Friday, 16 June 2017

Understanding Type Two Diabetes

Dr Jason Fung is a Canadian nephrologist, a specialist in kidney disease. I've written about him as an expert here. This issue concerns us all. Although we might not have yet developed type two diabetes, most of us are on track to do that. One in five of us will become diabetic, unless we take corrective action. The best time to take corrective action is 20 years before diabetes develops in your body. For many of us; too late for that. Act NOW, understand the issue, it's not too hard.

With regards to type two diabetes, Dr Fung says that if we have a disease where given the best treatment, patients continue tho decline and eventually die of the disease. Perhaps we should reconsider what we are doing. Maybe the "treatment is wrong." This is exactly the position Dr Tim Noakes takes too. Dr Noakes' father was diagnosed with type two diabetes, and treated in the same way most diabetes is still treated today, and died of complications caused by diabetes 18 years later.

Dr Noakes himself, having run marathons for much of his life, having eaten a high-energy high-carbohydrate diet, as recommended for athletes for 30 years, was also diagnosed with type two diabetes. This got Dr Noakes rethinking everything he thought he knew about healthy diets. Professional colleagues in the USA pointed him in the right direction. Noakes discovered a very-low-carbohydrate diet. He now has no symptoms of type two diabetes.

With his new knowledge, Dr Noakes became involved in a new initiative to improve the diet of South African's. They started a company called "The Real Meal Revolution" and produced a book of that name and an online training programme, both for people who wanted to learn how to eat better food, and for people who want to be nutritional consultants based on the principles of "The Real Meal Revolution." The success of this venture caused conflict between the traditional establishment which supported the Dietary Guidelines for South Africa, and the very outspoken and popular Dr Tim Noakes.

In the following video, Dr Jason Fung, explains that if there is excess glucose in the blood, taking medication to remove the glucose from the blood doesn't cure the problem it merely shifts the problem elsewhere. It's the same problem a city has in disposal of sewerage, we can put it into a river or into the sea, but it doesn't go away, and wherever we put it, a new problem is created. As ecologists tell us, "there is no such place as 'away'."

In this video Dr Fung is talking to the public, so his focus is on blood glucose management. It's simple; don't eat and your glucose levels will go down.

When talking to medical doctors Dr Fung doesn't talk about blood glucose control. For a medical practitioner, blood sugar control in the patient is the wrong target. The right target is to reduce, minimise and eliminate insulin resistance. Since a doctors time is limited, Dr Fung doesn't recommend a very-low-carbohydrate diet. (Training people to understand nutrition and to choose food wisely, simply takes up too much time.) Dr Fung recommends intermittent fasting.

Type two diabetes is not a chronic irreversible disease. You can cure yourself, but you need to understand the problem. First, all carbohydrates become sugar in the body. Diabetes is a problem of too much sugar in the body, so shifting it from the blood into glycogen stores, or into adipose tissue, isn't a solution. You must find a way to get it out of the body, or stop it from getting into the body. So your diet is critical.

Try to understand the issue. If you eat excessive carbohydrates for a long time, slowly your body becomes insulin resistant, and eventually you become fat and diabetic. That "disease" cannot be cured by taking medication. The only solution is to change your diet. Intermittent fasting, is a quick and dirty solution that works. A better solution is to understand nutrition and to improve your diet, but that takes time and effort. Until you've done that, perhaps you should fast, or use the "Take Out Diet" as I've recommended for two years.

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Thursday, 1 June 2017

Better Quality Food

In the previous post I wrote about the debate, as to which foods were truly nutrient dense. Perhaps we should also think about a second food group, foods that are anti-inflammatory. I think in meat and fish we can have both.

For a couple of years now we've been buying a lot of bacon in our household. We're slow learners. We tried to buy the cheapest bacon we could find. Streaky bacon is cheaper than middle bacon. And since we're not lipo-phobic (We don't fear saturated fats.) we're happy about buying that. From the Supermarket here in New Zealand we were paying $16.00 a kg.

About eight months ago I went to Euro Gourmet Meats, and purchased some aged middle bacon, $29.00 a kg. Seems expensive. (New Christchurch shop: Address: 2/303 Colombo St, Sydenham, Christchurch 8023) That was enlightening. Cooking supermarket bacon takes a long time, and white foam develops on top of the meat as it cooks. That's caused by the water and additives they pump into the bacon, coming out as the bacon cooks. The bacon pieces shrivel up to half their size. In contrast the Euro Gourmet Meats bacon produces no white foam, and cooks in half the time, and shrinks hardly at all.

Book Cover
Excellent descriptions of meat cuts and more than 77 recipes.
Beautiful photographs.

On their web site, Euro Gourmet Meats say; "We have top quality meat cut by experienced butchers. While our specialty is Cressy Farm pork we also have aged beef, prime lamb and hogget and some approved wild game. All our meat is free-range and we try our best to source direct from the farm."

I need to know more. So in the last few months we've been talking more to our local butcher. We've been buying kidneys and liver there, rather than from the supermarket. Once again there is a marked improvement in the quality of the product. (Peter Timbs Meats Ltd, in Bishopdale this time.)

So I went to Traiteur of Merivale (European butchery on the corner of Aikmans and Papanui Roads, Christchurch.) I couldn't find any prepacked bacon. But they sliced some for me. $26.00 a kg, but once again well worth the price. Beautiful bacon. We will shop there again.

The local butcher (Peter Timbs Meats Ltd) doesn't carry chicken on the counter. But he will order it for you. So Carolyn placed an order. She got two packs of chicken breasts, $10.00 each, enough for six meals for the two of us. Another success, that just required us to talk to the butcher.

Following up on that, I determined to learn more about quality meats. I purchased "Lidgate's The Meat Cookbook; Buy and cook meat for every occasion" from the Book Depository. I think I paid $21.00 for the hardback edition (Including delivery.). I see Amazon have even cheaper options, plus delivery.

