From shady Statin research to poor dietary guidelines.

In my last blog post I talked about the good, the bad and the ugly in regards to the new Dutch dietary guidelines by the Dutch Nutrition Center (Voedingscentrum). In the ugly part, i talked briefly about how shady cholesterol lowering drug (statin) research seeped into nutritional science, leading to dietary guidelines that should at best be regarded as controversial. In this post I will look a bit deeper into how shady science , in a very unfortunate way ,found itself a foundational place in nutritional science, and how this science has managed to, even today poison dietary guidelines and in effect poison the health of whole populations.

I will look at this from the perspective of the Dutch dietary guidelines, but judging from many other national nutritional guidelines, a similar cascade has probably been applied in the creation of other such national guidelines. So let’s look at the dutch Disk of Five (Schijf Van Vijf) and trace how the advice came to be.

The new Dutch dietary guidelines refer to saturated fats quite often and once to LDL-cholesterol. These are foods the guidelines wants us to avoid, and the foods we should use instead:

  • Coffee high in cafestol; use filtered coffee instead.
  • Hard margarine; use soft margarine instead
  • Hard baking fats; use liquid margarine or olive oil instead.
  • Hard deep-frying fats; use vegetable oils instead
  • Butter; use soft margarine instead for bread or liquid margarine for baking.
  • Coconut oil; use vegetable oils or olive oil instead.
  • Non-lean meat cuts; use lean cuts instead.
  • Full-fat dairy; use low-fat dairy instead
  • Croissants; use full-grain bread-buns instead.
  • Cookies; use full-grain peanut-butter sandwich instead.
  • Chocolate; use fruit and nuts instead

Next to these, the guidelines advise the consumption of legumes for its LDL lowering properties.

There are issues with many of these guidelines, issues we will get to later in this article. First we will look at why the the Dutch Nutrition Center made these recommendations. What reasoning was behind them and where did the data for this reasoning originate? Well this is where things get a bit complex. The  Dutch Nutrition Center claims their recommendations are science based, and objectively speaking they are. So how did things go so wrong anyway? Let’s have a look.  The guidelines by the Dutch Nutrition Center are themselves based mostly on a more abstract guideline by the Dutch Board of Health (Gezondheidsraad). These guidelines come with multiple background documents, including one on macronutrients, that I tried to give feedback on when it was published due to in my view questionable use of LDL-c as causal marker and control for cardiovascular disease. My input was rejected as the Board of Health claimed the subject was covered in another document describing the use of a set of three markers:

  • Blood pressure
  • LDL-cholesterol
  • Body Mass Index

We will leave blood pressure for what it is, and for BMI I’ll refer to my earlier posts on that subject. The thing we are interested in here is LDL-cholesterol. The document justifies its use of LDL-cholesterol as stand-in for CVD endpoints by refering to a publication by the American Institute of Medicine (IOM) entitled Evaluation of biomarkers and surrogate endpoints in chronic disease.

 

BCMJ -#51Vol4-May09.qxp

And this is where the real problem starts. Surrogate endpoints. Remember that correlations aren’t necessarily the same as causation. Remember the difference between a good risk marker and a usable control? Well, this document, to some extent, for the Dutch Board of Health apparently to a decisive extend claims that LDL-c can be treated as being causal, that is, LDL-c can be used not only as a risk MARKER, but actually as a control. We won’t go into LDL-c as risk marker here. The case of LDL-c being a risk marker is solid. There are clear signs that there are multiple much better markers available today, in fact the same goes for the other two markers we just mentioned, but let’s accept LDL-c as a useful marker. The interesting part is: how does the document make the leap from marker to control, or as the document refers to it, surrogate endpoint?  

The answer is: intervention studies. Statin based intervention studies to be precise. So to summarize, the current dietary advice hinges on a collection of statin intervention trials. On first glance there wouldn’t seem to be anything wrong with that. We have intervention trials where lowering bad cholesterol (LDL-c) has shown statistically significant reduction of real CVD linked endpoints, so LDL-c is indeed a useful control, right? Well not quite. It could be if lowering cholesterol was all that statins do, and it would be if next to being statistically significant, the results also had practical significance. And guess what, on both accounts this turns out not to be the case. First, statins combine a whole set of potentially CVD preventative related properties:

  • Lowering LDL-C
  • Thinning the blood
  • Acting as antioxidant
  • Acting as anti-inflammatory agents.
  • Lowering triglyceride levels

And on the other side of the spectrum, statins have actually been linked to CVD causing effects. In fact, some recent trials actual show increased CVD in statin treated groups.

  • Worsening cholesterol sub-group/size profiles
  • Reduce protection from artery calcification by inhibiting K2 synthesis.
  • Reduce protection from peroxidative stress by impairing selenium containing proteins.
  • Impair muscle (including heart) functions through depletion of coenzyme Q10

So far we only looked at CVD related properties, but statins are not without side effects:

  • Vitamin D depletion
  • Severe cognitive issues including memory loss
  • Increased risk of diabetes
  • Severe muscle problems
  • Liver damage
  • Birth defects
  • Erectile problems

Some of these side effects come with their own increased mortality numbers. Others just diminish the quality of life without actually killing you. Recent research has shown that using statins for many many years will increase your life expectancy by just a few days. Not that impressive considering that the price for those days may be years of muscle, cognitive and erectile problems. And then there is the controversy surrounding statin trials. The most notable being the JUNIPER trail. But also recent meta analysis that show that statin results have been exaggerated and side effects have been downplayed in a scaringly structural way.  Multiple MDs as a result of the controversy have called for a complete reappraisal of  the cholesterol theory of heart disease. The bottom line: Statin trials, from a data engineering perspective could never prove LDL-c causality for CVD, and could never prove the suitability of dietary changes aimed at LDL-c reduction as an in any way useful control for CVD.

1402279

So let’s look again at some of the guidelines that these statin trials ended up spawning. Remember that two known positive effects of statins were its function as antioxidant and anti inflammatory agent?  Well, let’s look at how the Dutch dietary guidelines are doing on those. Especially those guidelines based on the LDL-c hypothesis. The first thing that stands out is the use of cold fat sources high in polyunsaturated omega 6 fats as alternative to fat sources high in saturated fats. It is well established that an imbalance of omega 6 and omega 3 intake works pro-inflammatory. As such, saturated fats, while leading to higher LDL-c levels than omega-6 fatty acids, also lead to lower inflammation when compared to omega 6. Inflammation has not only been linked to CVD, but to a multitude of major diseases including diabetes and cancer. 

Than there is the advice for cooking fats. Unsaturated fats can be healthy in the right proportions. At a proper ratio of omega 6 to omega 3, unheated polyunsaturated fats can undisputedly be healthier than saturated fats and so can monounsaturated fats. But that is cold. Once you start cooking with it, the tables turn. While LDL-c as shown above is highly questionable when used as control, the link with ‘oxidized’ lipoproteins is significantly more convincing.  Oxidized unsaturated fatty acid consumption is linked quite strongly with oxidized lipoproteins. So where there is sense in replacing butter with MUFA-rich oils  for cold unheated usage, when it comes to cooking, the reverse must be considered. Saturated fats in butter and coconut oil are stable fats that don’t oxidise as quickly as unsaturated fats in olive oil and vegetable oil. Suggesting the use of MUFA and PUFU over SFA for cooking purposes should be considered the most questionable advice in the dietary guidelines.

mrfit-blood-cholesterol-and-heart-disease

Finally there is the epidemiological data. High cholesterol isn’t the only cholesterol related risk marker that we can identify in the data. Low cholesterol is also a serious risk marker. Thus a population wide guideline with the effect of the reduction of cholesterol levels may very well backfire. Looking at the China Study II data set, SFA intake overall is relatively low. When however we at mortality figures and look at the top ten correlation for foods that potentially improve the probability to live to the ripe old age of 80 years old, SFA (and MUFA) truly stand out. When we look at cholesterol levels, the lowest levels are linked quite strongly to the highest mortality. Unfortunately, due to distribution concerns we can’t check the link for statistical significance, but we can take it as a strong indication that cholesterol lowering might be detrimental to the health of certain groups of people within the population.

dominoes

Summarizing,  statin trials, due to the complex working of statins, the controversy surrounding some statin studies,  the at-best unimpressive effects of statin intervention, and the combination of different beneficial and decremental effects of its use, must be seen as being inconclusive with regards to LDL-c being causal for CVD. If we combine this fact with known health effects of some of the SFA replacements that are advocated in the guidelines, we can only conclude that shady statin trials poison not only nutritional science, but in effect literally poison the whole population of countries that indirectly base their dietary guidelines on the outcomes of these statin trials under the mistaken assumption that the results of these trails are in any way conclusive with respect to the causality of LDL-c for cardiovascular disease.

