in convincing Americans that butter is dangerous, when in fact it is a valued component of many traditional diets and a source of…fat-soluble vitamins. These include true vitamin A or retinol, vitamin D, vitamin K and vitamin E as well as all their naturally occurring cofactors needed to obtain maximum effect. Butter is America's best source of these important nutrients. In fact, vitamin A is more easily absorbed and utilized from butter than from other sources.61 Fortunately, these fat-soluble vitamins are relatively stable and survive the pasteurization process.”

But what about cholesterol and heart disease? Well, if you’re still asking these questions, I recommend you go back and read this series from the beginning. All of the articles are archived at Or, if you’re just a little skeptical, stay tuned; the next article will be “What About Dietary Cholesterol?” and then the next, “Understanding Your Lipid Panel.” The apostasy goes on unabated, for your reading pleasure.

© Dan Brown 8/7/11

Sunday, July 31, 2011

The Nutrition Debate #22: Too Much Omega 6; Too Little Omega 3

If you haven’t heard about fish oil supplements, like the caveman in the Geico commercial, you’ve been living under a rock. Fish oil, especially cold water fish oil, contains a high concentration of Omega 3 fatty acids. Together with Omega 6 fatty acids, these two acids, which are derived from linoleic acid (n=6) and linolenic acid (n=3), are known at the Essential Fatty Acids (EFA’s). That means that the body can’t make them (efficiently) and we therefore have to get them through our diet. And since most people don’t eat a lot of cold water fish, supplementation is an easy way to get our Omega 3’s. And Omega 3 supplementation is probably a good thing to do. I do it: 2 grams a day, every day. Each gram contains compounds called EPA and DHA in a 3 to 2 ratio that together give me a combined EPA/DHA total of 1 gram.

There is also solid evidence that when combined with a low-carbohydrate diet, fish oil supplementation will significantly lower serum triglycerides, an important blood lipid marker. The effect is dose dependent and additive if you are taking a statin. I was once on a statin, and for about a year took 4 grams of fish oil daily and very dramatically lowered my triglycerides to about 50, where they remain today. If I were to do it again, today I wouldn’t take more than 3 grams a day, and I wouldn’t do it for more than a year.

But getting enough Omega 3’s, and even lowering serum triglycerides, is easy. Fish oil capsules are big, but cheap. The real problem is that we are getting too many Omega 6’s. Way, way too many. Ten and twenty, even twenty-five times too many. And they are hidden and omnipresent in our modern diet. They are the main component in polyunsaturated fat in the vegetable oils (soy bean oil, corn oil, safflower oil, sunflower seed oil, and cotton seed oil) that are ubiquitous in the fried foods and baked goods that most people eat every day. Don’t believe me? Check out the label on the packaging, if there is a label. It’s there. Soy bean oil and corn oil are the primary cooking oils. More than 70% today.

Again, citing Enig and Fallon’s “The Skinny of Fats,” “Problems associated with an excess of polyunsaturates are exacerbated by the fact that most polyunsaturates in commercial vegetable oils are in the form of double unsaturated omega-6 linoleic acid, with very little of vital triple unsaturated omega-3 linolenic acid. Recent research has revealed that too much omega-6 in the diet creates an imbalance that can interfere with production of important prostaglandins. (34) This disruption can result in increased tendency to form blood clots, inflammation, high blood pressure, irritation of the digestive tract, depressed immune function, sterility, cell proliferation, cancer and weight gain. (35)” The footnotes are cited in the article, which can be viewed at

Improving your Omega 6/Omega 3 ratio will not be easy. You really don’t want to swallow more than two grams of fish oil a day. And by raising the denominator in the fraction, it will only slightly improve the ratio (while hopefully lowering your serum triglycerides). So, to make a real difference you will need to find and eliminate the Omega 6’s you are eating. That means changing your diet. Eating less fried food, and eating fewer processed foods made with any vegetable oil.

Michael Pollan’s “In Defense of Food: An Eater’s Manifesto” and “Food Rules” would be good guides here. The first part of “The Omnivore’s Dilemma” makes a frightening case for the omnipresence of corn in our industrialized food industry. The second part makes a good case for ways to avoid industrialized food, as do his later two books cited above.

Dr. Kurt Harris’s Archevore blog ( is another guide to eating in a way to avoid the Neolithic Agents of Disease (NAD), as he calls them: wheat, excess fructose, and excess linoleic acid (Omega 6 fatty acids).