Muscles for lunch - Three days.

I've mentioned previously in this blog my ignorance about buying whole fish. Yes I need to learn more about fish too. But that's another exercise.

In the meantime; whenever muscles are on special at the supermarket I buy a little more than 2 kg. I steam them for 6-7 minutes half a kg at a time. (About 12 muscles) I use a liquid 50% the salted water from the steam pot, and 50% cider vinegar to cover them. Any extra salty water makes a delicious drink hot or cold. Or add it to a soup or gravy.

A quick easy lunch is two or three muscles and a lump of cheese. You can eat it on the run. You can drink the water the muscles were kept in too. With saturated coffee; 17g carbs, 74g protein and 114g fat.

Another tiny lunch, of a similar type is to eat canned sardines. Zoe Harcombe gives sardines a special place as a "superfood" if such a thing exists. Sardines (half a can) and cheese make an excellent quick lunch. With saturated coffee; 7g carbs, 73g protein and 124g fat.

Once a week at least we buy filleted fish. Usually from the supermarket. I note though that Theo's in Riccarton, appears to be an excellent fishmonger. Given what we've been learning about meat, maybe we should go there more often.

Ten Years of Nutritional Guidance

Dr Marion Nestle has been writing a blog on food for 10 years. Over 3000 posts. A remarkable effort. Dr Nestle, is a professor of nutrition. She believes that a calorie is a calorie, and that eating less is good, and that minimising sugar and eating more plants is always the right choice. She's against carbohydrate restricting.

On the other hand, she says that eating a Paleo Diet could be healthy, but she sees no need to restrict dairy foods. Her comments on low-carbohydrate high-fat diets are dismissive. "Why would anyone want to give up those delicious carbohydrate foods," she asks?

While she would not agree with Dr Tim Noakes, or Dr Eric Westman, about the best way to control obesity, the position she does take is always moderate and sensible. Here she writes about why she's kept writing for 10 years.

Please feel free to talk about your own buying experience in the comments below.

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Saturday, 27 May 2017

Nutrient Dense Foods: Nutritious Foods

Open Future Health Blog

The standard American diet, by default has become the standard diet of the world. The standard American diet is said to be energy-rich, meaning full of calories, and nutrient-poor, meaning lacking essential amino-acids, vitamins and minerals, and being deficient in omega-3 fatty acids. The first official recognition of this fact was in the 2005 Dietary Guidelines for Americans, which recommended that people seek to eat nutrient-dense foods. But exactly what those foods were was not defined.

In the Banting world, there is a very clear concept of what nutritious foods are. More on that later.

When I search online for guidance, I discover wildly different ideas of what nutrient-dense means, and which foods should be included is not well defined. Most of those expressing an opinion are keen the EXCLUDE some foods. Most obvious are the "authorities" that exclude all meat, and those that exclude red meats. Some are clear that all dairy foods are inflammatory in the diet of adult humans. More recently, by promoting a "healthy gut" the idea of being gluten free, has been expanded to being wheat free, and then grain free.

Banting Foods

This takes me back to the McGovern Senate Committee and the debates they had in 1977. Many Senators had been influenced by Nathan Pritikin or Dean Ornish and were keen on promoting a vegetarian diet. McGovern sought help from science, but the science was confused, and unreliable. Eventually market pressures prevailed. The committee supported the American farmer. Whatever the American farmer produced must be good. So we have for the first time strong promotion of wheat and corn, crops in surplus. The suggestion that red meat should be excluded from the diet was dropped, in favour of the cattlemen.

In a paper called, "Concept of a nutritious food; toward a nutrient density score" (American Society for Clinical Nutrition, 2005) Dr Adam Drewnowski, finds there is no agreement. In the literature, this point had already been argued for 30 years. Many dietitians adopt the view that there are no good or bad foods, only bad diets. This supports the idea that "a little bit of everything" is likely to be good.

If you look at food marketing, foods that are sugar free, or fat free, and sometimes salt free, are described as "healthy" and given ticks or stars of approval, by the heart association or the diabetes association, when there is zero science backing that assessment. Those ticks and stars are recognition of the payment of money from industry to the association, and acknowledge that some sort of "partnership" agreement exists. It's a financial transaction, with marketing objectives.

It's agreed that people shouldn't need a calculator to decide what to eat. That means, that without a good rule for choosing nutrient-dense foods, what's "good" is a matter of personal opinion.

Banting Food Pyramid

Energy dense foods are easier. Dried fruits and sugar by any of it's 40+ names and potato crisps and whole grains and cereals, are all energy dense. In terms of cost per calorie, the calories supplied by sugar and grains are very cheap indeed. When any government or the United Nations, or a relief agency is purchasing food for a refugee camp, or for poverty stricken tribal peoples on a "reservation" this is what they buy. 2200 calories a day per person, 70% carbohydrate (energy dense foods), 20% protein (very little meat or fish, beans and lentils are cheapest), and 10% oils (Vegetable oils are cheapest.) The effect of this sort of diet over the long term is well understood.

In our own society, people with inadequate income, who buy the cheapest possible food, looking for "bulky foods," something to "fill then up" are likely to buy a lot of bread, potatoes, rice and pasta. They eat something very close to the diet supplied to refugees, but without the 2200 calorie limit. The health effects are the same and worse, malnourished children and obese adults. Excess calories, but undernourished. Over-fed and starving at the same time.

So there's a clue. The most nutrient-dense diet is likely to be exactly the opposite of that.