 

This entry was posted on 29th March 2016. 1 Comment

New Dutch dietary guidelines; The Good, The Bad & The Ugly

Schijf-van-Vijf-vaknamenWhenever anything related to nutrition hits the media in the Netherlands, the first thing that tends to happen is that the Dutch media consults with the expert of the semi authority Voedingscentrum are consulted. This organisation that in the past has repeatedly been criticized  for questionable ties with the food industry have acted as the conservative sentinels of both the food industry and of the low-fat school of nutrition for many years untill this very day. Fair to say that when the Voedingscentrum announced an update of their “schijf van vijf”, a Dutch variant of the Food Pyramid, expectations were not that high with those that viewed them with suspicion. And to be fair, as far as science based goes, the resulting guidelines are absolutely not without their faults. Yet given their reputation amongst critical thinking nutritionists and well informed consumers, they could have been much worse indeed. In this blog post I want to look closely at the Dutch guidelines. At how they both exceed expectations and fall short of delivering that what Voedingscentrum claims as its mission.

The Good

Lets start with the good part of the guidelines. And this is a big one that should silence many of the more paranoid critics of Voedingscentrum. The new guidelines take a firm stand against processed foods. At least most processed foods. We will look at the exceptions later, but its a clear sign that Voedingscentrum is not going out of it’s way to please the food industry parties that it has been linked too. A second really good one and a big step forward is their stand against fruit juice. Given that a glass of fruit juice has extreme levels of sugar that inarguably are very much unhealthy, a very good step forward indeed. The third and final truly good part is the addition of nuts and legumes. Both foods that have been shown to have amazing health benefits.

To summarize the good parts:

  • Whole foods.
  • A big NO for fruit juice
  • Nuts
  • Legumes

The Bad

So much for the good parts. Now lets look at the stuff that Voedingscentrum got wrong. Or at least the part of the guidelines that are not directly supported by both epi data and controlled trails. And some of the parts that are simply and terribly wrong. Lets start of with the questionable stuff. The guidelines are pretty much dominated by starchy foods. Grains, and potatoes basically. Both epi data and controlled trails are known to show convincingly that there are strong links between grain consumption, specifically wheat consumption, and many serious modern illnesses including diabetes, heart disease, obesity and basically the whole package that comes with insulin resistance. Yet almost 30% of the food diagram is dominated by grains. Their defence: it’s all full grain exclusively, we ban things like white rice, white bread and anything not made from whole grains. Well, that is a nice theory and there are some signs that full grain, when not highly processed, may indeed be less harmful than highly processed white flour, but we are basing one third of the guideline on this nice theory that so far has very limited controlled trail evidence and basically non-existent epi data. Not something you should want to bet the health of a nation on. If we look at epi data from sizeable data sets for noticeable health effects, we see that starchy tubers have decremental effects on live expectancy and that people using unprocessed grains, especially rice, do much better than people consuming high amounts of processed wheat flour products. That is, there is compelling evidence suggesting switching wheat flour products and starchy tubers for rice is a good idea. There is a minimum amount of evidence showing that eating processed wheat at all is anything more than slightly less harmful when you choose the full grain variant.

Remember the good part of taking a stand against fruit juice? Well, they went one step further than that. They actually also discourage consumption of vegetable juice. To much sugar is the claim. A claim that might be true for beet juice or carrot juice, if however you make green juice using a slow juicer, the micro nutrient sugar ratio is absolutely off the scale. Yes they tell people to eat more vegetables, 250 grams a day to be precise, but they also advocate eating a whopping 200 grams of often sugary fruits like bananas, mango’s etc each and every day. Again both apparently based on very little actual science. If you replace the 200 grams of sugary fruit with 100 grams of lime and berries, you could easily juice a full litre of above ground, mostly green, vegetables and get the same amount of sugar at many times the vitamins and other important and beneficial micro nutrients.  Note that I’m not suggesting that people need to drink a litre of veggie juice each day, just that veggie juice as a whole should not be on any black list, and there is no actual substantial body of evidence supporting any beneficial effect of choosing fruits over vegetables for more than a single serving a day.

We already talked about processed grain where the Voedingscentrum ignored their own core stand against processed foods, but it gets worse. In the previous guideline the dietary advise was to consume fish twice a week. The revised guidelines have reduced that to once a week. In an other part of the guideline, the use of vegetable oils is promoted. Next to these vegetable oils being classifiable as highly processed oils, and thus not in line with the base stand against processed foods, there is something that makes this a serious step back from a health point of view. In recent years, the role of inflammation as major health risk has come to light, and the ratio of omega 6 to omega 3 intake plays a major and unmistakable role in inflammation. Less fish means less omega 3. More vegetable oil means more omega 6. Combined result: the omega 6 omega 3 ratio shoots up. A healthy ratio should normally be somewhere between one and three. Raise it an order of magnitude and mortality rates shoot through the roof. These two guidelines combined thus are not just poor advise. They combine into potentially deadly advise working directly against the excellent advise to eat more whole foods, avoid fruit juice and eat more nuts and legumes.

To summarize the bad part:

  • Massive amounts of (full grain) processed wheat products.
  • A NO for vegetable juice
  • Worse Omega 6 / Omega 3 ratio when compared to previous guidelines.

The ugly

Much of the avoid this and limit that advise in the guidelines stem from the combination of two ideas:

  • Saturated fats raise bad cholesterol (LDL).
  • Bad cholesterol raises the risk of heart disease.

At fist glance a large body of research seems to agree with these two ideas and with the idea that as a result saturated fats raise the risk of heart disease. If however we look closely at most of the research one thing stands out, most of the research that supports this link can be linked in one way or the other to pharmaceutical companies and the promotion of statin drugs. Statins are a drug that reduce the bodies own cholesterol production and as a result lower the blood cholesterol levels, and in clinical trails a modest reduction of cardiovascular events has repeatedly been seen with the use of statins. In recent years however, it has been discovered that statins also have anti-inflammatory properties, and produce other effects that could reduce cardiovascular events. Taking that into account, proof that the LDL lowering property of statins is in any way related to the modest results of this drug has basically evaporated. In fact, statins can now be actually be considered the most convincing proof that just lowering LDL cholesterol, either by dietary or drug intervention has zero effect (at best) on heart disease mortality.  Recent studies even suggest that LDL particle size may be an important factor, while other studies underline the role of inflammation. Both factors where saturated fat actually does better than both processed vegetable oils rich in omega 6 and full grain wheat flour that are so actively promoted as being heart healthy. Basically we should face up to the fact that statins are probably the biggest scam in the history of the pharmaceutical industry, and as a result we should just throw away a large body of tainted science and start over. Organizations like Voedingscentrum however stick to the tainted research and as such tainted science spreads from pharma to nutritional science leading to dietary advise that, in an attempt to reduce the cardiovascular epidemic actually may end up contributing to it. Let me sum up:

  • LDL-c is an established  risk MARKER for cardiovascular disease.
  • Evidence showing intervention in LDL-c reduces cardiovascular events is all statin based evidence.
  • Meta analysis of statin studies have shown the positive effects of statins to be minimal
  • Non cholesterol related effects of statins have been found that could more than explain for statins positive effects without any effect from the cholesterol lowering properties of statins.
  • Statins are most likely the biggest scam in the history of the pharmaceutical industry, yet much of nutritional science builds upon statin infomercials posing as real science.
  • LDL size has been identified as a stronger risk marker than LDL-c. Large size being good, small size being bad.
  • Inflammation has been identifies as a risk marker as well.
  • Saturated fats improve LDL particle size profiles.
  • Vegetable oils are significantly more pro-inflammatory than saturated fats, and  so are processed grains.

Non of this is Voedingsentrum’s fault of cause, it’s a giant stain upon the field of nutritional science that may take many years to clean. By that time however, many people may have already died prematurely from a guideline that bans innocent saturated fats for its LDL link and promotes foods that through their inflamation link may be much more dangerous.

To summarise the ugly parts:

  • A big NO for SFA
  • A big yes to a multitude of inflammatory food choices.

Conclusion

The bad is pretty bad and the ugly is terribly ugly for sure. The focus on whole foods and the guidelines on fruit juice, nuts and legumes taken together however, I must admit I’m still rather positively surprised about the new guidelines.  A critical note so to speak, not just for the Voedingscentrum, but to nutritional science as a whole that has been duped by statin infomercials into believing LDL-c to be a useful control. Inflammation and metabolic syndrome should absolutely be a bigger concern in future guidelines than saturated fats, and both full grain and fruit intake lack the scientific data to truly support having them in such large quantities. Having said this however, kudus for the good parts, especially the stand on whole foods. If whole foods would include grains and fats it would be that much better though.

This entry was posted on 23rd March 2016. 2 Comments

Tweaking a vegan diet for a long life expectancy.

A few posts ago, I showed some objective data from the China Study data set that from a vegan versus meat eaters view seemed to greatly favour the idea that being vegan might be rather bad for your health. Although I don’t have any moral issues with eating animals, especially if the data shows that eating animal flesh should objectively be beneficial to my health, it becomes quite a different picture when we factor in the ecological aspects.