This past winter I went to a Mets Spring Training game and the folks next to me were eating fried dough sprinkled with confectioner’s sugar. I looked at it and said (to myself): all three Neolithic agents of Disease (wheat, sugar which is 50% fructose, and vegetable oil for frying). I said this while I drank a beer (wheat) and ate peanuts. Oh well, nobody’s perfect.
© Dan Brown 7/31/11

Sunday, July 24, 2011

The Nutrition Debate #21: The Dangers of Polyunsaturated Fats

For the last fifty years we have been told to eat less saturated fat and cholesterol and to exercise more, and we (collectively, as a population) have complied; yet, we (again, as a population) have been getting fatter and sicker. “The Nutrition Debate” is about why this has happened. If you’ve been following the column, you already know that I suggest an alternative approach is worth considering. If you haven’t read them, the previous columns are archived at

One of my favorite “alternative” organizations for nutritional information is The Weston A. Price Foundation. President Sally Fallon and Board Member Emeritus Mary Enig, PhD, collaborated in 2000 to produce a paper “The Skinny on Fats” as a chapter in their book “Nourishing Traditions.” If you have any interest in the subject of this mini-series, “Know Your Fats,” you will want to go to their site,, or just google “The Skinny on Fats” and read this article. Here, however, I will just reproduce an excerpt on “The Dangers of Polyunsaturates,” from a chapter in the book. The footnotes are all provided in the reference cited:

“The public has been fed a great deal of misinformation about the relative virtues of saturated fats versus polyun-saturated oils. Politically correct dietary gurus tell us that the polyunsaturated oils are good for us and that the saturated fats cause cancer and heart disease. The result is that fundamental changes have occurred in the Western diet.

At the turn of the century, most of the fatty acids in the diet were either saturated or monounsaturated, primarily from butter, lard, tallows, coconut oil and small amounts of olive oil. Today most of the fats in the diet are polyunsaturated from vegetable oils derived mostly from soy, as well as from corn, safflower and canola.

Modern diets can contain as much as 30% of calories as polyunsaturated oils, but scientific research indicates that this amount is far too high. The best evidence indicates that our intake of polyunsaturates should not be much greater than 4% of the caloric total, in approximate proportions of 2 % omega-3 linolenic acid and 2 % omega-6 linoleic acid. (30)

EFA [essential fatty acid, i.e. omega 3 and omega 6] consumption in this range is found in native populations in temperate and tropical regions whose intake of polyunsaturated oils comes from the small amounts found in legumes, grains, nuts, green vegetables, fish, olive oil and animal fats but not from commercial vegetable oils.

Excess consumption of polyunsaturated oils has been shown to contribute to a large number of disease conditions including increased cancer and heart disease; immune system dysfunction; damage to the liver, reproductive organs and lungs; digestive disorders; depressed learning ability; impaired growth; and weight gain. (31)

One reason the polyunsaturates cause so many health problems is that they tend to become oxidized or rancid when subjected to heat, oxygen and moisture as in cooking and processing. Rancid oils are characterized by free radicals-- that is, single atoms or clusters with an unpaired electron. These compounds are extremely reactive chemically.

They have been characterized as "marauders" in the body for they attack cell membranes and red blood cells and cause damage in DNA/RNA strands, thus triggering mutations in tissue, blood vessels and skin. Free radical damage to the skin causes wrinkles and premature aging; free radical damage to the tissues and organs sets the stage for tumors; free radical damage in the blood vessels initiates the buildup of plaque.

Is it any wonder that tests and studies have repeatedly shown a high correlation between cancer and heart disease with the consumption of polyunsaturates? (32) New evidence links exposure to free radicals with premature aging, with auto-immune diseases such as arthritis and with Parkinson's disease, Lou Gehrig's disease, Alzheimer's and cataracts. (33)”

When I first read this article, I went to the kitchen cabinets and (with permission) threw out virtually all the mostly polyunsaturated vegetable oils. I then went to The Weston A. Price Foundation website, bought the cookbook and started cooking only with saturated and monounsaturated fats.

The next column will get delve into detail on Omega 6’s and Omega 3’s, and how to correct this really important ratio.
© Dan Brown 5/22/11

Tuesday, May 3, 2011

The Nutrition Debate #20: Know Your Dietary Fats: Saturated and Unsaturated

I am about to embark on a mini-series on fats, and this may be a little dense for many of my readers (assuming I have many readers). I can actually recall a time when “good cholesterol = HDL” and “bad cholesterol = LDL” were not yet fixed associations in my mind, so I am sympathetic if you still find yourself there now. Nevertheless, if you are going to take an interest in your health, as I sincerely hope you will, you are going to have to acquire an understanding of some of the basic science of human nutrition. So, let’s begin with the classification of fats into Saturated and Unsaturated.

Simply put, saturated fats are in solid form at room temperature and unsaturated fats are in liquid form. In the new “Dietary Guidelines for Americans, 2010,” the HHS/USDA has begun to use “saturated fat” and “solid fat” interchangeably. In the same document and in their “food pyramid”, the HHS/USDA describes unsaturated fats as “oils.”

Saturated fats are for the most part animal fats, i.e. fats found in intramuscular tissue as well as under the skin and around the organs. Both in the animals we eat, and in our own physiology, fat serves as both energy source and energy reserve. It also cushions the organs and skeleton from damaging blows and insulates the body from cold. More recently – and this is a development of monumental importance in our understanding of fat metabolism -- fat stores have come to be recognized as an endocrine organ as well. Leptin, a hormone discovered in adipose (fat) tissue in 1994, is an appetite suppressant, sending a strong signal to the hypothalamus at the center of the brain. Our fat is in a constant state of flux as its primary form, triglyceride molecules, are being synthesized (created), or catabolized (broken down).