In 1979, R.G. Hansen et al. was developing a "Nutrition Quality Index of Food." He writes that apart from thiamin, in terms of nutrients "bread, cereals and whole grains are not particularly notable." However, in terms of calories, protein, calcium and iron, this food is cheap. This stands in contrast to the often stated opinion that whole grains are nutrient-packed. This confusion indicates that even today, the science is unreliable and marketing is influencing the messages reaching the public. In trying to develop a "Traffic Light" system for classifying the foods families would buy, H.A. Raynor et al. (2002) wrote that "attempts to classify foods appear arbitrary, tautologous and imprecise."

Here's a clue. In Sweden in 2002, Michels and Wolk, made a set of rules or standards which "healthy foods" would need to meet. They then tested 60 common Swedish foods. The criteria eliminated all foods except rye crisp bread, salmon, herring and some other fish, lettuce, cucumber and tomatoes. That's not very practical. So what is nutritious food? The researchers shared the viewpoint of Supreme Court justice, Potter Stewart, who said; "I know it when I see it." So is that a clue?

When people have more income, what do they eat? That's well researched, they eat more red meat, poultry, and fish. They eat more dairy foods, butter, cheese and eggs. They have more fruit and vegetables and they eat less bread and cereals.

Can we conclude then that without a calculator, and without scientific advice, people do know which foods are nutrient-dense, and if they can afford those foods, they will buy them. However, people do not understand, and don't count as a cost, the future health consequences of buying foods that lack essential nutrients.

Adam Drewnowski, goes on at length trying to identify "Naturally Nutrient Rich" foods. He seems to conclude that meats and dairy foods have the highest nutrient-density. But vegetables supply vitamin C in bioavailable forms. Foods high in vitamin E and B12 are relatively few. The search for low cost food is the root cause of the high-energy low-nutrient problem in the American diet. Fewer than 15% of Americans are eating a diet that supplies adequate amounts of the nutrients recommended.

So now we come back to the Banting Diet. Banting recognises the nutriment value of meat, and the fat on the meat. But also the special value of offal meats, like liver, kidneys and brains, that we've been avoiding, but are full of nutrients and are relatively cheap. Banting also recommends buying bones and making bone broth based soups. Or buy fish-heads and carcasses and make fish soup.

Dr Zoe Harcombe, is very vocal about the poor quality of much of the "healthy food" we eat. The nutriment value of vegetables and grain is a fraction of the nutriment value of chicken liver, sardines and eggs. People avoid offal meats, perhaps identifying them as strong flavoured. That's right, but that's also the benefit. Low cost to buy, and full of dense nutritional value.

Taking up Ted Naiman's point, if you FEED yourself with quality food, you eat less bulky foods, you can use a smaller plate, and you'll eat less often. If the result of that is loss of weight, and better health, we suspect the benefit of a nutrient-dense diet in reduced future health costs will be considerable. How much is an additional year of healthy life worth? Several doctors dealing with older adults tell us that the dividend of a healthy lifestyle and diet is something like ten years of healthy lifespan.

If you eat a poor diet today; the last ten years of your life are likely to be difficult. Getting about will be problematic, and you'll have many aches and pains, if not more serious problems. The solution is to look for foods that are nutrient dense. FEED yourself.

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Wednesday, 24 May 2017

Changing Dietary Understanding. Dr Ted Naiman

Given what he's now doing and saying, it's useful to look at Dr Naiman's background. (Pronounced Neighman) He trained first as an engineer, hopeful of joining Boeing on graduation. History, got in the way, in 1993 Boeing was putting engineers off. Naiman needed a plan B. So he entered the Loma Linda University Medical School, a place steeped in vegetarian traditions.

[From Wikipedia:]Loma Linda University (LLU) is a Seventh-day Adventist coeducational health sciences university located in Loma Linda, California, United States. The University comprises eight schools and the Faculty of Graduate Studies.

Today, a community of about 9,000 Adventists in the Loma Linda area are the core of America's Blue Zone. They live as much as a decade longer than the rest of us, and they believe much of their longevity can be attributed to vegetarianism and regular exercise. Plus, Adventists don't smoke or drink alcohol.

Loma Linda was chosen as an American Blue Zone by Dan Buettner for his book, "Blue Zones: Lessons For Living Longer From The People Who've Lived The Longest."

Life as a vegetarian,

Ted Naiman at 28 and again at 43

Naiman was raised as a vegetarian, in Colorado. He was delighted to attend Loma Linda University, and he was very strict about eating in a vegetarian way. Beans and soy were a significant part of his diet. He thought he was "healthy."

On reflection he now understands that he wasn't healthy at all. His body structure was weak. He was always hungry. He felt tired all the time. His skin condition was poor. His athletic ability was weak.

"In my medical education, there was no focus on diet. As far as I could tell, I was eating a "text book" healthy diet. Lots of vegetables and whole grain foods. Almost zero saturated fat, and hardly ever any animal products. In medical school we were taught to look at families, where you could often see a pattern of good health or poor health. We were taught that this was the effect of genetics in the family. Most of the medical problems we would meet as doctors were natural, the effect of aging and genetics."

Having graduated in 1997, he worked for the next three years as a junior doctor, under supervision, in a hospital. During that time, a patient who he had previously seen, suddenly lost weight and reversed his diabetes symptoms. Naiman had never seen that before, so he asked how that happened. He was told about the Atkins diet. Naiman discussed this with his supervisor. He was told that he must never recommend the Atkins Diet to anyone. The patients "success" was dismissed, with the view that on an Atkins Diet, in a few years he will be dead. High cholesterol was the problem, in his supervisors opinion.

"So as medical students we were told to accept that because of their poor genetic make-up, and their failure to exercise, most patients would get fatter and sicker, and there was nothing that we could do about that."

Over the next two years Naiman studied nutrition for a research paper he was expected to write at the end of his residency. He discovered that there was a lot of prior literature that supported the Atkins Diet, and that his own personal experiments seemed to have gone well. In 2000, Michael and Mary Eades published their book "Protein Power" which confirmed the dietary direction his own work was already taking.