When we look at the steep part of the meat mortality correlation from my earlier post, and if we look at the world meat production, than people are eating significantly more meat than would be justified purely by the mortality numbers. If you purely follow the data, than eating 2 grams of meat for every 3kg of body mass should be a healthy level. If every person on earth would follow that eating pattern, the world production of meat could more than half. Something that by itself should be a good move in the right direction would it not be for other nutritional health issues regarding fats and issues with respect to macro splits and protein production. Basically there is a fundamental protein and ecology issue with both vertebrate based protein sources and plant based protein sources that is often downplayed by plant based food proponents. In earlier posts I talked about the use of insects as sustainable source of protein, showing that some species of insects provide for a more ecologically sustainable source of protein than for example soy beans. But lets discard the macro split issues for now and look at what options a vegan would have to avoid becoming part of the mortality statistics that seem to show a vegan diet may lead to a premature death.

cholesterol

I can imagine the reaction of many a vegan when I mention that cholesterol levels could be contributing to higher mortality for people who eat less meat and saturated fats than the most of us. But guess what, other than what we have been bombarded with for decades by processed oil vendors and cholesterol lowering drug producers, high cholesterol isn’t the only cholesterol level problem that is linked to increased mortality. Low cholesterol is actually an other, possibly much more dangerous problem. Vegans like to point out that people in China have far lower mortality from heart disease, and have lower cholesterol levels, and that is true, but if we look at the data from the China Study II data set, we see a trend that is the opposite of the one we see in the west: Higher plasma cholesterol is linked to seriously lower mortality rates. People with low cholesterol are dying in significantly larger numbers than people with normal and slightly elevated cholesterol levels. When looking at other sources, it becomes evident that this is not just a Chinese anomaly. Low cholesterol is really really dangerous and greatly increases a wide range of mortality causes. But indeed, not ischaemic heart disease. Other unexpected causes including even things such such suicide and accidents are unmistakingly linked with very low cholesterol levels. Does it really matter what causes your death when your total risk of dying prematurely goes up dramatically when your plasma cholesterol is very low? mrfit-blood-cholesterol-and-heart-disease

As you see in the graph, coronary heart disease really does follow the pattern we have all been told to worry about. But when we look at all cause mortality, and cholesterol levels below 180, the picture becomes quite a different one. Below 160 the different picture becomes quite dramatic, and given the slope of the mortality correlation, at extremely low levels say below 140, low cholesterol clearly becomes a truly formidable health risk.

To put it into perspective, in the China Study II data set, in some regions the average serum cholesterol is below 130. and the highest average for a Xiang in the data set is in the 180 range. Safe to say thus that in China, low cholesterol is a serious health risk. Now if we look at the health results related to meat and saturated fat consumption and look at how these are correlated in our data set, we must conclude that part of our results could be explained simply by the fact that low serum cholesterol levels are a serious health risk associated with a diet low in animal foods.  Now if we look at other sources for information about this, we see some worrying numbers when it comes to vegans.

en_a06tab02Vegans in general have shockingly low serum cholesterol levels. In fact, almost half of all vegans according to this table seem to be below the worrisome 140 mark. With sigma at about 30, and given the slope of our mortality correlation, this should put groups making up multiple percent of all of vegans at extremely high mortality risks, comparable if not exceeding those of  morbidly obese with hypercholesterolemia and high blood pressure.  So what could vegans do to overcome these risks? First of all, having your cholesterol checked is probably a good idea. Anything below 150 should be serious cause for worries.

Coconut oil and fresh coconut on white background

And secondly, we already know that saturated fats raise cholesterol levels. Coconut oil is a completely vegan healthy source of cholesterol raising fat.Next to raising cholesterol, being a saturated fat it is much less sensitive to damage from heat than many alternative fats, thus as a cooking oil it reduces the amount of toxic oxidised fat you consume. So as a vegan, unless you suffer from familial hypercholesterolemia, replacing mostly unsaturated cooking oil with coconut oil is probably a good idea for more than two thirds of all vegans if the above numbers are correct. For those that worry about coconut oil being solid at room temperature, consider that it is fluid at body temperature.

Omega 3

A second issue with the vegan diet, at least if we look at the China Study II data seems to stem from high levels of polyunsaturated fat. So are polyunsaturated fats bad? No, not if you consume them in a balanced way. Problem though with the Chinese diet, and also with the modern western diet,  the polysats are far from balanced. Ideally you should want to have a 1 to 1 upto 1 to 4 ratio of omega 3 versus omega 6 fatty acids. At an unbalance towards a 7.5 ratio, higher levels of polyunsaturated fats are strongly linked to higher mortality rates. With grass fed beef, meat eaters in China have both a lower overall polyunsaturated fat intake and also a slightly better omega 3 to omega 6 ratio. eggplant-steak-5So how do we improve our ratio without eating non-vegan fish-oil capsules or something like it ? Well the answer is quite simple again. Just add one simple totally vegan product to your diet: crushed flax seed. Flax seed is very high in omega 3 and is a very simple way to improve your fatty acid split on a vegan diet.  Add them to your vegetable smoothy. If you are an oats person, add them to your oats. You can mix them into your salad dressing. or stir them through your stew with some coconut oil. Flax seeds are an amazing whole food that should be an every day food item in every vegans diet.

Suplements

Not being a big fan of suplements, the data shows there is no way around it for vegans. While protein sources are available, they are often very one sided in single foods. The data from my earlier post showed clearly that a one sided amino acid profile protein source could potentially be a health concern. Apart from this, if you are an active person who works out with weights on a regular basis (if you don’t. than you should), it is hard to get a high enough macro split for your proteins. Mixed legumes are probably the best single source whole food protein source that you can get, but supplementing with mixed vegan protein powders should be a good idea.  Turn your flax seed enhances dmoothy into a protein shake by adding mixed source protein powders and you will not only ensure a healthy amino-acid profile that could possibly prevent premature death, you will also recover better from your workout, get stronger and acquire a better physique. Finally, of-cause the obvious one you probably already know about: B12.  Recent research has shown the importance of o combination of B12 and folic acid  in the reduction of homocysteine, an important cardiovascular risk reduction factor for cardiovascular disease. For most vegans folic acid won’t be a problem, but B12 is definitely a major concern. There is no getting around it: as a vegan, take B12 suplements! A third supplement that I highly recomend,  is carnitine.  Meat is not just fat and protein, it also comes with some other substances that have been shown to have great health benefits, especially when combined with going to the gym. There are absolute reasons to believe that carnitine might be a contributing factor to the observed positive effect of meat consumption, and purely vegan carnitine suplements are widely available.

Avoid processed fats and carbs.

Unfortunately there is no getting around processed protein, that is unless you don’t lift (something I can’t recommend), it is still a good idea to avoid processed carbs and fats. Highly processed oils are often high in omega 6 and mess up your omega 6 omega 3 ratio, but next to that, they are often made from GMO crops and are produced using industrial techniques borrowed from the petrochemical industry. Stick with cold pressed oils rich in monounsaturated fats. Get fat from whole foods like nuts and advocados and ban all vegetable oils and any oil that is industrially produces. As for processed carbs, avoid dried and salt preserved carb sources such as raisins, canned veggies, etc, and avoid any fine grain flower based product. Whole grain may sound healthy, if you can’t actually feel the individual  coarse particles of grain, chances are its really unhealthy stuff. The finer the particles the unhealthier the products made from them. Don’t allow grains to become a staple food.

Limit starchy tubers and fruit.

The data I showed in a previous post clearly showed issues with high levels of starchy tuber consumption. While starchy tubers and fruit are healthy in small amounts, again these foods are apparently ill suited as staple food. The case against starchy tuber as staple food is stronger than against fruit.  In the China Study II study for example, fruit consumption is so low that no useful info can be extracted. Studies often look at fruits and vegetables as if the two were the same thing and differentiation would be folly. However looking at the nutrients and sugar contained in fruit and studies looking at sugar consumption, it would be safest to conclude that fruit requirements for a person consuming high amounts of vegetables are relatively low. Most of the fruits available in stores are far removed from their natural ancestors.  Their sugar levels are extremely high while serving no other purpose than satisfying our sweat tooth. A banana for example, no longer able to reproduce with seeds, and many times as sweet as its seed baring ancestor, is a mutant clone that can only reproduce by us making an exact copy of the parent plant. You really don’t want to use such unnatural food sources as staple food.

I hope the above guidelines show how it is perfectly possible to counteract the negative effects the China Study II data set showed with regards to a vegan diet versus a diet with substantial amounts of meat. By adding a small handful of plant based foods and supplement and by not allowing an other handful of foods to become staple foods, minimizing mortality risk on a purely vegan diet should be totally possible.  I hope the above article shows I am not trying to bash a vegan lifestyle in my engineers approach to diet and workout and it shows that looking at the data carefully can provide solid alternatives to what at first glance seem like undeniable truths.

