Saturday, August 11, 2012

Nutrition Seminar


Okay everybody. Let’s talk nutrition. 

It’s a bit scary though, this subject is rife with conflict. It is crazy. I would much rather bring up abortion or evolution with a random stranger at the grocery store than dare talk about the garbage in their shopping carts. I suppose that’s mainly because the views that I hold aren’t exactly the status quo yet. But they are gaining ground out there and people are definitely coming around. 

So what do I think is healthy nutrition? Not so fast. First, lets look a little closer at the conventional wisdom out there. 

What do we know about nutrition? What’s healthy to eat and what’s not healthy? Well those are huge questions. Questions that drive entire industries, including but not limited to food companies. The agriculture industry, the pharmaceutical industry and plenty of other folks out there are interested in what we eat and are watching carefully the changing whims of the people so they can be ready to make a profit. Well, we better make sure all the things we’ve heard are correct. 

Let’s start by looking at some common nutrition wisdom and analyzing it carefully. I’m gonna start big. Go big or go home right? Well, I am home, but I’ll go big anyway. We’re going to start by looking at what may be the single biggest nutrition myth perpetuated today:

Saturated fat causes heart attacks and obesity. Fat makes you fat, and clogs your arteries. That’s actually pretty straight forward thinking. It seems like common sense. Fat on your plate jiggles, fat on your body jiggles, there you go. Artherosclerotic plaques in your arteries look like grease, piece of cake...literally.

Fat is one of three macronutrient classes. Macronutrients make up the fuel sources for our bodies. The different macronutrient types are: fat, protein, and carbohydrates. The idea that the health woes of our society are all the result of a single macronutrient class is an attractive idea. First, it provides a simple understanding of a complex subject. It’s tempting to over simplify and over generalize. Our brains seek to find order within complex systems, and as a result we come to incorrect conclusions. If history is any guide the only truly safe bet we can make about any of the conclusions science has reached is that it’s more complicated than we think. We would love to think that fat is the problem and if we can find a way to eat zero fat, we’d experience zero heart attacks.

Well, unfortunately it’s a little more complicated than that. This is the starting point that got Ancel Keys looking at fat intake as the cause of heart disease way back in the 1940s. He was so convinced that this was the case that he made it his single minded purpose to show that this was true. He collected data on fat intake and graphed it against the number of heart disease related deaths in various countries and his graph indeed did demonstrate a correlation between the intake of fat and the number of deaths from heart disease. This is a result we call a “correlation.” It shows that one variable correlates with another variable. It is important to point out that “correlation is not causation.” Which is a common issue among people on both sides of any nutrition argument. Anytime we look at data on nutrition we typically are looking at epidemiological data. That is we look at populations of people, measure two variables present and try to see if they seem related. To understand why this is an imperfect approach lets look at a few other correlations. 

Here’s Ancel Keys’ original graph showing the relationship between saturated fat and heart related deaths:
Just to demonstrate how sometimes a correlation may not represent a causation, here’s another graph, based on the most recent data on heart related deaths:
In my graph I looked at the current number of heart related deaths per country graphed against the number of mcdonalds in that country. You can see clearly that as the number of McDondald’s restaurants increases the number of deaths from heart attacks decrease. All we need to do is build more McDonald’s and we’ll see our rates of heart attacks drop to zero. Case in point: Correlation does not equal causation. 

Is it that the presence of McDonald’s represents an indicator of a separate variable that wasn’t measured. Perhaps the more affluent countries have more disposable income and have attracted more McDonalds restaurants? They also, because of their increased wealth, have better access to medical services and better emergency care of heart attacks, which results in fewer deaths in those populations. The relationship we see in these correlation studies might not be due to the variable they measured but due to a second variable reflected in the first. Because we are looking at heart attack deaths and not the total number of heart attacks, those countries with better medical care available would have a misleadingly lower number than comparable populations with better medical care. Hence the dangers of relying on epidemiological, or observational data when assessing health factors. 