Dr. Ted Naiman on Blood Tests, Diabetes, Obesity, Carbohydrate and more #LCHF. (Video 40 Minutes.)

Working as a doctor.

"For a long time I tried to apply what I was learning in my own life. In the Medical Center where I worked there as a strong view that low-carbohydrate high-fat diets were dangerous. So while his my confidence grew, I seldom shared this knowledge with patients. For a long time I flew under the radar."

Today he's very open about what he's recommending, and he's got hundreds of patients with successful results, using the LCHF approach. Still at the Virginia Mason Medical Center, where he works, many doctors remain strongly opposed to his interventions.

"In my daily work I like to deal with people who have obesity problems, or type two diabetes, because I know I can help them. But I also deal a lot with people who have addiction problems, alcohol, meth, heroin, cocaine. It's interesting. If people who are addicted, can feed themselves in the same way I ask people who are obese to eat, if they can eat nutrient dense foods, their addiction is much easier to deal with.

Insulin Resistance

The plague in our society is undiagnosed, even unsuspected insulin resistance. You can't get fat, or get type two diabetes without it. There is a simple test anyone can do, you only need a tape measure. Measure your height, and waist. (cm or inches) Divide your waist by your height, and the result should be a number less than 0.50. This measure is quite sensitive, at 0.53, you are already overweight. At 5.55 you need to seriously consider corrective action. At 5.60 your doctor has been telling you for a long time that you are too heavy. There is serious risk for future CVD, stroke and diabetes. Even at 0.51, probably when you were 30, insulin resistance is already developing, and it builds and builds over the years. If weight is an issue for you, insulin resistance is the topic you need to discuss with your doctor.

Measuring your weight or calculating your BMI, are less reliable measures of your health.

70% of all deaths today, are from chronic diseases, many of which were virtually unknown 100 years ago. These are modern lifestyle diseases all caused in the first instance by our poor nutrition, and secondly by our failure to exercise. It's easy to do something about that. Some of us will. Target insulin resistance, not blood sugar. Refer to Dr Jason Fung for that detail.

Mitochondria for Fat Oxidation

People don't understand where the energy of the body comes from. All of your cells have mitochondria that are continually converting glucose, fatty acids or ketones into ATP, the energy your cells use. (Krebs Cycle) You have less than 6 seconds supply of ATP in your body at any time, so this production process is continuous and under strict control.

Mitochondria are energy conversion units.
They are inside every cell in your body.

If you exercise your cells produce more mitochondria to help with the process. The most effective exercise for that is easy to do and it's very quick. Exercise the muscle to failure with a suitable weight and a very slow continuous movement. It should take between 60 seconds and 90 seconds to reach failure (inability to continue) if the weight is right. Then don't do that again for 7 days, allow the muscle to recover fully. (See "Body by Science" by Dr Doug McGuff.)

There are five exercises to do. You don't need to change your clothes or even break a sweat. You don't need any equipment except a bar to hang from or pull-up on.

The five exercises: Horizontal push (moving the door frame, or the car), and horizontal pull (rowing).
Vertical pull (pull-up on a bar) and vertical push (push-ups).
Finally a squat either a stationary squat with your hands pressing up against a table, or a moving squat with your hands holding weights.

FEED Yourself

People eat too much because they are malnourished. Your body has a requirement for certain fatty acids and amino acids that it can't make itself. If those are not already in your food, you body will drive you to eat more. If you eat the same old wrong foods, that doesn't help. You MUST eat foods that contain those essential acids. We don't lack calories, most of us eat far too many calories, but we eat empty calories, without the essential nutriments.

So the first step to good health is to FEED yourself. Eat good quality food. Start the day with four to six eggs and a little bacon on the side. You may not need to eat again for six hours. Eggs are an ideal food, but so are fatty meats. Gram for gram both are about 50% protein and 50% fat. In calories that makes the breakfast 70% fat and 30% protein. By all means add tomatoes, mushrooms or spinach or kale for variety.

"Plan your day around the main sources of protein you will eat. Two meals a day, with something small or maybe nothing for lunch. Focus on nutrient dense foods and you'll never feel hungry because you've met your bodies need for essential fatty acids and amino acids."

As I planned to write this blog, yesterday, I looked up "nutrient dense foods" and I uncovered the old philosophical arguments that plague nutrition. There is some science, but mostly it's prejudice, pretending to be science. I will write about that next time.

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Thursday, 11 May 2017

Inflammation and Exercise Revisited

I wrote about inflammation on Saturday, 8 April 2017 and Tuesday, 18 April 2017. I was telling the story that my very-low carbohydrate diet had reduced my inflammation if negligible levels and everything was under control.

Chronic Vascular Inflammation is caused by high Insulin levels in the blood.
Click Image to enlarge

You should never say things like that. It's the fruit season. There are free apples and pears and quinces. I've always enjoyed eating fruit. I wrote on the 8 April that excess fruit in the diet was probably the main cause of the chronic rash I developed in late summer 2014.

Early this month, I'm scratching at the varicose veins on my ankle. Then I had an itchy back in the shower and I used the back brush to give it a friendly rub. Why is my skin becoming itchy? It's inflammation in my body.

This didn't get serious, I acted on the warning sign. I've stopped eating fruit, and mostly the problem has gone. Not fully solved, but the inflammation is receding. Truth be known I'm also eating more than the 50g of carbohydrates I allow myself each day.

For me, not being diabetic, I can be a bit loose with my practice and I suffer very little. Insulin works, and now I might even be insulin sensitive again. So my weight is perfectly stable, at 75kg. My objective in maintaining ketosis is to minimise chronic inflammation. So; how do you do that?