This entry was posted on 15th February 2016. 1 Comment

Why “What is the best way to lose weight?” is such a bad question.

16 - 1Every time you see numbers on obesity, you see the Body Mass Index is being used as metric to show that obesity is getting a bigger and bigger problem. The Body Mass Index is basically a body length corrected measure of body weight. When diets go head to head, “losing weight” is used as measure of success.  When making a choice between a Paleo diet, a Keto diet, a vegan diet,  a Mediterranean diet, etc, etc, people will often ask the question: “What diet is best to lose weight”, and many a proponent of whatever diet he/she is trying to sell, will go out of his/her way to show how successful the diet is at helping you lose weight. High number for body weight and BMI have become synonymous to obesity and with all obesity related illnesses.  As such, the concept of “loosing weight” has become synonymous with the idea of improving health and a way for obese people to stop being obese.   In this article I will show how not only BMI and body weight are poor measures for obesity, but also that the focus on loosing weight is actually a major contributor to the obesity problem.  A contributor that is creating a situation where people are discouraged from continuing the most effective obesity measures. A contributor also that is creating an increasing number of low-BMI obese people, creating a situation where the true size of the obesity epidemic is being obscured from sight.

A linguistic problem?

Obesity is a term that describes a person having unhealthy levels of body fat. That is, as a term, and as a medical problem, obesity is about body fat. Looking at actual health problems in fact and their correlation to body fat levels, it may even be fair to sat that as a medical problem, obesity is about high levels of visceral body fat. Visceral fat is the part of our body fat that resides within the abdominal cavity around our internal organs. Having massive love handles may not be aesthetically pleasing, from a health perspective there are to my knowledge no convincing studies showing the existence of  independent risk factors from subcutaneous fat.

So let’s recapitulate. We have medical issues that are strongly correlated with visceral fat levels. We have visceral fat levels that are correlated relatively strongly with total body fat levels, and we have total body fat levels that are relatively poorly correlated with total body fat levels.

bmiIf we assume the lack of evidence of independent correlations excludes the possibility of causality, than a likely correlative diagram like the one on the right is probably pretty much accurate. We have a possibly causal link between visceral fat levels and a wide range of medical issues. It is also still possible that both the medical issues and visceral fat levels simply have a common cause, but if there is a causal link between obesity and health issues, this is where we will find it.

Next, there is a strong correlation between visceral fat levels and total body fat levels. This correlation obviously flows two ways.

Finally there is a correlation between total body fat and body weight. Fat has weight, so more fat mass obviously means more body weight, yet much of a person’s body weight is made up by other things than fat. As BMI is a measure of body weight, we get the diagram here on the right. So why do we measure obesity with BMI? And more importantly, why do we refer to obese people as being overweight, while weight is so indirectly and weakly linked to the actual obesity related medical problems?  And worse, why do we urge obese people to make changes primarily to their BMI by means of “loosing weight” ?  Given that what we care about appears to be percentage driven, does it even make sense to lose weight if we don’t differentiate between the components tat make up our weight. In fact, we could possibly improve body fat and visceral fat levels by increasing our weight in the right way.

Obesity is not a weight problem, it is a visceral fat problem at best. Visceral fat as percentage of total body weight if we trust the data. We should stop using weight and BMI as measure of obesity. We should stop referring to obese people as being “overweight” and we should most pressingly stop referring to personal attempts at reducing obesity as “loosing weight”.

A sad story

A friend of mine, just about a year ago decided to try and make a change is his life. He had been fighting obesity for many years, but after we spoke about my approach, he decided as a new-years resolution to give a low-carb high caloric diet combined with  a rigid strength training program a try. Four and a half months into the program his visceral fat levels were down by a whopping 6%, his total body fat level by 8%. Seriously, I dream of having such amazing progress myself, I had never seen anyone react that well to a strength first approach. His progress wasn’t just in these numbers, it was really starting to show. Than disaster struck. After having visited his GP first and a dietician second, my friend stopped going to the gym. A few months later I ran into him again and asked him why I never saw him any more in the gym. What happened was that his GP had tried to convince him his BMI was getting to high (apparently the added muscle mass had tipped his BMI just above an alarming level), and had send him to a dietician.  That dietician had consequentially convinced him that body composition machines at the gym were inaccurate, that his daily caloric intake was  more than 1000 calories to high, and that switching to a low caloric low fat diet in order to get his BMI back to a healthy level would be the only sane thing to do. I tried to tell him that while I am just a lowly engineer and no health profesional, the mirror didn’t lie to him, I seemed to be getting trough to him for a moment, but than after some thought he just said to me: “Sure, your diet and workout did make me look and feel better, but I rather lose weight and avoid the health problems with being overweight”. I couldn’t think of anything to say at that moment. Unable to even comprehend the reasoning and the level of disconnect. We are collectively so obsessed with body weight that even dropping a full 6% from visceral fat levels in just four and a half months, looking much better in the mirror and most importantly feeling better isn’t sufficient to convince us that  our BMI going up half a point in the process may not actually be a problem. Not just that, health professionals are clinging to these numbers as if they are the one and only variable that has any meaning.

The dangers of loosing weight

If we look at loosing weight, the most common way to do it is to go on a diet that leaves you with a caloric deficit. Something that to the human body would be close to indistinguishable from famine. If we look at the data from the China Study II, a data set created almost 30 years after the great Chinese famine, we see some shocking correlations in the data set. The correlation between people who suffered from the Chinese famine and  all cause mortality for the 70-79 age group is very much presents and has an order of magnitude that should definitely be taken seriously. We shouldn’t jump to conclusions, but even if artificial famine may bring down visceral fat levels to safe levels, what new dangers is it creating in our bodies?

An other issue with loosing weight lies in the loss of muscle mass and the impact on your metabolic rate. The numbers differ depending on who you ask, but a kg of muscle mass will burn the energy equivalent of about a teaspoon of sugar a day just sitting still. On the wrong diet, especially  the pseudo-famine diets that promise to make you lose weight in record time, loosing 20 kg of body weight could easily set you back 6 or 7 kg of lean muscle mass. That is 6 or 7 teaspoons of sugar worth of energy per day.  Now guess what happens when you end your diet and start eating the same you ate before your diet. While before you started dieting your body may have been in something of an energy equilibrium, if you now consume the same, you will now end up with an energy surplus of about 100 calories. A 100 calories surplus may not sound as much, but it adds up to about 4kg of new fat a year. And that is on top of the surplus you already had that made you end up in a situation where you wanted to lose those 20kg in the first place. So if it took you 5 years to gain those 20kg in the first place, this time two and a half years will end up doing the trick. Realizing that 3 kg of muscle mass will burn the energy equivalent of 2kg of fat mass every year should make you think twice about allowing yourself to lose substantial amounts of muscle mass. If anything you should try to gain muscle mass.

Hidden obesity

Now repeat the cycle a few time, as many people end up doing. The fourth time you lost that 20kg, your lean body mass is  bound to be so low that even with a BMI of 21 your body fat percentage is off the scale. In the BMI based statistics however, you won’t show up as obese, next year you might, but this year you are on the bottom of your roller-coaster ride. You will be part of the hidden part of the obesity epidemic. But not just people who repeatedly starve themselves are hidden obese. Many people who don’t work out and eat junk food all the time don’t have any “weight” problem and may even look skinny but have such high levels of body fat that they should be considered obese. So none of the aesthetic issues with obesity but all of the health risks.

Fat mass and muscle mass

The best way to visualize the disconnect between BMI and obesity is using a simple graph. Lets take a highly simplified body composition consisting of muscle mass or non-fat mass and fat mass. We take the muscle mass or non-fat mass of a person as X-axis, and use the Y-axis for body fat mass. Now you can describe a person’s body composition with a simple vector that points from the origin of the graph to the point with the persons fat and non-fat mass. We can also, for any given age/gender draw a straight line depicting the ideal body fat percentage for our person. Now for obesity. You can say that obesity is quantified by φ , then angle between our persons body composition vector and the ideal body fat line.

As for the BMI, how does BMI fit into all of this. Well imagine we use the same graph to show whe body composition of a thousand random and mostly sedimentary people of the same body length. Than from those people we look at those with an ideal body fat percentage and take the average body weight of that subgroup to scale our whole graph with.

Now we end up with a graph where BMI is defined relative to the magnitude of the vector on our scaled graph while obesity is defined relative to the angle of the vector. For anyone with even an elementary understanding of  mathematics, using |V| as stand in for φ should be complete and utter madness. Apparently however for many nutritional and health professionals there is nothing wrong with doing so.

