Interesting items from my inbox and elsewhere …

We’re under-statinated!

Yup, according to this article about a Harvard study, even more people should be on statins:

A new study from Harvard T.H. Chan School of Public Health researchers has found that it would be cost-effective to treat 48-67% of all adults aged 40-75 in the U.S. with cholesterol-lowering statins. By expanding the current recommended treatment guidelines and boosting the percentage of adults taking statins, an additional 161,560 cardiovascular-related events could be averted, according to the researchers.

Well, why the heck stop at 67 percent? The way these guidelines keep expanding the definition of “at risk,” you’ll soon be considered at risk for a heart attack the day you’re born.  Best start adding statins to baby formula just to be sure.  I’m reminded of something Dr. Malcom Kendrick wrote in his terrific book Doctoring Data:

The boundaries that define illness have narrowed inexorably. When I first graduated from medical school in 1981, a high cholesterol level was anything above 7.5 mmol/L. Over the years, this level has fallen and fallen to the point where a ‘healthy’ level is now 5.0 mmol/L. I suspect it will soon be 4.0 mmol/L. Anything above this figure, and you have an increased risk of heart disease – allegedly. Considering that over 85% of the adult population in the western world has a cholesterol level higher than 5.0 mmol/L this is a quite amazing concept. I will admit that I have never been that brilliant at statistics. However, it seems to me that attempting to claim that more than 80% of people are at high risk of heart disease stretches the concept of ‘average’ to the breaking point – and well beyond.

Back to the article about the Harvard study:

“We found that the new guidelines represent good value for money spent on healthcare, and that more lenient treatment thresholds might be justifiable on cost-effectiveness grounds even accounting for side-effects such as diabetes and myalgia,” said Ankur Pandya, assistant professor of health decision science at Harvard Chan School and lead author of the study.

Yeah, what’s a little muscle pain, memory loss or diabetes when you might reduce your risk of a heart attack by teensy-weensy percentage?

They also found that the optimal treatment threshold was particularly sensitive to patient preferences for taking a pill daily, which suggests that the decision to initiate statins for primary CVD prevention should be made jointly by patients and physicians.

When your physician sits down with you to make that joint decision, I suggest you give the answer I gave when a doctor suggested a statin for my (ahem) “elevated” cholesterol:

“I wouldn’t take a statin unless you held a gun to my head and I was convinced you’d pull the trigger.”

Fat makes you feel full … and makes you fat … and … say what?

Pronouncements by nutritionists often make me want to bang my head on my desk. Others just leaving me scratching my head in wonder. A reader sent me a link to an article about avocadoes which includes this gem from a nutritionist:

As with many other fruits, avocados’ primary risks are related to overconsumption. “Consuming too many avocados may lead to weight gain because of the fat content, even though it is an unsaturated fat,” said Flores. “It can also lead to nutritional deficiencies, since fat is digested slower and leaves you feeling fuller longer than [do] other nutrients.”

Go ahead, try to wrap your head around that one. I double-dog dare ya. In just two sentences we learned that 1) fat makes you feel full longer than other nutrients, but 2) fat also makes you fat. So I guess the key to weight loss is to eat foods that don’t make you feel full. Oh, and 3) feeling full leads to nutrient deficiencies.

Uh … uh … because you stop eating before you eat enough to get your nutrients? But then you gain weight?

I’m starting to think every time a nutritionist leaves a crowded room, the average IQ goes up by at least 10 points.

Soy sorry about the soybean oil.

Somebody get Paul Newman on the phone and convince him to change the formula for those Newman’s Own salad dressings. A new study reported in an online article suggests soybean oil induces weight gain:

Sugar has been blasted in recent years for its link to obesity and a slew of health problems, but now experts say the food world has a new problem child: Soybean oil.

Soybean oil, considered a “healthier” alternative to some oils that contain more saturated fat, actually leads to more weight gain than fructose, according to new research on mice that was published in the journal PLOS One.