If you read about reducing inflammation in the body you get conflicting information. Vegetarians are sure that the secret is to remove the meat from your diet. Vegan's go further and remove all dairy foods. I have no expertise here. I do have my own experience. There's lot of evidence that vegan and vegetarian diets are not healthy.

Suggested Anti-inflammatory Foods

We're not worried about the short term inflammation caused by exercise, or in response to infections or accidents. It's long term vascular inflammation that concerns us. If you suffer from any problem that's called xxxxitis, like arthritis, that is also caused by inflammation, and an anti-inflammation strategy should help you.

Reducing Chronic Vascular Inflammation

Let's deal with meat first. Meat in the diet does cause some inflammation, but it also has it's own anti-inflammatory properties. Net result zero, with the advantage high density nutrition.

The most damaging high-inflammation foods are omega-6 vegetable oils. That's why you should stop eating margarine and butter substitutes, and look carefully at the ingredients in sauces and dressings. Some people believe that whole grains also cause inflammation. Gluten intolerance is one example. Many people report that although they are not made sick eating gluten, they seem better if they avoid it. So perhaps many of us are a bit gluten sensitive.

A similar story exists for dairy foods. It's not normal for most species to use milk as a food after weaning. Thousands of years ago, during famine, humans who were able to use lactose in their diet had a survival advantage. That's still in our genes. Most of us are lactose tolerant and we can eat dairy food without problems. I get a bit of a runny nose when drinking milk, but nothing else. There are great nutritional advantages if dairy foods are used, but some people can't, and they will know about that.

Evidence from the Harvard Study of Adult Development

George Vaillant reports that as the men in the W.T. Grant study reached their 80's study staff anticipated that dementia would be a serious problem. That wasn't the case. Most of the men developed vascular problems which became important health concerns.

"Of 189 "healthy men" at age forty, 103 had no risk factors, and 86 had one or more." Those 86 were already well on the way to worse outcomes. Poor health is created over many years, by the life choices you make.

Of the 86, "healthy men" who were less healthy at forty, 65 were either dead or chronically ill at eighty (76%).

Dr Ted Niaman
Vegetarian Diet in his 20's
Very-Low Carbohydrate Diet at 43

In contrast, of the 103 healthy men with no risk factors, at eighty, only 45 were dead or disabled. (45%) That's much better. Refer to the Dunedin Study where the biological age of people at 38 years of age was evaluated.

It's important to note what Vaillant was measuring regarding vascular risk factors. He lists smoking (significant), alcohol abuse (very significant), high diastolic blood pressure (very significant), obesity (very significant), type II diabetes (very significant).

Vaillant says; "The main causes of early death (before eighty) are vascular factors over which we have considerable control." Good health self-care before the age of fifty is something you can do. Stop smoking, avoid excessive alcohol or drug use, watch your weight, and control your blood pressure. If you just do that, your chances of being healthy at eighty are very good, according to Vaillant.

Factors that were insignificant in leading a long life may surprise you. They include; cholesterol level, exercise, parental social class, and psychological defence's. Getting a university degree was a very significant advantage in extending one's life (adding about 4yrs). The longevity of one's parents is irrelevant for most of us. However, for the extreme groups, the top 16% and the bottom 16% of ancestral longevity, there is a significant statistical advantage or disadvantage once you are over eighty. Late in life good genes might be an advantage.

To Exercise of Not to Exercise

Walking Daily is Life Saving

There is a strong association between exercise and good physical health. Association does not imply cause. "Some things are horses and some things are carts," says George Vaillant. We might be wrong to assume that exercise is a horse.

In the Grant study, earlier good health was a good predictor of exercise at every older age. Good health at 55, was a good predictor of exercise at 60, and again at 80.

In contrast, those who were exercising at 60, correlated less well with both good health at 80 and exercise at 80. A habit of exercise throughout one's life, is helpful, but it's only significant, it's not a strong driver. In contrast, at every age good health predicts future exercise.

Before 1960, most people led quite active lives both at work and in personal activity. They didn't need to go to the gym. Doctors have been quite conservative in recommending exercise. They know that people can exercise and also be very unhealthy. But the reverse is never true, many people who are very healthy do not exercise. If Vaillant is right, these are the people who are likely to take up exercise in future.

The American NFL, give evidence of that. Players who are big people have and advantage if they are also fit. Too many successful NFL players, on retirement become very obese and die early, some before the age of 50. They were fit but not healthy.

There is value in exercise. Exercise, helps the body maintain homeostasis. Those who spend little time sitting each day have lower c-reactive protein markers. Exercise does do micro-cellular damage that causes inflammation. That mobilizes macrophage's to clean up the damaged tissues, and red blood cells, white blood cells, stem cells and platelets then repair the damage. The muscle gets bigger and stronger. Exercise also produces protective substances called cytokines like interleukin-6 which is anti-inflammatory when produced by muscle tissues.

Englishman, Prof. Jeremy Morris, studied bus drivers v ticket collectors, and postal workers comparing the postmen v office staff. His research demonstrated the exercise was protective against CVD. Morris said, "Exercise is the best buy in public health." He took up exercise himself, swimming, cycling and walking. He died at 99.

Prof. Ralph Paffenbarger in the USA, studied college alumni, and San Francisco Longshoremen. He came to the same conclusion, exercise had a powerful protective effect for one's health. At 45 Paffenbarger began to run marathons, he stopped running at 71. Five 100 mile runs and 151 marathons to his credit. He died at 84.

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Sunday, 7 May 2017

Leading a Happy, Healthy Life

The Harvard Study of Adult Development has run for over 78 years. It began in 1938 as the W.T.Grant Study. Independently the Glueck study began the following year.

The W.T.Grant study of 268 elite men from Harvard, was intended to confirm the best ways of selecting managers for business or officers for the military. Both business and the military chose senior staff based on many desirable characteristics. In the course of fifty years the study proved that NONE of those characteristics have any predictive value. The list desirable characteristics in new leaders, still used today in most situations, are misleading. We usually choose the wrong people.