Two other saturated fats (both solid at room temperature) that are commonly found in foods are vegetable in origin: Both are tropical oils – coconut oil and palm oil. Coconut oil, a medium-chain saturated fat, is appearing with increasing frequency in the Western Diet, but both have been used for millennia in the cuisines of the tropical regions.
Saturated fats are solid because they are structured in a dense way, with every carbon atom along the carbon chain having two hydrogen atoms. In addition, as it has no “double bond” between carbon atoms, they are straight, packed closely together and thus solid. Since there are no “free” atoms, they are also very stable and are not liable to become rancid when exposed to oxygen. It also means that, in their normal state or in cooking they will not create harmful “free radicals” (unpaired electrons) or produce pro-inflammatory AGE’s (Advanced Glycation End-Products) when heated.

Unsaturated fats break down into two sub-classes: monounsaturated and polyunsaturated. The monounsaturated fats are primarily found in olive oil, and to a lesser extent in Canola oil and peanut oil. Additional sources are avocado and many popular nuts (macadamias, pecans, hazelnuts). Because they have only one “double bond” in the carbon chain, they are called monounsaturated. They are fairly tightly packed and fairly stable when heated or exposed to oxygen (as in air). Have you noticed how olive oil becomes solid when refrigerated? It is, therefore, safe to use. Note, however, that medium chain, monounsaturated fats like olive oil, and longer-chain fatty acids, such as those found in polyunsaturated vegetable oils that need bile salts from the gall bladder to be digested, are more likely to be stored as adipose tissue, i.e. body fat. Saturated fats (e.g. butter), in contrast, are more likely to be directly used (oxidized, i.e. burned) for energy.

Polyunsaturated fats are fats that have more than one double bond in the carbon chain (hence poly), and are therefore loosely constructed and always found in the liquid state as “oils.” Because of their loose construction, they are relatively unstable, “reactive,” become rancid rather easily, and are also easily damaged by heating and especially reheating. These are the vegetable oils that have become ubiquitous in our food supply due to the ability to manufacture them cheaply. But the refining and processing has deleterious effects that are becoming increasingly known and understood. Trans fat is only one example. Trans fats (the artificial kind created in the processing phase to make liquid oils solid and more stable for use in margarine and in manufactured baked goods and cooking) are partially hydrogenated vegetable oils. There’s a broad consensus that everyone should strictly avoid artificial trans fats.
It is important to recognize that all fats are combinations of the three types: saturated, mono and polyunsaturated. Butter, for example is 66% saturated, 30% mono and 4% poly; Tub margarine is 23% saturated, 55% mono and 22% polyunsaturated; olive oil is 15% saturated, 70% mono and 10% poly. Soybean oil, used in 70% of processed foods, including restaurant meals in the US, is 15% saturated, 22% mono and 62% poly. Canola oil, a genetically engineered variant of rapeseed oil, is 7% saturated, 65% mono and 28% polyunsaturated. What are we getting ourselves into now!

The next column will be “The Dangers of Polyunsaturated Fats.” I will not be espousing the government’s position here.

© Dan Brown 5/1/11

Thursday, April 28, 2011

The Nutrition Debate #19: The Archevore Way of Eating a la Dr. Kurt G. Harris, MD

I mentioned in my last column that I had a “peripheral interest” in Paleolithic Nutrition and in Dr. Kurt Harris’s Archevore Way of Eating in particular. It is peripheral because I have been a Type 2 diabetic for 25 years, and for the last 8 years have been eating (mostly) a Very Low Carb dietary. VLC is a very effective way to control blood sugar and lose weight.

If you are overweight, or have Metabolic Syndrome or diabetes, to improve your health Dr. Harris advises you not to eat the Archevore way. He recommends that you eat with special macronutrient ratios to address those medical conditions.

But, if you are not overweight or have Metabolic Syndrome or diabetes, Dr. Harris counsels that by emulating the “evolutionary metabolic milieu” he describes in his 12 step program, this “pastoral diet” can improve your health. He counsels the follower to “go as far down the list as you can in whatever time frame you can manage. The further along the list you stop, the healthier you are likely to be. There is no counting, measuring, or weighing. You are not required to purchase anything specific from me (him) or anyone else. There are no special supplements, drugs or testing required.”