Okay, how many scientists and health organizations have to announce that saturated fat isn’t actually bad for us before we stop seeing products labeled as “healthier” because they’re low in saturated fat? A hundred? A few thousand? All of them? Anyway …

For their research, scientists divided the mice into four groups and fed them each a different diet that contained 40 percent fat (similar to the average American diet). One diet used coconut oil (which largely consists of saturated fat), another used half coconut oil and half soybean oil (which primarily contains polyunsaturated, or “good” fat). The third and fourth diets had fructose added.

All four diets had the same number of calories, and the mice were fed the same amount of food.

Here’s what researchers discovered: Mice that were on the soybean oil diet gained 12 percent more weight than those that ate a fructose diet, and 25 percent more weight than mice on the coconut oil diet.

The mice on the soybean oil diet also had larger fat deposits in their bodies and fatty livers, and were more likely to have developed diabetes and insulin resistance. Mice on the fructose diet didn’t get off easy, either — they had similar issues, but to a less severe degree.

It’s only a mouse study, so let’s not get too excited. We can’t conclude that the effects on human beings would be the same. But here’s what I find most interesting: the ol’ calories-in/calories-out theory sure didn’t hold up in this study, did it? Yes, these are mice, but we’re told over and over that CICO is A LAW OF PHYSICS. Mice aren’t immune from the laws of physics.

Neither are humans, of course. If you gain weight, you absolutely, positively consumed more calories than you burned. But what this study demonstrated (again) is that the quality of the calories consumed affects the number of calories burned. To repeat a quote from the article:

All four diets had the same number of calories, and the mice were fed the same amount of food.

So only an idiot would believe the mice on the soybean-oil diet gained 25% more weight because of calories alone.

It could also be a matter of calories alone, certified dietitian-nutritionist Jessica Cording tells Yahoo Health. Soybean oil is a fat, and fats contain nine calories per gram, she says. However, carbohydrates such as fructose contain four calories per gram.

Every time a nutritionist leaves a crowded room …

This thing will stop your weight from ballooning?

Up, up and away …. or down, down and in your belly. A balloon is the latest, greatest weapon in the Just Eat Less! battlefront, according to this article:

The FDA has approved a gastric balloon to treat obesity, adding to a fat-busting device arsenal that includes gastric banding and a vagal nerve stimulator.

The ReShape dual balloon system is indicated for obese adults who have a body mass index (BMI) of 30 to 40, and at least one other obesity-related comorbidity such as hypertension, high cholesterol, or diabetes.

It’s placed into the stomach using an endoscope, and once it’s inflated it is meant to diminish obesity by triggering feelings of fullness, “or by other mechanisms that are not yet understood,” according to the FDA press release.

It gives me great confidence in the FDA to hear that they’re approving medical devices whose mechanisms are not yet understood. But I totally understand that “triggering feelings of fullness” method for losing weight. I feel full after my meals. But those meals don’t include sugars or grains (or soybean oil) that induce weight gain.  In fact, I’ve lost weight while eating meals that made me feel full.

So what kind of dramatic weight loss does the up, up and away balloon induce?

In a 326-patient clinical trial, patients on the device lost an average of 14.3 pounds over 6 months, compared with 7.2 pounds for those in the control group.

Hmm, let’s do a little simple math here. The balloon-belly treatment group lost 14.3 pounds, while the control group lost 7.2 pounds. The trial lasted six months. Okay, hang on … subtract, divide … WOW!! That balloon was responsible for an additional weight loss of 1.18 pounds per month!

I think it would do more good if they filled it with helium and gave it a slow leak. Then people could at least sound like the munchkins from the Wizard of Oz when they say, “I walked around with an inflated balloon in my belly all month, and I only lost one extra pound? What the @#$% is the point of that?!”

Rice not nice to teeth?