The Glueck Study, was of 456 young men from inner city Boston, men from the wrong side of the tracks mostly.

These two studies have become the Harvard Study of Adult Development — a study that has tracked the lives of 724 men, and is one of the longest studies of adult life ever done. Investigators surveyed the group every two years about their physical and mental health, their professional lives, their friendships, their marriages — and also subjected them to periodic in-person interviews, medical exams, blood tests and brain scans.

Eighty years ago people believed that once one became "adult" that development ceased. That's not so, we continue to develop and grow throughout out lives. The previous director of the Harvard Study of Adult Development, was Dr George Vaillant. His most recent book is "Triumphs of Experience." Vaillant tells us that when he was 30, he became the director of the study. The men were 55-56 and Vaillant assumed that these men were already at the peak of their careers, and that their lives were already beginning to wind down. He admits that the next 30 years were to prove that he knew very little.

The present director of the study, is psychiatrist Robert J. Waldinger, he shared some of the major lessons in a popular TED Talk (What makes a good life? Lessons from the longest study on happiness). He says, "the government has invested millions of dollars in the research, but few people know anything about it."

The big takeaways from that talk: Good relationships keep us happier and healthier, and loneliness kills.

1. A happy childhood has very, very long-lasting effects.

Having warm relationships with parents in childhood was a good predictor that you'll have warmer and more secure relationships with those closest to you when you're an adult. Happy childhoods had the power to extend across decades to predict more secure relationships that people had with their spouses in their 80s, as well as better physical health in adulthood all the way into old age.

It took fifty years to show that the only predictive characteristic of effective leaders is very simple. As a child, did he have a strong loving relationship with his mother? It took even longer to expose the abuse of alcohol as the leading cause of divorces and professional or business failures.

And it's not just parental bonds that matter: Having a close relationship with at least one sibling in childhood predicted which people were less likely to become depressed by age 50.

2. But … people with difficult childhoods can make up for them in midlife.

People who grow up in challenging environments — with chaotic families or economic uncertainty, for instance — grew old less happily than those who had more fortunate childhoods. But by the time people reached middle age (defined as ages 50–65), those who engaged in what psychologists call "generativity," or an interest in establishing and guiding the next generation, were happier and better adjusted than those who didn't.

An unhappy childhood is a big barrier. But it's possible by choosing the right life partner, and by learning to love through your children, to heal the wounds of the past.

3. Learning how to cope well with stress has a lifelong payoff.

We all develop personal ways of managing stress and relieving anxiety, and Waldinger and his team have found that some ways can have greater long-term benefits than others. Forty years ago George Vaillant, began an assessment of the psychological defence's that the men adopted. (Thirty years into the study, it was clear that, exam results, physical fitness, popularity, or more than 50 other measures of leadership had no value in selecting leaders.) Vaillant was confident that psychology would provide the answer, and that men who had more "mature defensive strategies" would prove to be the best leaders.

To be very brief: those who a habit of using "mature defenses" like sublimation (example: you feel unfairly treated by your employer, so you start an organization that helps protect workers rights), altruism (you struggle with addiction and help stay sober by being a sponsor for other addicts), and suppression (you're worried about job cuts at your company but put those worries out of mind until you can do something to plan for the future). These superior behaviours create a cascade of beneficial effects: It made them easier for others to be with, which made people want to help them and led to more social support, and that, in turn, predicted healthier aging in their 60s and 70s. (But to Vaillant's disappointment this promising approach also failed to predict the best future leaders.)

Everyone uses "mature defenses" on our good days. But most days we tend to use less elegant ways of coping with life. Vaillant calls these "neurotic defenses." (Neurotic is not used meaning madness, in this context neurotic is NORMAL.) He means it's normal to worry, and it's normal to be uncertain, and it's normal to change your mind frequently. So we make excuses, we work too hard, and we blame others, and we judge ourselves by one standard an others by a different standard. We know things are not perfect, but we find ways to get by, and do our best to hold our end up.

Maladaptive coping strategies include denial, acting out, excessive drug use, psychosis, or projection. Vaillant calls those strategies "immature defenses." Everyone used to use immature defenses while growing up. When a teenager does it, it annoys parents, and teachers and perhaps the community. The defence is "perfect" for the young person, the behaviors put all the "blame" elsewhere, it's not "me" that's causing a problem. So drug abuse, sexual misconduct, dishonesty, lying, anger outbursts, in a young person's life are disruptive, but we get by. If a 30 year old is behaving in the same way, that's a different story.

4. Time with others protects us from the bruises of life's ups and downs.

Waldinger has said "it's the quality of your relationships that matters" is one significant take away from the study. Looking back on their lives, people most often reported their time spent with others as most meaningful, and the part of their lives of which they were the proudest. Spending time with other people made study subjects happier on a day-to-day basis, and in particular, time with a partner or spouse seemed to buffer them against the mood dips that come with aging's physical pains and illnesses.

In Triumphs of Experience, George Vaillant explains how most people in their 70's and 80's are very happy in their marriages. Especially those who were able in their 50's and 60's to grow significantly in their ability to nurture younger people into leadership roles, were best equipped to develop new interests and activities that kept them engaged in interesting activities and involved with other people, late in life.

5. The Future of this Study?

Waldinger freely acknowledges how skewed their research group is — "it's the most politically incorrect sample you could possibly have; it's all white men!" (In fact, the group originally included John F. Kennedy.) With "only a handful" of the original subjects left to study, the Harvard team is now moving on to the men's 1,300 children who've agreed to participate (a group that's 51 percent female). But he's painfully aware that the proposed cuts to the National Institutes of Health could end even their long-running study. "Our kind of research might be one of the first projects to go. Our work is not urgent; it's not the cure for cancer or Alzheimer's," he says. "But we have a way of understanding human life that you can't get anywhere else and it lays the foundation for important, actionable things."