Another way to look at this is to see if there are cultures out there that eat a diet high in fat and remain relatively disease free. Well, as you probably guessed, there are such cultures. The first two that come to mind are the Maasai tribe from Tanzania and the Inuit from the icy north. Both eat a large amount of their calories, more than 60%, from fat. Yet both cultures have low rates of heart disease and chronic disease, and general outstanding health that basically make the rest of us slobs look like Gary Busey. It is important to note that these cultures are also eating traditional ethnic foods, prepared in traditional ways, entirely devoid of processed and refined ingredients and additives.

So maybe fat isn’t the evil death monger we have been led to believe it is. So then the real culprit must be the carbohydrates, right? Well, next we look to the Kitavans, a tribe in the pacific islands that, despite their very high carbohydrate intake, continue to demonstrate less heart disease rates, and better markers of cardiovascular health than ours in the western, more affluent cultures. The Kitavans get roughly 65% of their calories from carbohydrates. The sources include yams, potatoes, fruit, honey, taro and cassava. They also consume pork and fish, but not nearly as much protein as many other cultures with higher rates of heart attacks and strokes. 

So if it isn’t the fat, and it isn’t the carbohydrates, then maybe it’s the protein. Turns out there isn’t a culture that I know of that represents an excessive consumption of protein. Mainly because protein is not separated from fat and carbohydrates in most natural food items. But we do have data looking at relative protein intake and rate of heart attack deaths between countries. Germany eats about 20% less protein than Portugal does, yet has roughly twice the rate of heart attack deaths. If you look carefully at the total protein intake between countries and compare that to the rates of heart attack related deaths there isn’t a correlation.

The conclusion we can draw from this information is that there is no case for condemning any one macronutrient category. A better understanding would be that diet and health are linked through complex relationships that include as many variables as there exist in our diet choices, and every decision we make in terms of our diet has ramifications of varying degree in our health. It’s a little less satisfying, but hey, welcome to health and nutrition. Any system that's been around millions and millions and millions of years (like our metabolisms, digestive systems, and enzyme processes) will have worked in some complicated machinery that responds to pretty subtle gradations in our environments. 

I don't want to suggest that macronutrients don't matter. Once we get a patient pretty dialed in on their nutrient intake and make sure they are actually eating real food at most meals, we turn back to macronutrients. A higher carb intake can enhance thyroid signaling, decrease cortisol levels, and help with weight gain, while a higher fat and protein diet can support weight loss. We might change the macronutrients eaten at different meals to maximize the metabolic process and help maintain energy levels through the day. Neither do I suggest that the Inuit could pack up their harpoons and sleds and ship off to stay with the Kitavans and not have a hard time on a drastically different macronutrient intake. In other words macronutrients are more of an individual question for you and not a smoking gun for the population at large. 

The next part in our seminar was where I shut the heck up about the macronutrients and finally got to some information that people might be able to actually use. We got talking about vitamins, minerals and micronutrients instead. In other words the rest of what's in our food that supports our life, besides just the macronutrients: fat, protein, and carbohydrate.

Vitamins were originally "discovered" in 1912. They were difficult to identify at first so they were named with just letters (C, A, E etc.) Until we were able to identify the actual chemical structure of each (Ascorbic acid, Carotene, and Tocopherol, respectively). Vitamins are "essential" for us meaning that our bodies don't make them sufficiently to support our functions. Minerals are also essential.

A lot of us say, "I get all my vitamins and minerals cause I take a vitamin." Unfortunately there are a lot of reasons why this approach is insufficient. It's much better to get your vitamins from food if you can. In order to illustrate this concept we talked about a few examples at the class. The first was folic acid (typically found in vitamins and "enriched" food) vs Folate (the natural form found in food from natural sources.) Folic acid and folate are not active in our bodies until they are converted to tetrahydrofolate. In the case of Folate this happens as it crosses the intestinal mucosa. In the case of folic acid from a vitamin, folic acid is absorbed, goes to the liver and is converted there by an enzyme called dihydrofolate reductase. In the meantime all this unconverted folic acid is swimming around in your body contributing to big C. Yep cancer. Increased rates of colon cancer correlate with increased intake of folic acid. That is until these people switch to folate and the cancer rates return to normal. The issue is this: Folic Acid is not found in natural food sources. Our bodies didn't get exposed to it till 1945 when they synthesized this in a laboratory. The dihydrofolate reductase enzyme has other things to stay busy with rather than fixing our vitamins so they don't kill us. The good news? Some vitamins made by companies with integrity do put folate rather than folic acid in their pills even though it's more expensive. We'll cover this issue a bit more in the upcoming class on choosing effective supplements. 