Body compositionbody-fat-types

If we truly want to fight obesity, the whole “weight loss” mantra should be considered harmful. Instead of focusing on weight loss and on BMI, a healthy non obese person combines healthy body fat levels with decent muscle mass and bodily strength. In fact, you can fight obesity and be gaining weight. By gaining muscle mass, your resting metabolism will go up, not by much but still a significant teaspoon of sugar a day that will add up over time and will help to keep off any body fat you end up loosing in the process. Picking a proper diet will help shift your bodies fat deposit shift from visceral to subcutaneous, all adding to a better body composition. Refined grains, fructose and trans fats for example are linked to higher partitions of bodily fat being stored as visceral fat. Until we realize that obesity is about percentages, about the location of our bodily fat and hardly about weight or BMI, and until we stop looking at weight loss as a cure for obesity, there is no way we can even begin to address the issue. No “this diet will help you lose weight” is even relevant to reducing obesity in the end. You can have a BMI of 21 and be obese, or you can have a BMI of 38 and not be obese, and while BMI can be a useful tool for looking at whole populations, for individuals who need a metric to track progress with, BMI should be considered harmful. If you are obese, you are overfat, not overweight. Your weight is completely irrelevant to the condition of obesity at least as far as medical risk factors are concerned. So don’t ask “What is the best way to lose weight?”, weight is irrelevant, instead ask “What is the best way to improve bodily composition?”. Once you understand that asking the wrong question will give you the wrong answers, you can start making the mental switch that allows us to actually address the obesity problem. Lose visceral fat, gain muscle mass and get stronger. If in the process you lose weight, fine. If in the process you actually gain weight: even better.

This entry was posted on 31st January 2016.

What doesn’t kill me ….

trackThose of you who have been following my blog only since my move to engineer.diet may be under the impression that my only focus is on data engineering and that my upcoming book will have the same focus. In fact the only reason I am doing data engineering at all is to try and set safe boundaries for what is the core of my approach to diet and workout: control theory.

Basically my approach to diet and workout builds on two ideas:

  1. Use a control-feedback loop to achieve the best achievable values for solid health control variables.
  2. Achieve 1 in a way that avoids potentially dangerous input variable levels.

Recently I’ve been putting quite a lot of focus on #2. That is, I’ve been looking into input variables and input variable levels that might, according to all cause mortality figures end up doing more harm than good. In doing so we have identified that low-carb theory, while not being infallible in perfect in explaining our data engineering findings is pretty close to the mark, especially where older age groups are concerned. We also identified the importance of age and gender dependent risk factors. Basically the whole #2 part of my work is concerned with what might kill you. More specifically, with what might kill you despite of #1 markers showing great progress. In this post however I want to revisit #1, that is , I want to focus on whatever doesn’t kill you and helps in achieving a better health.

Markers and controls

Nutritional and medical science for a great part are about markers. For example blood serum markers are used when screening for diseases like cancer. The use of multiple independent markers that correlate with a condition is extremely useful for diagnosis. The condition itself may not be easily checked for, the markers, up to a point can stand in for the condition we are looking for. Risk factors have markers to, and while for diseases like cancer its obvious that trying to use a marker as a way to cure the disease by turning it into a control is futile, when talking about risk factors this may not always be the case. In control feedback theory, a control is an output that is used in a feedback loop to control input variables. The problem with this is that not all risk markers are good risk markers and not all good risk markers end up being suitable as control. Remember that markers are often found based on correlations and correlations may or may not have a causal connection of a useful size in the direction required for an effective control.

 

Health and exercise

We shall be looking at two markers for general health to be used in a control feedback loop. The first one is one that is often overlooked as provider of useful controls: exercise. It is well established that physical exercise contributes to a better health.  Conversely however controls based on exercise that correlate the most with physical health conflict with markers commonly used for an other health related variable.

Obesity

Obesity is a major health issue and a risk factor with respect to many diseases such as heart disease and diabetes. As such, no control feedback loop should be without an obesity geared component. But to do that we need to look at finding a proper control yet. Commonly used markers related to obesity have proven very  poor controls that have led to people prematurely abandoning a healthy exercise regime and that have pushed people towards the destructive dieting regimes that in potential do more harm than good while making people suffer in hunger, loosing weight, but not actually doing much for the overall bodily health. So before we pick our control we shall look at the alternatives first.

Correlation_between_BMI_and_Percent_Body_Fat_for_Men_in_NCHS'_NHANES_1994_DataWeight and BMI as control for obesity.

What is the unhealthy part of obesity? Is it the weight? Well that is what most of the world seems to want to convince us of. Looking at recent research however, it turns out that there are two components to weight related risk and only one has to do with obesity:

  1. Bodily fat
  2. Steroids usage

If we ignore the steroids usage end look at bodily fat, there absolutely is a correlation. But looking at the correlation it is clear that it leaves quite a bit to be desired for weight and BMI to be used as stand in for bodily fat levels. If we add to this that exercise on a healthy diet leads to muscle growth, we must come to the conclusion that while BMI is already a bad marker, it’s even a worse control.

Better controls for obesity.

When looking at the data of obesity related markers and obesity related risks, there are three distinct markers that are more suitable as control than body weight and BMI.

  1. Total body fat percentage (TBFP)
  2. Visceral fat levels (VFP)
  3. Waist-Hip Ratio (WHR)

Visceral fat levels are actually the correlated the strongest with obesity related health issues, but TBFP and WHR are closely tied for second, both leaving BMI far behind in usability as control. We shall be working on all three of these markers in different ways, using one directly as basis for control in our control feedback loop. As we already established our nutritional plan should probably be pretty close to a low-carb diet, and carbohydrate intake has been found to be the main driving force behind a visceral dominance of fat distribution, we consider that one covered by static dietary choices.  By picking strength sports, including the essential squatting exercise we cover the hip aspect of the WHR. So that leaves us with the TBFP for use in a control for our feedback loop.

An alternative Body Fat Index.

Depending on age and gender there is a recommended healthy range for your TBFP. Using a simple formula we can calculate a body fat index usable as part of a multi dimensional control. We first define three variables:

  • AGE : Your age in years
  • GENDER : 0 if you are a female; 1 if you are a male
  • TBFP : Your total body fat percentage as measured by a body composition measurement scale as found in most gyms today.
  • LBFP: Lower Body Fate Percentage. This is the lowest we should allow our body fat to go without risking underfat levels.

Now the first thing we need to do is calculate our LBFP based on our age and gender:

LBFP=20.5 14.5 x GENDER + AGE x (1+GENDER) / 20

Now, amusing that our LBFP is lower than our TBFP, we can calculate our Body Fat Index using the following simple formula:

BFI = (TBFP – LBFP) / 5

This will yield a useful gender, weight and age independent index that indicates how close you are to being the leanest you achievable. But remember, this is just one half of the picture, you don’t want to be just lean, you want to be healthy, and not being obese is just one half of the equation.

A weight relative Body Strength Index.

Next to not being obese, a healthy body is relatively muscular and strong. If you are under eating, your strength going down significantly is a first sign you are not on the right track to a healthier you, but might be messing up your body by a multitude of factors that might leave you thin but unhealthy. So how do we avoid this? We add a second index to the menu, the Body Strength Index. As with the BFI we want the index to be gender and age independent. To do this we look at your relative strength , relative to your body weight. You can be a 40 kg woman and have a better BSI than a 120 kg guy, basically. So lets look at our variables:

  • WEIGHT: Your total body weight.
  • SQUAT: The average top of your last four squatting sessions.
  • BENCH: The average top of your last four benching sessions.
  • LIFT: The average top of your last four dead lifting sessions.
  • GENDER: Again 0 if you are a female and 1 if you are a male.

Given that you are not in it to win the Olympics, and given that you are working at two connected variables at once that will keep you from reaching extreme strength levels, we set our strongest achievable strength level to a number of times your body weight. A number that is considered quite strong for your particular gender. At that level your BSI should be zero.For a man, we set our ultimate strength goal to 6 times your total body weight. If you are a woman, 4.5 times your total body weight would already be quite impressive.

So here is the Body Strength Index formula:

BSI = 6.75 +2.25 x GENDER – 1.5 x (SQUAT + BENCH + LIFT) / WEIGHT

If the BSI yields a negative number, that means you are pretty damn strong. Use zero for your BSI in that case.

Combining the two: Generic Body Health Index; an alternative to the BMI.

So now we have two indices to replace the old BMI as control, but how do we combine them and how do we plot a path to self improvement? Well to combine them we simply use a single complex number to express our Body Health Index with:

BHI = BFI + i BSI

gbhi1

If you wish to play around a bit with your stats to see where you are at, I’ve put the above is a little Google Docs spreadsheet here.(Please don’t vandalize the sheet and mess it up for others)

Now the key to plotting the ideal path to a healthier you lies in finding a balance between improving the size of the vector and in improving the balance between the two components of the vector. One way we can do this is by drawing a circle fragment with the following properties:

  1. It passes through our BHI
  2. It passes through zero at an angle of exactly 45°

We can now draw an arrow defining the initial target direction for our control-feedback loop that follows the direction of the circle at our current BHI. That arrow is our ideal path for now. The difference in heading between the arrow and our actual progress after our next 12 workout sessions will be our error that we shall try to steer on with our inputs. Making this process into a critically dampened control-feedback loop leading you to a balanced BHI as close to zero as humanly possible is the ultimate goal of my approach. One variable at a time. Some variables will lead you astray for a period but in the end you should have a diet and workout plan that is perfectly tailored for your body.