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Australian Video about Sugar in the Diet

Sugar in the Diet

Dr Maryanne Demasi investigates the bitter truth about the dangers of a sweet diet. This is an old video, it is saying things that must have been controversial at the time. For most people this is still new understanding.

In only a few decades, there are now more obese people on the planet than there are undernourished. When it comes to getting fat, we've been TOLD, and most of us BELIEVE, it's as simple as 'calories in' versus 'calories out.' If you want to shed the kilos, you need to burn more calories than you consume. Most people think that means eat less of exercise more. These beliefs are just indoctrination; there's no science behind it, even if the person proclaiming that belief is a scientist, or dietitian, or a medical doctor.

The Problem with Sugar and other Carbohydrates

Not all calories are the same. Some people absorb calories more efficiently and it matters what types of foods your calories are coming from. Sugar is the dietary villain that's making us fat and sick, as UK physiologist and nutritionist, Dr John Yudkin tried to tell us more than 50 years ago.

[From Wikipedia] From his book "Pure, White and Deadly" (1972). The last paragraph of Chapter 1 begins "I hope that when you have read this book I shall have convinced you that sugar is really dangerous."

That message was extremely unwelcome to the sugar industry and manufacturers of processed foods. These firms employed a number of methods to impede Yudkin's work. The final Chapter of Pure, White and Deadly lists several examples of attempts to interfere with the funding of his research and to prevent its publication. It also refers to the rancorous language and personal smears that Ancel Keys — the American epidemiologist who had proposed that saturated fat was the primary cause of heart disease — employed to dismiss the evidence that sugar was the true culprit. Keys wrote, for example:
"It is clear that Yudkin has no theoretical basis or experimental evidence to support his claim for a major influence of dietary sucrose in the etiology of CHD; his claim that men who have CHD are excessive sugar eaters is nowhere confirmed but is disproved by many studies superior in methodology and/or magnitude to his own; and his "evidence" from population statistics and time trends will not bear up under the most elementary critical examination."

The efforts of the food industry to discredit the case against sugar were largely successful, and by the time of Yudkin's death in 1995 his warnings were, for the most part, no longer being taken seriously.

Many Names for Sugar

Insulin Metabolism Pathway
Agave nectar Evaporated cane juice Malt syrup
Brown sugar Maple syrup Honey
Cane crystals Fruit juice concentrates Molasses
Cane sugar Glucose Raw sugar
Dextrose Maltose Sucrose
Alcohol Metabolism Pathway
Fructose Crystalline fructose Invert sugar
Corn sweetener High-fructose corn syrup Corn syrup

Honey is not a more healthy form of sugar. Most sugars once in the body are processed in one way, they are converted into glucose, and used as energy with any surplus converted to adipose white fat deposits. All these sugars use insulin to enable their transport into body cells, or conversion into fatty acids.

Fructose and alcohol sugars often used a sugar substitutes, are metabolized almost completely in the liver in humans. This process avoids the insulin pathway. Fructose is directed toward direct replenishment of liver glycogen and to triglyceride synthesis. The products of fructose metabolism are liver glycogen and de novo lipogenesis of fatty acids (Fatty liver deposits).

Not Just Sugar

Breakfast - Delicious
The problem is bigger than sugar in the diet. All of the vegetable based foods we eat have a little carbohydrate in them. Grains are especially high in energy and despite all you've been told, relatively low in nutrition value. Grains are low cost, sources of calories. If you want to buy calories rather than nutrition grains are clearly the obvious best source.

Grain based foods are profitable. Take corn, the cheapest food on the planet, convert it into crunchy flakes, add some sugar and sell it for ten times what it costs to produce. There are hundreds of versions of that model, sold as bread, muffins, buns, biscuits, cakes, pasta, pastries, the sort of thing most people eat all the time. So much so that people can't imagine living without ANY of those foods.

For 30 years I ate a non-cooked breakfast. Muesli (sometimes with honey), low-fat yoghurt and fruit, with added low-fat milk. Occasionally supplemented by toast, margarine and peanut butter. This breakfast has a Heart Foundation good health "tick." Sadly, it's not healthy.

Visceral fat causes organ malfunction

Today, none of that content is part of my breakfast. My aim at breakfast is not to stimulate the production of insulin. Instead I want to effectively continue my overnight fast, and also to eat well. The basis of breakfast is fatty meat and eggs. Vegetables are a desirable addition, avocado, tomatoes, mushrooms, kale, silver beet, or even lettuce. Offal meats or seafoods are a welcome addition.

If I eat any food at all with higher carbohydrate content, during the day, it's likely to be at dinner, in the evening. The only problem I have is at business meetings, morning or afternoon teas. Typically no real food is ever provided. Sometimes you can't even get real butter. This is disgraceful, but that's what's easy to do, and it's become what people expect. Obesity isn't in the person, it's in our whole society, in the way we all think. In what we all accept as "normal."

So we get fat, by making wrong dietary choices, sometimes because we seem to have no option. The most damaging fatness is invisible. Visceral fat; that is the fat created by your liver that collects inside and around your internal organs. As this fat builds up your organs find it more and more difficult to be efficient. Fatty liver has no symptoms until it gets quite serious, but that's 20 years after the problem began. We don't know how many people at age 50 have nor-alcoholic fatty liver disease, because we never test for it, but maybe almost everyone. Dr Tim Noakes tells us that it's probably the most under-diagnosed problem in medicine.

On the basis of current statistics, young people today will live shorter lives than their parents. They are fat 20 years earlier than their parents, and huge numbers are diabetic. This is entirely unnecessary. But to make effective change, our whole society has to develop quite different ideas about what a healthy diet looks like.