Dr. Harris’s 12 step program is taken directly, verbatim, from his blog at

1. Eliminate sugar (including fruit juices and sports drinks that contain HFCS) and all foods that contain flour.
2. Start eating proper fats. Use healthy animal fats to substitute fat calories for calories that formerly came from sugar and flour.
3. Eliminate gluten grains (wheat, barley, rye, malt). Limit grains like corn and rice, which are nutritionally poor.
4. Eliminate grain and seed derived oils (cooking oils). Cook with Ghee, butter, animal fats, or coconut oil. Use no temperate plant oils like corn, soy canola, flax walnut, etc.
5. Favor ruminants like beef, lamb and bison for your meat. Eat eggs and fish.
6. Make sure you are Vitamin D replete. Get daily midday sun or consider supplementation.
7. Two or three meals a day is best. Don’t graze like an herbivore.
8. Adjust your (Omega) 6’s and 3’s. Pastured (grass fed) dairy and grass fed beef or bison has a more optimal 6:3 ratio, more vitamins and CLA (natural conjugated linoleic acid). If you can’t eat enough pastured products, eat plenty of fish.
9. Get proper exercise – emphasizing resistance and interval training over long aerobic sessions.
10. Most modern fruit is just a candy bar from a tree. Go easy on bags of sugar like apples. Stick with berries and avoid watermelon which is pure fructose. Eat in moderation. If you are not trying to lose fat, a few pieces of fruit a day are fine.
11. Eliminate legumes (beans, lentils, peas, peanuts, soy beans).
12. If you are allergic to milk protein or concerned about theoretical risks of casein, you can stick to butter and cream and avoid milk and soft cheeses.

“No counting, measuring or weighing is required, nor is it encouraged.” “Archevores typically range from 5-35% carbohydrate, from 10-30% protein and from 50 – 80% fat (mostly from animals) but wider ranges are entirely possible if you are not dieting and you are meticulous about the quality of your animal food sources. If you are trying to lose weight, really minimizing fructose and eating 50-70g a day of CHO as starch is recommended. If you are at your desired weight and healthy, 20% of calories as carbs are plenty for most very active people.” “Archevore diets tend to be lower in carbohydrate than the Standard American Diet (SAD) because you can only eat so much, and eating animals gives you lots of fat. But it is emphatically not a “low carb” diet as you do not count anything. You just avoid certain foods that happen to be largely carbohydrate. Note that “Fat” and “Carbohydrate” are macronutrient categories that each contains good and bad. Saturated and monounsaturated fat is generally good. More than 4% of calories from PUFA (whether n3 or n6) is bad. For healthy non-diabetics, starch (glucose polymers) is good. Excess fructose is bad. In wheat, the carbohydrate starch is not the major problem. It is the gluten proteins and wheat germ agglutinin that come along with the starch. So, forget “carbs vs. fat.” It is Neolithic agents of disease versus everything else. Most Archevores only know macronutrient metrics in retrospect, as they don’t target numbers just like wild humans didn’t target numbers. If you are not trying to lose weight and you like to eat potatoes and rice, EAT THEM. Sweet potatoes, white rice and white potatoes are well tolerated by most people, and starchy vegetables per se are not Neolithic agents of disease. Many active people without diabetes or metabolic syndrome feel and function better with a fair amount of starch in their diet. YMMV (Your Mileage May Vary).” (end quotation from

So, if you are overweight, or have Metabolic Syndrome or pre-diabetes or diabetes, well…carbohydrates do count, as Dr. Harris makes clear. Woe is me. Next week we will start a 4-week series on “Know Your Fats.”

Dan Brown. 4/24/11

Sunday, April 17, 2011

The Nutrition Debate #17: Michael Pollan: Pied Piper of Pseudo Paleo Prandial Principles

I’ve read Michael Pollan’s last four books and enjoyed them all; he’s a good writer. But he’s a journalist, as he often reminds us in “The Omnivore’s Dilemma.” He’s not a science writer, and that is my quarrel with him. He “gets” a big part of the message I write about in this series (archived at, but he misses a critical part of the science (just how he misses is muddled in mystery), and so he “misses the mark.”

The first book of his that I read, “The Botany of Desire,” I bought in a Garden Center! But his latest three, all best sellers, are for the most part about the food we eat. “The Omnivore’s Dilemma” is the best read, but “In Defense of Food: An Eater’s Manifesto” is the most relevant to our discussion here. “Food Rules” is a compendium of “Defense” and just icing on the book sales cake. It is, however, a useful iteration of its predecessor for those with only an hour of free time or who want a quick reference for pocket or purse.

The mantra of “In Defense of Food” (recapitulated in outline in “Food Rules),” is “EAT FOOD, NOT TOO MUCH, MOSTLY PLANTS.” I completely buy in to the first two parts, both in overall concept and in virtually all the particulars. I also subscribe to his long prefatory rationale – the first two thirds of “Defense,” actually – almost in their entirety.

However, Pollan goes astray in the third part of his mantra when he buys into the government’s shift away from healthy animal fats (aka saturated or “solid” fats in the latest “Dietary Guidelines for Americans”) and towards a “mostly” plant-based diet. He ignores all the science in this area – even after lambasting all the errors of the last fifty years and apparently espousing the “alternative” hypotheses earlier in “Defense” – in order to align himself with the virtually vegan victuals point of view that our public health officials have taken up and are trumpeting to the masses.