Another example of this issue we covered is Vitamin E. Looking at populations who consumed more vitamin E and also had lower rates of prostate cancer, researchers came to the reasonable conclusion that perhaps supplementing vitamin E would protect men against prostate cancer. They set out to study this by setting up a 12 year study. Instead of seeing the cancer rates decrease, they needed to stop their study early because it became obvious that the treatment group was developing more cases of prostate cancer than the control group. The problem with this study is that the type of Vitamin E used was the typical synthetic form found in most supplements (which is typically extracted from petroleum material). Vitamin E is the molecule Tocopherol. There are multiple forms of this molecule and the different forms are denoted with different greek letter prefixes. Alpha tocopherol is the type most commonly used in vitamins and in supplements. The type most prevalent in our diet is gamma tocopherol. Most alternative practitioners use mixed tocopherols, or vitamin E supplements high in gamma tocopherol when treating patients. Again the food source of this vitamin seems to prevent Prostate cancer, while the synthetic form seems to result in increased prostate cancer. 

So bottom line? Much better to get your vitamins and minerals from your food rather than from a multivitamin or a handfull of pills. There are of course exceptions where the food sources may be inadequate for specific people, that what our next seminar will cover. 

How do you ensure that the food that you are eating is higher in nutrients? Well you get real food coming from real sources. The one thing that was the same between the cultures we looked at was that they were eating a traditional diet, entirely devoid of processed and refined foods and ingredients. The food they were eating was high in nutrients. It was coming from natural and wild sources, or it was cultivated using traditional ethnic techniques rather than conventional industrial approaches. Their food was coming from an ecosystem. The food item they harvested was a link in a complex chain.  It supported and received support from a rich web of other organisms. This all results in more nutrients in the food they were eating. These nutrient include vitamins, minerals, phytonutrients, and even living organisms like bacteria. 

It isn't possible for us to get all of our foods from a natural environment. We've got jobs and families, and don't really have the time to be traipsing around picking mushrooms and hunting game. What we can do is choose to buy our foods from those farmers and ranchers that maintain a more natural environment for the food they're growing. Here's a diagram I found that illustrates this concept:


Notice that every waste product from one area in the farm sustains another area in the farm. The waste from the corn harvest is composted back into the soil, the manure from the livestock goes to supplying the nutrients for the growth of the grass and vegetables, the scraps could go to the chickens. In this case there is also an aquaculture, where a fish pond helps to recycle nutrients into food and support the rest of the farm. This is closer to a natural ecosystem, with each step relying on other steps adjacent. This ends up increasing the nutrients in the food obtained from this system because the nutrients are maintained in the system, recycled from step to step. The same magnesium, zinc, copper, and boron are incorporating in one organism then another, then another, and the food in turn obtained from this type of farming provides more of these same nutrients. In conventional farming practices the fertilizer is not recycled material from the farm, but industrial fertilizers that provide Nitrogen, Phosphorus, and Potassium, but not much else. (Think macronutrients for plants without any additional vitamins or minerals). As a result the plants pull the vitamins and minerals they need out of the soil to grow. The vitamins and minerals get shipped off in the crop yield and as a result the soil gets quickly depleted of these minerals and vitamins, meaning the crops get depleted of these vitamins and minerals. We end up getting the same looking vegetables, but with radically different nutritional benefits. Here's an illustration of how the above flow chart would look for more of an industrial, or Big Agriculture operation:

As you can see the trace minerals are depleted from the operation, The population eating this frankenfood ends up, to quote Maoshing Ni and Cathy McNease "overfed, but undernourished." Meaning, although they are getting more calories than they need, they aren't getting sufficient nutrition.