This isn’t from an article; it’s from a book. When I commute to Nashville or spend five hours behind a mower cutting the back pastures, I listen to books. The one I just finished is Helmet For My Pillow, by Robert Leckie. If you saw the terrific HBO series The Pacific, Leckie was one of the marines featured. The audiobook is read by James Badge Dale, the same actor who portrayed Leckie in the series, which is a nice touch. You can listen to part of the book and then watch an episode of the series (as I did last week), and you’re hearing the same character speaking with the same voice.

Anyway, in Helmet For My Pillow, Leckie describes how after a battle, some marines would go prospecting in the mouths of dead Japanese soldiers. Why? Because at the time, Japanese dentists filled cavities with gold – and according to Leckie, some of the Japanese soldiers had a treasure of gold in their mouths. Lots and lots of cavities.

The Japanese weren’t eating lots of sugar in the 1940s – even today, the Japanese consume less than half as much sugar per capita as Americans. But they were certainly eating plenty of white rice in the years before WWII. In fact, on Guadalcanal, the U.S. navy was forced to withdraw for awhile, which left the marines stranded without a food supply. They ended up living on rations captured from the Japanese — which mostly consisted of rice.

So I’m thinking whatever its status as a safe starch, perhaps white rice isn’t so great for keeping a pearly smile.

Good thing I don’t much like the stuff.

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I’m just about out of the woods on the big work project.  I’ve been working long days partly to get ‘er done, and partly to front-load my billable hours so I can work shorter days next week.  Weather permitting, I’ll be spending part of my days next week in the front pastures, playing disc golf with Jimmy Moore.  It’s become an annual tradition — which for some reason we always observe during a July heatwave.

Speaking of Jimmy, The Ketogenic Cookbook: Nutritious Low-Carb, High-Fat Paleo Meals to Heal Your Body (which he wrote with Maria Emmerich) is now available.  I haven’t seen it yet, but I suspect he may have a copy with him when he arrives on Saturday.

As you probably know, I don’t measure ketones or aim for ketosis, but I always enjoy thumbing through new low-carb/keto/paleo cookbooks just because some of the recipes look awesome.  I still enjoy plenty of high-fat meals that would be considered ketogenic from a macronutrient standpoint.

We still have 500 pounds or thereabouts of pork in our downstairs freezer, so I’ll have to see if Jimmy has any especially good recipes for Boston Butt.  If not, there’s always sausage …

 

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Chareva and I were the guests on a recent episode of the AgriCast Digest podcast show.  We talked about chickens, of course, but also about diet and health, why we decided to move to a small farm, the upcoming kids’ book, etc.

You can listen to the episode here.

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Sometimes that darned working-for-a-living thing gets in the way of more important stuff — like writing blog posts.

I was too swamped with work on Monday to write a post, and I still am.  Chareva’s visiting her parents, so I’m also on chickens-dogs-cat-kids duty for the next few days.

See you next week … I hope.

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A production crew from Korea came to the Fat Head farm on Sunday to interview me and to film us collecting eggs and cooking them up with some sausage. The segments will go into a TV special about the controversy over whether saturated fat and cholesterol cause heart disease. I will, of course, be one of those who says nope, they don’t. They’ll interview several other people who share my opinion (Uffe Ravnskov and Chris Masterjohn among them, if I remember correctly) and, of course, the usual suspects who still promote the artergycloggingsaturatedfat! theory.

I wasn’t sure how specific they’d want me to be as far as citing research, so I took some time over the weekend to poke through my database of articles and studies. Turns out their questions were more general (“Do you worry at all about how much saturated fat you eat?”), but what the heck, since I came across a couple of interesting items in what I now think of as the Cold Case Files, I thought I’d share them.

The first is a study published in – wait for it – the Journal of the American Heart Association. The AHA is, of course, one of the organizations most responsible for scaring people away from saturated fat. Saturated fat raises cholesterol, and high cholesterol causes heart attacks, doncha know. At least that’s been their position ever since Ancel Keys joined the AHA board of directors.

But this study is from 1961 – before Keys joined the AHA board. So I find the study’s conclusions rather fascinating. The researchers gathered data on serum cholesterol levels and coronary artery blockage taken from 200 autopsies. Here’s what they found:

The mean atherosclerotic indices, i.e., the amount and severity of atherosclerosis in the aorta and the coronary and cerebral arteries, showed progressive increase with age.