This, more even than the data-engineering part is what should be considered the core of my engineers approach to diet and workout.  I hope all of this is making at least some sense. My (projected to be a free e-book) book will include info on how to build and tune a control feedback loop around these ideas.

This entry was posted on 8th January 2016.

10 nutritional candidate new years resolutions.

Its the time of new years resolutions. Resolutions that are notoriously hard to stick to, especially when they are diet and workout related. In this post I want to offer some potential new years resolutions with a light note that should not be that hard to stick with. Resolutions though that at first may seem like a real bad idea until you realize the truth that underlies them. So here we go:

1: Have a piece of chocolate instead of an apple.

Sounds good, right? But before you go stuff yourself with large amounts random chocolate, that isn’t what I meant. If you have been following dietary guidelines, chances are you are consuming multiple servings of fruit a day without hiving to much thought about what fruits you are eating. Apples and grapes are two popular fruits that have a relatively low micro nutrient to sugar ratio when compared to for example berries. Cut down your fruit intake by one serving and make the other serving(s) count by picking the most nutrient rich fruits you can find. Instead of that apple or those grapes that you are cutting, consume a single square of dark chocolate. This should be chocolate with a purity of at least 90%, not the crap that is mostly sugar. There are valuable micro nutrients in dark chocolate that you can’t get anywhere else.

2: Quit drinking ‘healthy’ fruit-juices and smoothies

While fruit can be healthy if you don’t overdo it,  a single glass of orange juice contains the sugar of more oranges than you should consume ll day. Next to that, without the fibrous containers supplied by many fruits that help with a delayed release, that sugar will hit your system like a flash, resulting is a massive hormonal imbalance that can set of an avalanche of cravings that will have you wanting to eat everything in sight. If you want to consume fruit, consume fruit and don’t juice it. If you want to consume juice, use a variety of veggies instead. Less sugar, more micro nutrients.

3: Stop eating ‘heart-healthy’ full-grain  foods.

Basically, there is no such thing. full-grain is just a marketing name for unhealthy highly processed and quickly absorbed carbohydrates. Processed carbohydrates are almost as bad for your health as sugar. They offer inferior proteins and relatively low fibre counts. Replace all grain products with legumes. You get all of the promises from hearth-healthy full-grain that full-grain does not deliver on.

4: Eat foods that are high in calories.

Many food bloggers today seem to be advocating foods that are low in caloric count without looking at micro nutrients. Not all micro nutrients can be consumed in unlimited numbers without risk to your health. Next to that, the data from epidemiological studies shows  no link between life expectancy and caloric intake, yet it does show a clear correlation between eating more grams of food and for example not reaching the ripe old age of 80. As such, there are clear signs that consuming energy dense foods is actually good for you. Note that choosing high caloric foods doesn’t imply consuming more calories. You just eat smaller portions. It is healthier to eat 200 calories worth of nuts than 200 calories worth of pickles. The pickles option will give you a substantially bigger portion, but the pickles will have you consuming a whopping 14.5 grams of sodium against half a m-gram for the almonds.

5: Eat saturated and animal fats instead of vegetable oils

Saturated and animal fats have had a bad rep for decades, but as it turns out, that bad rep is largely undeserved. Sure, many sources of animal and saturated fat are linked to negative health effects, but for the most part, these negative health effects can be traced back to other factors such as adding salt to butter, the processing of meat using industrial processes and chemicals, or the use of antibiotics and the feeding of grain and soy to animals that are supposed to eat grass. Saturated fat may not be as healthy as mono-saturated fats, they are a hell of a lot healthier than vegetable oils and margarine. Vegetable oil and margarine are often produced from GMO crops, are produced using processes originating from the petrochemical industry that result in what is referred to as trans-fats. Nasty little molecules that even in minute percentages should be considered as toxins. Apart from that, many vegetable oils have high levels of omega-6 fatty acid. Omega-6 isn’t bad when part of a balanced diet that also contains comparable amounts of omega-3. If however the omega-6 levels end up one or two orders of magnitude higher than omega-3 levels, as will often be the case when using substantial amounts of vegetable oils, these omega-6 fatty acids become highly inflammatory. Something that is linked to a multitude of health issues including heart disease. Yes that is right. After years of being tolled swapping saturated fats for polysats to prevent hert disease, with veggie oils it turns out these healthy polysats actually have the reverse effect. So if the choice is between saturated fat in the form of coconut oil, fatty unprocessed meat from grass-fed cattle or unsalted butter, or for vegetable oil that is either high in omega-6, is made from GMO crop or contains trans-fats, saturated and animal fats are actually the healthy option.

6: Stop eating/drinking low-fat dairy

If you are not eating dairy at all, good for you. There are multiple reasons why dairy products may be a bad dietary choice. Lactose is a sugar basically and not a very nice sugar at that. Dairy at its core however can be healthy. There are multiple valuable micro-nutrients in dairy that can contribute to your health. When however you think choosing a low-fat option is healthy, think again. There are two reasons why you should probably be picking the full-fat variants of your favourite dairy products. The first reason is macro-nutrient balance. We all know by now sugars are bad for you, and if you are consuming the lactose but not the fat, the percentage of calories from sugar in your diet will go up. That is a bad thing. The second reason to opt for full-fat dairy products is related to vitamins. The vitamins in dairy for the largest part are so called fat-solvable vitamins. Take away the fat, you take away the vitamins. End result, more sugar, less vitamins, worse macro-nutrients balance. Opt for full-at dairy but watch the portion size again. High-density foods, remember. Same calories; lower volume.

7: Throw away your scale

This is probably the best new years resolution you can go for. A healthy diet is one thing, a healthy lifestyle is just as important and a healthy lifestyle includes hitting the gym at least every other day. After decades of getting indoctrinated on the idea that our BMI is a useful measure of obesity and thus a useful control for progress, the trip to the gym can become disappointing pretty quick. Problem is, with a healthy lifestyle comes a healthy body composition. That means less fat and more muscle mass. Muscle mass is relatively heavy when compared to fat mass, so the desired ‘improvement’ to your BMI might not happen as fast as you thought it would. In fact, you may actually gain a little. Basically the idea of BMI and the very existence of your scale will undermine your motivation to continue what may actually be great progress. Throw away your scale and use a measuring tape to trace your progress. Measure your waist/hip ratio instead. If that number goes down, even if your weight is going up, you are making great progress. That scale is probably your worst enemy. It is lying to you about your progress, trying to make you quit. Throw it out.

8: Raise your cholesterol levels

For years we have been tolled that serum-cholesterol levels are a health risk. After that it turned out only LDL levels were relevant. Still later we find out that LDL particle size is actually the thing that matters for as far as cholesterol matters. Loads of people, including MD’s haven’t gotten the news yet on the latest one. Anyone struggling with cholesterol levels, read up on diatary changes that can help you raise your HDL levels and LDL particle-size and after making the proper dietary changes, try to convince your MD you want a particle-size test. If the results come out OK, than your LDL levels are hardly relevant, and if your MD wants you to take cholesterol lowering drugs despite of your particle size test results, or if your MD tries to tell you particle size tests aren’t relevant than seriously you need to find a different MD. Cholesterol lowering drugs aren’t harmless, they are linked to many severe side effects. You truly don’t want to be taking these drugs without a real need for them. Unfortunately however they are probably the most oversubscribed   drug at this moment and the drug with the highest rate of misdiagnosed side-effects (many Statin side effects such as muscle pains and loss of memory are routinely ascribed to ageing). As said, the only cholesterol metric that counts is LDL particle size and for a great part getting the particle size up can be achieved with diet and harmless supplements. Get those numbers up and get yourself away from Statins and other cholesterol lowering disciplines.

9: Eat more meat

You know dietary guidelines telling you to eat less meat, especially less red meat? Well guess what, if we look at epidemiological data that includes all-cause mortality and if we than calculate the probability of living to be 80 years old, turns out eating more meat and other sources of animal fat and protein is actually correlated with a higher probability. It isn’t all that simple though. for young people there is a significant correlation between red meat and mortality rates. For seniors however this correlation is negative in a dramatic way. Problem: due to the epidemiological nature of the data it is impossible to conclude if old people dying due to eating red meat is the result of a lifetime of meat eating or is the result of continuing to eat large amounts of meat at an old age.  There is definitely more study required to figure out what exactly is going on, but the idea that consuming less meat will reduce life expectancy is contradicted by the data. So sorry to my vegan friends out there, you are doing an amazing thing from an ethical and ecological standpoint, but is may result in a lower life expectancy. When we are at the ethical side of things though, an other angle taht requires more research is the consumption of insects. If replacing meat, dairy, fish and eggs with insects could yield the same life expectancy results as meat and other commonly used sources of animal protein and fat, than an ecological footprint approaching that of our vegan friends could be achieved without reducing our life expectancy.