Perhaps his virtual visits to the abattoirs of the industrial beef production industry, and his actual experience slaughtering a few chickens on a farm in the Shenandoah Valley while researching “The Omnivore’s Dilemma,” affected him more than he realizes. Or perhaps it was the easy-to-fall-into trap of writing “to the market”, i. e., pandering to a perceived predisposed mindset of the reader. Even though he pulls his punches a bit with “mostly plants,” I think it is a miscalculation, if a calculation at all. Or, we could blame the pandering to the government line on his editor/publisher.

There is no doubt that Pollan has become a Pied Piper, though. He has put himself out in front of the lemming masses. To the extent his Pseudo Paleo dietary advice is followed, he will lead them over the abyss, after he stops at the bank.

Pollan himself, it should be noted, does not claim to be advocating Paleo principles of eating. His precepts initially resemble Paleo ideas, but in the final analysis they are decidedly not paleo (more on what Paleo is in the next installment). He correctly identifies all of the dietary errors for the last 10,000 years, suggesting that he is heading towards an evolutionarily informed way of eating. Then he doesn’t. After setting us up to follow him back to “healthy eating,” he takes us instead in the direction that our government, etc, etc, is currently leading us - the complete opposite of where we should be going. Avoiding animal fats, and cooking with Crisco and Wesson Oil (or any other polyunsaturated vegetable oils that are high in Omega 6 fatty acids), is not what we should be doing (more on this too in coming weeks). Again, we could blame this on his editors too. Maybe these two books, “In Defense of Food” and “Food Rules,” were their idea too, to capitalize on the enormous (and deserved) success of “The Omnivore’s Dilemma.”

Philosophically, this lack of thematic consistency, which l attribute to his “journalist” grounding, both in the good and bad ways described, damages the force of his argument. And due to the lack of grounding in science, on his part or his editor’s, these books ultimately fail to give good advice in the “mostly plants” section.

This column was not meant to be a book review, but that is what is has become. In the next installment I will describe what is meant by “Paleo Nutrition” and how its principles can be used in guiding us forward in the present milieu. Why should we be guided by what our primordial ancestors ate and what they didn’t eat? Is there a scientific basis, anthropologically, physiologically and biochemically speaking? And should we use it to prescribe a way of healthy eating today? Let’s explore that next.

© Dan Brown 4/10/11

The Nutrition Debate #18: Paleolithic Nutrition and the Archevore Diet

“The modern dietary regimen known as the Paleolithic diet…is a nutritional plan based on the presumed ancient diet of wild plants and animals that various human species habitually consumed during the Paleolithic” era, according to the Wikipedia entry. A fundamental precept of this Way of Eating is that it “ended…with the development of agriculture” and animal domestication at the advent of the Neolithic era. Hence, the “contemporary Paleolithic diet consists mainly of meat, fish, vegetables, fruit, roots, and nuts, and excludes grains, legumes, dairy products, salt, refined sugar, and processed oils,” quoting from Wikipedia but with emphasis added.

“Paleolithic nutrition is based on the premise that modern humans are genetically adapted to the diet of their Paleolithic ancestors, and that humans have scarcely changed since the dawn of agriculture, and therefore that an ideal diet for human health and well-being is one that resembles this ancestral diet.” From the time of the onset of our hunter-gatherer stage of evolutionary development some 2.5 million years ago, hominids have been carnivorous animals. We ate whatever we could hunt or catch or forage. We fed, and then we fasted until the next kill or catch or gather. We also most likely ate the whole animal, including organs, blood, fat and bone marrow, before we put the hide and bone to use.

“The ancestral human diet is inferred from historical and ethnographic studies of modern-day hunter-gatherers as well as archeological finds, anthropological evidence and application of optimal foraging theory,” again quoting Wikipedia. Today, a Paleo diet would of course include cultivated plants and domesticated animal meat as an alternative to foraging and hunting. However, the Industrial Revolution led to the large scale development of mechanized food processing techniques for these cultivated plants. Refined cereals, refined sugars, and refined vegetable oils have become major components of Western diets [such as the Standard American Diet (SAD)]. Intensive livestock farming methods produce fattier (corn fed) meat (from cattle); while selective breeding has produced leaner pork and poultry with greater amounts of white meat. Selective breeding also resulted in larger, sweeter fruits. Modern transportation systems provide year round availability for almost every sort of food stuff. The Paleo diet rejects some of these newer foods as “Neolithic agents of disease,” in the words of Dr. Kurt G. Harris, author of the Archevore (formerly PāNū) blog.

These modern-day developments are described (and deplored) in Michael Pollan’s “The Omnivore’s Dilemma,” where he slams the industrial production of corn-fed feedlot beef and cooped-up chickens. He followed up with “In Defense of Food: An Eater’s Manifesto” and “Food Rules,” where he defined “real” food and enumerated some twenty-odd rules of thumb on how to identify it. I am in complete accord with Pollan, insofar as his definition of “real” food goes. However, to hone my approach to Paleo eating, on my blogroll at, I subscribe to the thinking of Dr. Kurt Harris. Dr. Harris developed his interest in health and nutrition after reading Gary Taubes’s “Good Calories-Bad Calories.” More recently, Taubes is the author of “Why We Get Fat: And What To Do About It.”