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Tuesday, 18 April 2017

Beyond weight Loss - Inflammation

I thank Dr Stephen Phinney for the key information in this post.

Dr Stephen Phinney

Background on Inflammation

In the past GP's have been trained to think only of acute inflammation: redness, pain and heat; signs of distress in the body, and the effort the body is making to repair cellular damage. So they were taught to treat the symptoms of inflammation; for instance putting ice on a sprain, and football players taking to cold pools after the match. It turns out that both these practices delay healing, which is the purpose of inflammation. Even with something this basic, our understanding of how to treat traumatic injury, or fever has been wrong for a long time.

The presence of low-grade chronic inflammation in the body wasn't recognised in science before 1992. Dr W.D. Kannel of Harvard, reviewing data from the Framingham Heart Study, noted that high cholesterol only identified about 50% of those who had heart attacks. Looking for another risk factor he noted that an elevated white blood cell count, but still within the normal range, was apparently a good marker of heart disease risk. Why that might be so, was not understood.

The Women's Health Initiative, the study terminated in 1998, produced the data that confirmed Kannel's observation. Type two diabetes, is characterised by system-wide inflammation. The population of the study was divided into quartile's on the basis if type two diabetes risk. Then the inflammation data for each group was evaluated. There were two measurements of inflammation, C-Reactive Protein, and Interleukin-6.

Comparing the mean inflammation of the lowest risk quartile with the highest risk quartile, they found this result. C-Reactive Protein was 15.7 times higher, and Interleukin-6 was 7.5 times higher in the high risk quartile.

In 2005 Karen Margolis reported from the WHI data, that "The white blood cell count, is a stable, well-standardized, widely available and inexpensive measure of systemic inflammation, and is an independent predictor of CVD events and all-cause mortality in postmenopausal women."

In 2007 Margolis reported that "Postmenopausal women with higher WBC counts have a higher risk of incident invasive breast, colorectal, endometrial, and lung cancer, as well as a higher risk of breast, lung, and overall cancer mortality."

Measuring Inflammation in the Body

There are many possible measures of low grade inflammation, at least 20.

The must commonly used are the following six
Total white blood cell count
Absolute granulocyte count
C-reactive protein
Serum amyloid A

Dr Phinney says; "The only tool in my list of medications for reducing inflammation, is one of the newer statins. The best solution for this problem is to find ways to reduce or avoid the creation of inflammation in the first place."

Fighting Inflammation with Nutrition

The following foods reduce inflammation: Fruits and vegetables, especially the colourful ones with flavanoids. Omega 3 oils, like fish oil. Moderate use of alcohol. If you want an anti-inflammatory supplement use gamma-topopherol

The following foods are inflammatory. Omega-6 fats are essential, but our diet is flooded with them, and in excess they are highly inflammatory. Iron in excess too, and Dr Phinney thinks Iron is over prescribed, when the real problem is carbohydrate intolerance. Trans-fats, are highly inflammatory, but in NZ there is no requirement to label products containing trans-fats, and no ban on their use (The argument is made that they are rarely used in NZ food products). Sugar, but particularly fructose is inflammatory. Alpha-topopherol is sold as an anti-inflammatory, but in the body it blocks gamma-topopherol, the bodies natural inflammatory defence, defeating our objective.

So Phinney recommends eating fish three times a week, using gamma-topopherol (Sometimes sold as Gamma-E), drinking wine in moderation, eating lots of fat or olive oil, and eating a very low carbohydrate diet.

Evidence Supporting LCHF Diets to Reduce Inflammation

Cassandra Forscythe
Cassandra Forsythe, Women's Fitness
Cassandra Forsythe, in research for her PhD, looked at low-fat v low-carbohydrate diets, and the inflammation they produced. Cassandra was working with Dr Jeff Volek in the Department of Kineseology at the University of Connecticut. Both Stephen Phinney and Richard Feinman were part of her advisory team.

Inflammation is clearly recognised as a prominent feature of many chronic common medical problems. Heavy intake of carbohydrate at any meal, induces an increase in reactive oxygen species, and activates pro-inflammatory pathways.

Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation:
Forty overweight men and women were enrolled. Qualifications; aged 18 to 55; BMI >25; total triglyceride's elevated; and low HDL-C. People using glucose lowering, blood pressure lowering, or lipid lowering medications were excluded. Two groups were formed balanced for gender, age and BMI. One group was assigned a low-fat diet. The other group a very-low-carbohydrate ketogenic diet.

The study was for 12 weeks. No advice to reduce calories was offered to either group. All participants were given individual counseling and a personalised diet, by a registered dietitian. This was reinforced each week when each participant came to a weigh-in. Further education and advice was offered as required. Detailed 7 day food diaries were maintained for weeks one, six and twelve.

Reducing the amount of carbohydrate in the diet led to "considerably greater reductions in a number of pro-inflammatory cytokines, chemokines (both signalling protein molecules indicating cell damage) and adhesion molecules.

While weight loss may help reduce inflammation, the greatest reductions of inflammation were achieved by those who best restricted carbohydrate intake regardless of weight loss. The very-low-carbohydrate diet had strong advantage in blood lipid normalisation, blood glucose control and in reducing the demand for insulin.

A striking result of the VLC Ketogenic Diet was an increase in arachidonic acid, which appears to be beneficial. Several pro-inflammatory markers were reduced including; TNF-α, IL-6, IL-8, MCP-1, E-selectin, I-CAM, and PAI-1 that were related to the increase in arachidonic acid.

The abstract to the paper, "Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation," is available (PDF). Today, she works as a nutrition educator and weight loss coach and is the author of two popular books for women: “The New Rules of Lifting for Women”, co-authored with Lou Schuler and Alwyn Cosgrove, and “Women's Health Perfect Body Diet”.

John Stephen Veitch
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