10: Eat less fresh foods

Well, fresh foods are important of-cause, but next to fresh food, you should consider looking into foods that are , well, not that fresh. That is: you may want to look into the health effects of so called fermented foods. The data on fermented foods, while limited is quite interesting. Enough so to warrant adding at least some fermented food sources to your diet.

 

Well that was it. Ten hopefully thought provoking nutritional candidates for a new years resolution. Hope you give aech of these candidates serious considerations for the new year. Have a great and healthy 2016 everyone.

This entry was posted on 6th January 2016.

Dietary advice by the Health Council of the Netherlands [part 1, eating less red meat?]

Recently, the Health Council of the Netherlands published their revised dietary guidelines.  I must say the council did quite a thorough job and they also published a decent collection of background papers. For any of you who understand dutch, everything is made available here.

We won’t be looking in dept at the background papers, the point is, the details are all meticulously looked at and as we will see, getting lost in the details can sometimes make people loose track of a bigger picture. What is the number one health risk we would want dietary guidelines to focus on? Are they markers for poor health like blood levels of certain proteins? Is it cancer? cardiovascular disease?  No, the number one high level health risk is ‘death’. We shouldn’t really care that much if our food gives us a higher risk of a stroke or a heart attack or cancer, or even if our food contributes to a higher probability of committing suicide. The one number we actually care about is called all-cause mortality.

So lets look at some of the high level dietary advice’s that the council gives us and lets look what we can find about their impact on all-cause mortality. A while ago I created a simple generic data-set browser that can help to get a high level view of a multi-variable data-set. The tool shows per-variable distribution densities and than allows you to select a second variable and get a heat-map showing the rough relationship between the two variables.  One useful source of data to do this with is the data from the China Study. It contains both nutritional information and data on mortality rates including all-cause mortality. The data browser for the China Study II is available here. So lets look at ten points of advice we should be able to have a look at in our data-set to see if the advice agrees with the data.

So what does the council advice that could possibly be confirmed or rejected with our data-set:

  1. Eat less red meat
  2. Eat fatty fish once a week
  3. Prefer plant based oils over solid and animal fats
  4. Eat legumes one time per week
  5. Eat 15 grams of nuts per day
  6. Eat 200 grams of vegetables per day
  7. Eat 200 grams of fruit per day
  8. Limit added salt to 6 grams a day
  9. Consume no alcohol at all, or at most one glass a day.
  10. In general, eat more plant based and less animal based products

Over the next few days I will look at each of those independently to see how they pan out. Today I’ll look just at red-meat. I’ll discuss a few more in my next blog post soon. Before we start though, a word of caution. All cause mortality in our data set is divided up into age groups. The units used for the different age-groups differ though. For the age groups 0..4, 35..69 and 70..79 the mortality numbers are in yearly deaths per thousand people. In the age groups 5..14 and 15..34 however, mortality is significantly lower, and an other scale is used where the numbers represent the number of deaths per one hundred thousand people per year. Please note also that the low number of deaths in these later groups make the results statistically much less conclusive if we look at the data from these groups. To get a rough idea of the kind of mortality rates we are talking about, a few normalized examples. We normalize to the number of yearly moralities per 100000 people in the given age group :

  • 0-4 : 200-1600
  • 5-14 : 27-150
  • 15-34: 70-360
  • 35-69: 850-2350
  • 70-79: 3000-15600

We need to keep these numbers in mind when looking at the data set.

Eat less red meat ?

 

redmeat

OK, lets start with an interesting one: red meat. What does the data set tell us about red meat? Well, the distribution of average red meat consumption has a nicely shaped form and ranges from a large group who eat no red meat at all to a thin tail where red meat consumption reaches levels up to 116.5 grams of red meat per day. Lets first look at the correlation with all-cause mortality for the different age groups. While we know we should not put to much value on the 5-34 age-group results, the positive correlation for the 5-14 age group is absolutely massive. Way too massive to ignore. Also for the 0-4 age group there is a quite convincing correlation there. As such, eating less or probably eating no red meat for under 15 year old would seem like a solid advice indeed. When however looking at the other side of the spectrum, 70 to 79 year old people, we see a massive negative correlation, that given the numbers involved we can be statistically confident about.  A negative correlation means that eating more red meat actually correlates with lower mortality rates. The lowest point on the heat map actually is around the 100 grams of red meat a day level.

Two age groups we didn’t look at yet: 15-34 and 35-69.  Lets look at the most statistically significant one first. We see a solid overall negative correlation, but we see something else that can often be seen in heat-maps like these: We see a basically V shaped mortality graph. There seems to be some magic amount of red meat, somewhere around 50 grams a day.  Great, looking at current consumption in the Netherlands, again the council seems to be spot on for this age group as it was for the children. But are they? Chinese people tend to be smaller than dutch people, and for many nutritional aspects, the amount of food per kg of lean body mass is actually what counts. If we look at the weight questionnaire from the same data set, the average weight of a person, depending on the locality is between 46 and 61 kg. This means we need to add almost 50% to all our figures here. That is, for an average dutch person in this age group, it is likely that the sweat spot should be more like 70 grams per day if we trust these heat maps. Still OK if everyone eats about the same as the average, than cutting on red meat consumption would be good advice. Now lets look at our last age-group left. As stated, less statistically solid, but still.  The correlation has become virtually zero for the overall graph, but look closely. The same V shape from our 35-69 group is also visible with the exact same sweat spot we just identified. The hypothesis that this heat-map depicts a transition from the 5-14 age group graph to the 35-69 age group graph appears very likely indeed. But as said, for this crucial age-group the total number of deaths is to low to extract any solid info on this proposed transition from our data-set. So what conclusions should we draw from this with respect to the councils advice to eat less red meat?

  1. With respect to children and adolescents the advice is solid and possibly even a bit conservative. Eating no red meat at all would seem safest when looking at our data set.
  2. With respect to adults with an average eating pattern the advice is solid as is it for young adults under an as yet undetermined age threshold who eat very little red meat to begin with.
  3. For adults after a certain as yet undetermined age threshold who already didn’t eat all that much red meat, eating less might not be in their best interest. For this group, (assuming a strong body-mass correlation) the data set suggests an optimum of somewhere under one gram per day per kg of total body mass.
  4. For senior citizens, eating less red meat seems ill advised. In fact, senior citizens when looking purely at our data set may actually want to significantly increase their dietary intake of red meat.

Note that this is just a preliminary visual inspection of the data-set using just two variables at a time. A more thorough multi-variable analysis of this advice will be done as a use-case in my upcoming book, so more on this to come. I hope at any rate that this analysis shows that even good solid dietary advice can potentially be detrimental to  specific groups of people as in our case here the senior citizens.

In my next few blog posts I’ll be discussing some more of the councils dietary guidelines.

This entry was posted on 5th November 2015.

An Engineers Food Pyramid

Pyramid4

We have all seen the old food pyramid, and many alternative food pyramids have been created. Vegan food pyramids, low-carb food pyramids, anti-inflammatory food pyramids, Paleo food pyramids, etc etc.

While working on my personal data and feedback loop driven approach to diet and workout, non of the food pyramids actually ended up coming anywhere close to what the data and multiple feedback-loop rounds ended up telling me. In this blog I want to talk about the food pyramid that resulted from my data-first approach to diet and workout. Some of it will look anti-intuitive. Some of it will look plain disgusting and some of it will look totally insane. But please bare with me while I try to explain the ideas behind this alternative food pyramid.

One important thing to note about this pyramid is that it assumes you are working out; lifting weights, and doing so at least three times a week.

layer 1: Protein, Micro-nutrients, fluids and feedback-loops 

At the basis of our pyramid we a set of important concerns that should be considered pivotal:

  • The engineers approach to diet and workout dictates we use a control feedback loop approach to our diet. No two persons are the same. Measure your results as objective as possible (in our case using the Generic Body Health Index  and its differential.
  • The most static part of our diet is protein. You should stay within a daily protein intake bandwidth ranging from 2.2g to 2.6g per kg of lean body mass. You should do this in a way that maximizes the diversity of amino-acids.
  • An other relatively static part of our diet is micro-nutrient diversity.
  • Where possible, we should try to get at least part of our protein using protein sources that also provide  relatively high levels of EPA and DHA Omega-3 fatty acids.
  • Where possible, our micro nutrient rich foods should also be sources of ALA Omega-3 fatty acids.
  • Finally, sufficient fluids are an other foundational ingredient of our diet.