“Archevory refers both to a dietary approach which strives to focus on essentials without superfluity, but also to the yearning to consume or learn about essential principles in general,” Harris says at Harris explains, “The Archevore diet and approach to health is centered on a simple idea – that the diseases of civilization are largely related to the abandonment of the metabolic conditions we evolved under – what I have called the “evolutionary metabolic milieu” EM2. “I believe we can make sense of many of the diseases prevalent now and relate them to some simple but profound changes that have occurred with the introduction of agriculture and the more recent industrialization of our foodways. These changes are related to how the food environment, including its availability, interacts with the metabolic environment of our bodies.”

Harris says his conception of the “evolutionary metabolic milieu” is “not derived from a single science or field of inquiry, but draws first on medical sciences like biochemistry and endocrinology, and only then looks back with history and paleoanthropology. It is becoming clear now that many of the diseases afflicting humanity are not a natural part of the aging process, but are side effects of technology and other powerful cultural changes in the way we eat and live that have occurred since the dawn of agriculture roughly 10,000 years ago. These changes seem to center largely on the sequential introduction of what I call the Neolithic agents of disease – wheat, excess fructose, and excess linoleic acid.”

Dr. Harris’s “12 step program to remove the Neolithic agents of disease in an efficient and practical manner” will be the subject of the next installment in this series. I have a keen, if peripheral, interest in this ascendant eating program.

© Dan Brown 4/17/11

Sunday, April 3, 2011

The Nutrition Debate #16: Diets and Dieting: Had Enough? Ready to Move On?

Diets and dieting have been around forever. I started this series with a story about William Banting, a retired London undertaker who in 1863 published a pamphlet, “Letter on Corpulence,” after following a diet his doctor had heard about while attending a medical conference in Paris. Banting lost 50 pounds on the diet. It is not recorded if he gained it back.

These days, every few years we hear about a new diet that has caught the public’s imagination. Why is that? The answer seems to be that, for most people, we may lose weight on a temporary basis, but usually we gain is back before too long. So, we continue to look for “a diet that will work for us.”

A few years ago there was a flurry of interest in the Blood Type Diet, a “nutrigenomic” program based on your blood type (obviously) but that was also based on your ethnic-geographic origins and therefore presumably your ancestor’s primordial dietary. Other still-popular diets include the Mediterranean Diet and the South Beach Diet. However, it is the contrast between the establishment’s low-fat diet and the alternative low-carb diet that is of special interest to me.

Diets and dieting, of course, are for those who are overweight, obese or even morbidly obese. These days that includes about fifty percent of the US population. The incidence of morbidity as it relates to Type 2 diabetes and the lesser recognized Metabolic Syndrome is also increasing at an alarming rate. Associated co-morbidities include hypertension (high-blood pressure) and CVD (cardio-vascular disease). Other Diseases of Civilization, including Alzheimer’s dementia, many cancers and numerous lesser known diseases are also frequently associated and are increasing dramatically.

Paradoxically, at a time of plenty in the food supply for most of the developed world, especially the US, the relatively “poorer” classes demographically are fatter as a population than the economically “better off.” Although some of that can be attributed to poor education about food choices, it seems to me that it is simply the economics of the food choice dilemma that is causative. The less expensive foods (carbohydrates) are more fattening; the more expensive foods (protein and fat) are, well, more expensive. Sadly, the choice is simply, what can I afford to buy for my family?

Thus, the poor get fat because they can’t afford to “eat healthy.” Hence the recommendation in the latest “Dietary Guidelines” to eat a vegan diet to get your protein and fat from less expensive plant sources: “beans and peas, nuts and seeds,” as well as “fortified soy beverages.” It’s a clever device to promote both a meat-free diet and the vegan agenda. Our government has been snookered and swallowed it whole. They want you to as well, especially if you’re in the “poorer” demographic. That’s what Public Health does: prescribe a regimen for all that will accrue a benefit to a few. For my take on the “Dietary Guidelines,” see installment #14 archived at

But not everyone today is overweight and obese. Some of my readers, especially those who haven’t developed the damaged glucose regulatory mechanism about which Gary Taubes hypothesizes, will ask, “How have I managed to avoid getting fat?” Are these folks so precisely attuned to their metabolism that they eat exactly the amount of food their body requires, not a calorie more? Or do they attribute their metabolic balance to the amount of exercise they do, increasing the amount each year as they age? Or do they “eat right?” If you think it is the latter, I think you’re right.

If you need to lose weight, and keep it off, you would be well advised to change what you eat permanently, for life, (double entendre intended). If you are not overweight, you may already “eat right,” but would benefit from avoiding foods that may harm you in ways other than making you fat. The Diseases of Civilization, attributed to the Western Diet, are frequently independent of a tendency toward overweight. They are multifarious, and more are being identified by association and/or by causative agent in the literature with each issue of almost every medical journal. A search on any disorder will produce a vast amount of (often conflicting) research attempting to attribute association or even causality.