So the moral to this story is look for food grown in a traditional style ecosystem. Unfortunately, buying organic isn't necessarily enough. I know of amazing farmers that put out unbelievably nutritious food, but aren't considered "organic" (Polyface Farm comes to mind). As well as organic operations that operate much like the flow chart above, depleting their soil and bringing in organic, but no less stripped industrial style fertilizers. I get my eggs from a local farm, Abundantly Green. The chickens dig through the compost and are pastured, meaning they forage in the fields for bugs. The chicken's highly nitrogenous waste fertilizes the grass that in turn feeds the cows, and so on. That is a natural style ecosystem. Understanding that about their farm is more important to me than knowing if they are organic or not (which they happen to be). The eggs I get from their farm are rich, with amazingly bright colored yolks that turn my omeletes an incredible bright orange. The organic eggs I get from the store on the other hand, have pale, flat yolks, bland flavor and fragile shells. The difference is that the chickens at Abundantly Green live a life and eat a diet more in line with their evolution and result in better quality eggs. My recommendation would be t go find a local farm and get to know them. If the people that provide your food won't let you walk through their operation, that's a bad sign. See the chickens, ask questions, feel the grass. Get to know your food from its source, and health benefits will be dramatic.

Next we covered some super foods that I think everybody should make bigger parts of their diets. Some specific foods that I would recommend are:

Greens:
Kale, chard, collards, mustard greens, beet greens, etc. These are highly nutritious additions to a diet. They are high in Magnesium, iron, calcium, vitamin K, and fiber. Magnesium is deficient in the majority of the american population and deserves some serious attention. In addition the brassica family (kale, chard, brussel sprouts, broccoli, cauliflower, etc) has actions that speed up both phase I and phase II conjugation in the liver. This results in faster detoxification of environmental toxins, more tight regulation of hormone levels, and decreased long term oxidative damage from toxin build up. (read slower aging). The fact that they provide a good source of vitamin K is important as well. Vitamin K is involved in the clotting cascade as well as being a key factor in the proper utilization fo calcium. In the absence of sufficient Vitamin K and Vitamin D calcium can lay down in the arterial walls leading to increases arthersclerosis and cardiovascular risk.

Pastured Foods:
This refers to allowing animals that in nature would forage for their own food to follow their natural inclinations and eat their natural diet. Think cows out grazing in the grass, their natural food, being outdoors with space to move and eating their natural diet. The alternative is feedlot operations where the cows are kept in small enclosures without any growing grass anywhere nearby. The only topography provided comes from the piling up mounds of their manure. The food is trucked in and poured into troughs, and by the way comes from food sources that cows have never eaten in the history of the cow (such as corn, chicken parts, and ground bones.) Pastured food is more expensive but is well worth the price. Grass fed is another term that usually can be used interchangeably. Pastured is not the same as organic; pastured animals may or may not be organic, but are likely much better for you than animals raised in a feedlot setting under organic conditions. You can get pastured beef, chickens, eggs, milk, cheese, butter, and pork.

Raw Dairy:
Milk is not a terrible food. Even though dairy is a relatively recent introduction into our historical diet, genetic studies into different populations have established that some ethnicities are well adapted to consume dairy without any adverse effects. This is a personal question. If you have decided that you work well with dairy, and that your ethnic background makes you well suited to consume dairy (those from the northern european regions tend to have the highest incidence of persisting lactase production after infancy, and are best suited to continue consuming dairy into adulthood.) It is best to consume raw dairy. This preserves some important nutrients, by avoiding the pasteurization process. There was a landmark study called the "Gabriella study" which found that consuming raw dairy greatly decreased the incidence of asthma in youth. Part of the reason that raw dairy maintains healthy immune regulation is that it provides active probiotic cultures in the form of mainly Lactobacillus strains. It also provides a richer source of various vitamins and nutrients than does pasteurized milk. In fact raw, whole fat milk contains every known fat soluble vitamin. Check out the farm supplying your milk and make sure that you trust them and they take the process seriously.