So how do we achieve these levels? We will combine animal with plant sources for our protein intake. Nuts are both a source of healthy fats and of proteins. Diary is a great source of protein and some micro nutrient. The ratio’s of fat versus protein in nuts and diary are higher than what is suitable for our protein requirements and total caloric needs, so we need  to turn to add lean sources of protein. These could be eggs, meat and sea food.  Alternative to much of these animal sources, insects can form an environmentally friendly source of protein. Yes I know. Eating bugs sounds disgusting. The problem though is that plant based sources of protein tend to both have a to low protein/calorie ratio to satisfy our protein needs, and also lack beneficial diversity in amino-acid content. On the other side, diverse,lean, low-carb sources of protein come with an ecological footprint that is unsustainable for our current let alone our future world population. We need to find a middle ground between eating things like meat and turning vegan, and replacing at least part of our animal protein sources with insects seems to be the only way forward. If you are not up to it (yet) than go with more traditional animal protein sources, but in the mean time you should try to break through the mental obstacles that make eating bugs unacceptable to you. Eating bugs is healthy for you and  for the planet. We need to slowly adjust out mindset to the concept of eating bugs.  The foods discussed so far aren’t just sources of protein. If we choose them carefully and consume the whole spectrum, they should provide for a wide range of amino acids, part of our Omega-3 needs and part of our micro-nutrient needs. There are other essential micro-nutrients missing though. To supplement these, and to address our fluids requirements, we add veggie juice and water to our foundational layer. Take it easy on the starchy tubers though and add berries for taste and nutrient spectrum. We want to maximize the micro nutrient/carb ratio of our juice, at least at this level.

Layer 2: Fat & Veggies

Once we have our foundation secured, we can look at adding (mostly) fat and veggies upto a level slightly above our bodies base resting metabolism. We add veggies, spices and dark chocolate for additional micro nutrient diversity and additional dietary fiber. The fat part should mostly be mono-unsaturated fat, but saturated fats are a decent supplement when we don’t overdo it.  We already covered (most of our) Omega 3 needs in our foundation. Stay away from processed oils, oils made from GMO crops and fat sources high in Omega-6. No Canola oil or anything like that. When you need to choose between Canola oil and lard, lard is actually the healthier option. Not as healthy as olive oil, but much healthier than the highly processed oil from GMO rapeseed. As for mayonnaise. Mayonnaise is an easy addition to many foods that can add more healthy fats to your diet, but some care is needed. Most mayonnaise is made from processed oils and often contains high levels of sugar. Make your own mayonnaise using olive oil or other unprocessed oils high in monounsaturated fats and low in omega-6.

Layer 3: Timed carbs

You may have noticed that up to now everything has been quite in line with low-carb discipline. Fat, protein and lots of micro-nutrients with relatively little carbohydrates. The point to this has been: You truly don’t need carbohydrates if you are sedimentary. When you want to do a high intensity strength oriented workout, like the one my ebook will be advocating, than you really really need some well timed carbs. But when you do take carbs, its a good idea to time these carbs perfectly relative to the time of your workout.  Much of the carbs from our veggie juice can be included in our carb timing on our workout day, but chances are these won’t be enough.  We add more sources of carbohydrates to the timed layer of our diet. We do this in three parts:

  • Starchy foods in our pre-workout meal
  • Fruits as pre-workout snack
  • Coconut juice mixed with water and possibly part of our veggie juice as sports-drink for consuming during our workout.

It is possible that your personal control feedback loop will add some post-workout carbs also, but the core concept of this layer of the pyramid is that most of your carbohydrate intake is concentrated around your workout. On resting days your diet should be a low-carb diet. There seems to be absolutely no benefit in high carbohydrate levels for sedimentary days. If you do consume high carbohydrate foods on resting days, do so in limited quantities and prefer starchy foods over sugary foods. No sweat fruits or fruit juice and certainly no dried fruits.

Layer 4:  Use sparingly

A food pyramid wouldn’t be complete without a ‘use sparingly’ section. While processed foods of most types should be considered off-limit, a diet meant as a way of life instead of a short period of suffering, can only be sustained if you allow yourself to indulge yourself in a bit of the bad stuff. In this diet the bad stuff that is acceptable for occasional indulging are sugar, grains and non-processed oils rich in Omega-6. You shouldn’t make consuming these foods to much of a habit, but banning them completely won’t make you popular at parties. So if you are invited to a lunch, have that bun of bread, or at that party that piece of pie. Unless you have a really big family and end up eating pie twice a week that is 😉

 

 

This entry was posted on 19th October 2015.

Can insects safe your heath and the planet?

The data set from the China Study II is such an amazing source of data. While there are plenty of limitations to the data set due to the nature of epidemic research tendency to use combined data points, the ability of this data set to debunk wild theories keeps on amazing me.

Before I will go on to demonstrate where Vegans are wrong regarding some of their health claims, let me start of with a word of admiration for Vegans. When it comes to the environment, vegans, with their aversion towards animal foods are spot on. If you care about the future of this planet we live on, than eating less or no animal based food is the best way to go. If you do the math, the energy production of human consumable calories through meat, fish, eggs and dairy is hopelessly inefficient in terms of energy. Terrible in terms of water usage, and than we aren’t even talking about global warming, dead-zones in the sea and a declining world fish populations yet.  Think CO2 from fossil fuels is our main environmental issue? Well, think again, the damage from animal based food production and (over) fishing is much much worse. Even when just looking at global warming, I know it sounds silly and ridiculous, but global warming is likely to have significantly stronger links with methane from animal based food production (cow-farts and the likes) than from all cars and airplanes combined.  I’m not a vegan myself, but these facts combined make that for me, vegans are my heroes.

If you are a vegan for these reasons: good for you, you are an amazing person. If however, like me, your personal health is something you think to be more important than that of the planet, and (unlike me) you have been convinced that being a vegan is actually the best thing you can do for your health, than you now have a choice: read on and be set for a fundamental and difficult choice between your health and that of the planet, or stop reading now and go read the book with the same name as the study I’ve been using the data set of. I won’t tell you to eat meat, but what I suggest may make you wish I had suggested it 😉

So here we go:

If we look at the all cause mortality numbers for woman in the age of 35 to 69, a gender and age group I focused on already in my previous post, and we correlate those numbers to the intake of a few animal food sources, a few things stand out:

  1. Significant negative correlations mostly across the board.
  2. Only dairy is positively correlated.
  3. The persistent V shape of the correlation heat-maps.
  4. The fact that for eggs there is no such V shape.

Red meat, -0.29. Fish, -0.43, percentage of calories from animal fat, -0.33, animal protein, -0.42. But that is before we examine the V shape of the heat map. Most animal-food/mortality-rate heat-maps show a clear V shape with a distinctive sweet-spot where the mortality rates for females in this age group are significantly lower than anywhere else. Below the sweet spot the correlation is very much negative, above the sweet spot it turns very much positive. This also goes for the one animal food with an overall positive correlation: dairy. So what does this mean? Very much that we are omnivores and not eating any animal food sources may be a bad idea, yet at the same time, eating a whole lot of animal based food may also not be that good an idea. So lets look at a few sweet spots. Please note that the correlations are between average gender and age independent food intake and gender and age dependent mortality, so the numbers will need some nuance before applying to your diet, but the general order of magnitude should be about right. A short indicative list:

  • Red meat: 50 grams/day
  • Fish: 30 grams/day
  • Dairy: 100 gram/day
  • Percentage of animal fat: 20%
  • Percentage of animal protein: 30%

And than there are the ones that is persistently negative: the number of days per year people eat eggs. If we assume there is a V shape in there somewhere just after the end of our heat-map, we could safely say:

  • Eggs: 1 egg/day
  • Poultry: 20 gram/day

Its quite possible that the upward arm of these two will not happen for much, much longer, but the data isn’t there, so its safe to be conservative here.

But lets not get caught in the details to much. The interesting numbers are these two:

  • Percentage of animal fat: 20%
  • Percentage of animal protein: 30%

Can we serve both our health by providing our bodies with these percentages, and serve the good of the planet by not partaking in the destruction of the planet ? Well, it seems there is a potential way out: Insects.

incects

Turns out that potentially Insects can be produced both energy and water efficient, and what is more: insects don’t fart, so the global warming thing won’t be an issue either. There should absolutely be controlled and epidemiological studies investigating the health effects of replacing meat, fish, eggs and dairy with insects, but on paper things look pretty favorable. Could we safe both our own health and the planet at the same time by admitting that yes we do need animal foods for our health, but if we pick energy and water efficient animals, animals that can be produced without a significant ecological footprint  instead of the cows that may be the main thriving force behind global warming or fish species that may go extinct if we keep consuming them.

 

This entry was posted on 21st September 2015.