This suggests to me it is time for everyone to assess their own diet and consider what makes sense for them. I personally have “an interest in eating,” as the publisher wryly noted in an early introduction to this column. But I also have a special interest in eating well, both for my pleasure and for my health. I have lost a great deal of weight by adopting a Way of Eating that works for me. More importantly, my health is much better by all the metrics that my doctor uses: my lipid panel is now “to die for” (oops!) and my blood sugar is now under control, practically without meds. I have the fasting blood glucose and HbA1c of a non-diabetic! I feel great and am never hungry. My diet is very high fat, moderate protein and very low carbs. Your mileage may vary, but gradually eating fewer calories from carbohydrates is a good start.

© Dan Brown 4/3/11

Monday, March 21, 2011

The Nutrition Debate #15: Did Grandma Know About Macronutrients and Phytochemicals?

We all love(d) our grandparents, of course, and I have nothing but fond memories of mine. My mother’s father was a truck farmer who owned 40 acres on Staten Island. I remember his really rough hands. Every week he drove his chain-drive, solid-tired, flat-bed truck through the Holland Tunnel to the Washington Street market before dawn. There, he sold crates of vegetables at the wholesale market where the World Trade Center was later to be built. He and his wife, my grandmother, were both fat and died at about age 75, he of lung cancer (he loved cigars) and she of Alzheimer’s.

My father’s father died at age 79 when I was only 8 but his wife, my grandmother lived to be 89 and was skinny all her life. She hadn’t eaten a tomato since 1895. Poison, she said, nightshade family. So are potatoes, of course, and eggplant, Bell peppers, chili pepper, paprika, tobacco, petunia, and belladonna (deadly nightshade). So far, they haven’t killed me. (Aside: When my wife read this column in draft, she told me her father ate unripe tomatoes as a kid and got really sick.)

I did not derive any enduring wisdom about eating from any of my grandparents. I wasn’t asking, and they weren’t saying, but YMMV (Your Mileage May Vary), to use internet slang. Increasingly, however, we hear this advice: Don’t eat any food that didn’t exist when your grandmother went food shopping, or don’t eat anything that is sold in a box or a bag; or has more than 4 ingredients; or has things in it that you can’t pronounce. In other words: eat whole, unprocessed, unrefined foods. In sum, as Michael Pollan says, “Eat Real Food”. I think that’s good advice, as far as it goes. It’s a start anyway. And you have to start somewhere if you want to improve the quality of your life and avoid getting a “progressive” dietary disease like Type 2 diabetes, or even a syndrome. Woe is me, not Metabolic Syndrome!

It’s easy to make these pronouncements, but we all lead busy lives and preprocessed foods are convenient. Besides, dietary advice is constantly changing and so much is still unknown and uncertain. Low-fat, low carbohydrate, who’s to know? Your doctor’s in charge of your health, right? And the government knows best. Well. Now you’ve gone too far for me, but if you’ve reading this column (archived at, you know this.

So, as it turns out, our grandparents made smart food choices by default! Real Food was the only option they had. But in truth there were bad choices they could have made and did make. White flour was preferred because it kept longer. And farmers have been breeding fruit to be sweeter for hundreds of years (at least), increasing the fructose load that our livers have had to deal with to protect our bodies from its toxic effects. So, fruits got sweeter, and more fructose went directly to the hepatic portal vein without the usual oxidative metabolism required of glucose. Then sucrose (table sugar), a disaccharide of refined cane sugar containing equal parts fructose and glucose, replaced molasses, and was added to lots of foods. Now, high fructose corn syrup (HFCS) is commonly used to sweeten foods and beverages. Our livers are in fructose overload. As a result, non-alcoholic fatty liver disease (NAFLD) is now on the increase.

And as we try to avoid saturated fat, as recommended by the “Dietary Guidelines for Americans” (see installment #14), we are 1) eating more and more monounsaturated fats like olive oil, which is otherwise a “good” fat but which is more likely to become added body fat than saturated fats and 2) eating too much polyunsaturated fat, which tends to be partially hydrogenated trans fats and also contributes to an unhealthy ratio of Omega 6’s to Omega 3’s.These PUFA’s are often hidden in baked goods and in fried foods that are cooked in high-heat vegetable oils that are used repeatedly. Repeated use destroys the delicate omega 3’s and oxidizes the rest. Oxidation = rancidity.

So, the challenge is 1) to eat Real Food; 2) avoid excessive amounts of fructose; and 3) avoid partially hydrogenated trans fats from vegetable oils in store-bought baked goods and fried foods and restaurant cooking and deep fat frying.