Local Foods:
Eating local means choosing foods that have been grown in the local soil, shipped a minimum distance and in turn tend to be eaten soon after harvesting. This maintains the maximum nutrients in the food you choose. If you are eating foods that have been grown in Chile, shipped to florida, trucked across the country, kept on a palate in the refrigerated warehouse of a grocery store supplier for a few days and finally put on the shelf, you are missing out on significant nutrition. These fruits were picked before ripening, meaning that all the vitamins haven't had a chance to form. The fruits and vegetables have lost considerable amounts of vitamins through the shipping process. The fruits and vegetables have been bred to last on the shelf, often at the cost of nutrition and flavor. Also, when you eat local you are supporting the local economy, providing jobs for your kids, and for the neighbors kids, putting more money into the local government coffers and supporting the people you see at the bank and at the local chamber of commerce. It's a great thing to do for your health, your friends and the community.

Seasonal Foods:
There is a concept in Chinese Medicine, that each food represents a particular energetic state. Any biological system is also in an energetic state. By choosing the right foods at the right times you can bring any imbalances in your system back into balance. The foods that are available at different times of year, tend to align very well with the energetic landscapes we have in our bodies at any given time. Take for instance the fruits and vegetables of the summer: bright fruits, juicy, sweet. These are all of a cooling energetic nature. When the weather is warm this aligns well with your internal environment. When the weather cools off the fruits aren't growing anymore and we see more gourds, squash, and tubers coming out. These foods are heartier and align better with the cooling months of fall. In winter we traditionally eat more stews and stocks, broths, and meats. Just by eating the foods that are available and fresh at a given time of year you end up automatically staying in balance with the seasons and giving yur body just the type of foods it needs at that time of year.

Healthy Fats:
Fat has been chased enough by the lynch mob. Fats are not unhealthy foods. The source of fats you choose can make them either good for you or bad for you. The important thing is where they come from. Some healthy sources are: coconut oil-contains lauric acid a natural anti-inflammatory, consists of mainly medium chain triglycerdes, which absorb quickly and actually contribute to weight loss. Fish Oil-balances omega 3 and omega 6 ratios to decrease inflammation, lower cholesterol, improves cardiovascular health. Pastured fats-butter, grass fed beef, and pastured pork.

Proline and Glycine rich broths:
Proline and glycine are two amino acids responsible for the formation of collagen formation. These amino acids are also involved in the formation of the intestinal membrane. They are typically deficient in our diets as we don't consume a large amount of the types of tissues that are rich in these amino acids (cartilage, connective tissue, and epithelial tissues). In order to remedy this a great step you can take is making a glycine and proline rich broth from the large joint bones of cow and pigs. It's easy to throw a few in a crock pot and cook it slowly over several days. The benefits on your health after a few weeks of consumption will be obvious, including healthier skin, decreased joint pain, better digestion, improved mood (often), and healthier hair.

Bacterial Support:
Our food supply is overly hygienic. Pasteurized milk, antibiotics in our meat and dairy, and processed food all lead to a less robust bacterial presence in our colons. Our colony of bacteria (termed our microbiota) constitutes a lotal of over 10 times more cells than we have human cells in our bodies. It contributes immune regulation, assistance in breaking down and digesting different food items, as well as absorption of minerals and vitamins. In short, it's important. 
Ideal foods: Jerusalem artichokes, onions, garlic, green bananas, cultured foods (sauerkraut, kimchee).


The big picture here is summed up by a short phrase: "eat close to the ground".

The common trend here is the more steps your food takes before getting onto your plate the worse for you. As a result we have food-like substances that our grandmothers would never recognize as food. Processing, storage, transport, manufacturing, or unnatural cultivation methods all represent food that is further from the ground when you eat it, and typically less nutritious. Minimize steps between harvest and plate in order to reap maximum benefit from your food. 

Thanks for everyone who made it to our class. If you had questions that didn't get answered feel free to add those to the comment section below. 



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