Now, add to all this the refined grains. Although the Dietary Guidelines don’t tell you this explicitly, “refined grains” means anything made with bleached, enriched, white flour from wheat, or any other refined (milled, bleached, enriched etc.) grains. I’m not telling you this. The “Guidelines” are telling you this. They just can’t say it in so many words without getting the Industrial Agricultural Complex mad as hell. They already have the beef and lamb and pork industries up in arms. They can’t afford to get Archer Daniels Midland and Cargill up in arms too. Besides, their representatives were on the Dietary Guidelines Advisory Committee, so there wasn’t much danger of that. So was the Center for Science in the Public Interest (CSPI), the quintessential nanny-state advocacy organization. Together, these groups are now in the driver’s seat of my grandfather’s chain-drive, solid-tired, flat-bed truck on the way to today’s market. Personally, I hope that market will eventually “move” too, the way the Washington Street Market did to make way for the Twin Towers.

© Dan Brown 3/4/2011

Friday, March 11, 2011

The Nutrition Debate #14: The New “Dietary Guidelines for Americans, 2010”

My heart is pounding, and I’ve only just re-read the Executive Summary of this year’s long awaited “Dietary Guidelines for Americans, 2010” ( I had listened live to the press conference on January 31, 2011, when it was released to the public, and had managed to calm myself since, but now my blood is boiling again. Where to begin?

First, to be fair, the government’s “Dietary Guidelines” is a public health document, and a public health recommendation is geared to an entire population with a broad purpose which is often interpreted by a much narrower segment to which it may not be applicable. There is much too much variability within the population for such broad pronouncements to edify or be efficacious; but they are made nevertheless in the broad interest of “the public health.” So, if you’ll pardon the expression: “take it with a grain of salt.”That being said:

This year’s “Guidelines” are cleverly crafted by wordsmiths with skills for euphemism: “(A)t a time of rising concern about the health of the American population…,” we are told that “poor diet” and “physical inactivity” are “associated with major causes of morbidity and mortality” in the US. True enough. Then, we are told that “15 percent of American households have been unable to acquire adequate food to meet their needs.” Then, “This dietary guidance can help them maximize the nutritional content of their meals,” and “Many other Americans consume less than optimal intake of certain nutrients even though they have adequate resources for a healthy diet.” Again, all this is certainly true.

Parsing those words, they mean that on limited incomes many people make poor food choices, and the government wants to help. I’m reminded of a headline I read in Honolulu last September that 50% of Hawaiian residents were on food stamps. The government dole, not the pineapple company, helps these poor folks survive in paradise.

So, the guidelines start with several iterations of the obvious, universally-held truth (NOT) about the “Energy Balance Equation: Energy In = Energy Out,” (see installment #6 at Then the “Guidelines” summarize the “key recommendations” this way: “Americans currently consume too much sodium and too many calories from solid fats, added sugars, and refined grains. These replace nutrient-dense foods and make it difficult for people to achieve recommended nutrient intake while controlling calorie and sodium intake. A healthy eating pattern limits intake of sodium, solid fats, added sugars and refined grains and emphasizes nutrient-dense foods and beverages – vegetables, fruit, whole grains, fat-free or low-fat milk and milk products, lean meats and poultry, eggs, beans and peas, and nuts and seeds.” I could, and will, quarrel with some of this in later installments, but not bad so far.

A little later we are told where to find a meal plan with such a dietary: “Two eating patterns that embody the Dietary Guidelines are the USDA Food Patterns and their vegetarian adaptations and the DASH (Dietary Approaches to Stop Hypertension) Eating Plan. I haven’t gone there yet (I will), but first I want to characterize the “Key Recommendations.”

There are seven “foods and food components to reduce” and nine “food and nutrients to increase.” We’re told to reduce our sodium intake, consume less dietary cholesterol, keep trans fat from synthetic sources as low as possible, limit saturated fat by replacing it with mono and polyunsaturated fats (hmmm), and limit refined grains, “especially refined grain foods that contain solid fats, added sugars and sodium”…and limit alcohol consumption. By word association, they unfortunately and erroneously link trans fats and “…other solid fats,” and “solid fats and added sugars” as things to be reduced or avoided together. In recommending the substitution of mono and polyunsaturated fats for saturated fats, they are stepping into a trap of their own making they will rue and wish they had avoided in the years to come. I will speak to this in later installments. And note, if it wasn’t already clear, that “solid fats” is a new term in the “Guidelines” and a euphemism for saturated fats, which in our dietary is almost entirely animal fats, the only exceptions being the tropical oils (coconut and palm), which are not common in most people’s daily “food pattern.”

Of the food and nutrients to increase, recommended are fruits, vegetables , whole grains plus some vitamins and minerals (as supplements if you can’t get them in “real” food); but, five of the nine recommendations were ways to avoid saturated or “solid” fats, including eating “beans and peas, soy products, and unsalted nuts and seeds” and “fortified soy beverages.” I may just have to look at those “USDA Food Patterns and their vegetarian adaptations” after all. But first, I want to examine what Grandma knew about food patterns, and then what Michael Pollan is telling us.