The mean serum total cholesterol concentration rose progressively from the first decade to a maximum level in the fifth decade and subsequently declined.

In other words, cholesterol tends to rise until sometime around age 50, then drop a bit. The buildup of plaque in the coronary arteries, meanwhile, progresses throughout life. The researchers noted those facts because they wanted to avoid a false association:

The mean serum total cholesterol showed a progressive rise from the first to sixth groups of aortic atherosclerosis, but, at the same time, the mean age for each group also increased. Since the amount of atherosclerosis in the aorta increased with age and the serum cholesterol concentration also rose up to the fifth decade, it is important to determine if the significant correlation between the concentration of serum total cholesterol and aortic atherosclerosis is a correlation with severity of atherosclerosis per se or is merely due to the effect of age, or both.

So they compared serum cholesterol and coronary blockage within age groups. The results:

No correlation could be found between the two, indicating that, when the age factor was removed, the positive correlation between aortic atherosclerosis and serum total cholesterol is statistically insignificant.

And later in the same paper:

In the present study, we did not find any significant correlation between the blood serum total cholesterol and atherosclerotic index as a representation of the extent and severity of atherosclerosis for any of the vessels studied. The mean serum total cholesterol concentration in the six groups of aortic atherosclerosis showed a successive rise but, when the age factor was taken into consideration, the correlation between atherosclerosis and serum cholesterol in these same groups was found statistically insignificant.

No significant association once you take age into account.  Doesn’t that just make you want to run out and get a prescription for statins?

In my research database, I also found an abstract from a European Journal of Clinical Nutrition study of diets in the U.K. vs. France. It’s a bit of a silly study, based on dietary recall and all that, but I saved it because of this gem:

There were positive and negative trends in food consumption in each country. UK respondents reported eating more beans and pulses, less cheese, red meat, and processed meats than French respondents. However, on the negative side, they ate less fruit and vegetables, fish and poultry, cereals, and more sweets and chocolates and cakes, pastries, biscuits and puddings.

Hey, way to go, UK! Sure, the Brits reported eating more sweets and biscuits. But by gosh, they also reported eating less meat, processed meat and cheese than the French. I’m pretty sure they also eat less butter than the French. And aren’t foods like meat, cheese and butter the causes of heart disease?  They raise cholesterol levels, ya know.

The study was published in 2000. I happen to have spreadsheets of World Health Organization data on average cholesterol levels and heart-attack deaths from that period. (Some of it’s from 2000, some from 2002.) I plucked the data for the UK and France. I also added data for the Czech Republic, Germany and Russia. Why? Well, the Russians have low average cholesterol, the Czechs have the same average cholesterol as the French, and the Germans have one of the highest average cholesterol levels in the world.

Here are the average cholesterol levels among men, from lowest to highest:

Russia 189
UK: 197
France: 209
Czech Republic: 209
Germany: 220

According to the Cholesterol Kills! theory, the Russians are in great shape as far as heart disease, while the Germans are probably grabbing their chests and dropping like flies.

Here’s a chart I created in Excel to plot cholesterol levels against rates of heart-attack deaths. The blue line is average cholesterol levels among men; the orange line is annual heart-attack deaths per 100,000 men.

Hmmm, things aren’t looking so good for the Russians after all. And German men have fewer fatal heart-attack deaths as a group than men in the UK, despite an average cholesterol level that’s 23 points higher.

The Russian heart-attack rate is so high, including Russia scrunches the chart. So here it is again with Russia removed.

If high cholesterol causes heart disease, those lines should more or less rise together. But they clearly don’t. If anything, they tend to move in opposite directions.

It was fun digging through the Cold Case Files. But I’ll be happy when the entire Cholesterol Kills! theory is a cold case file.

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Many of you are probably familiar with Dr. David Perlmutter because of his book Grain Brain. I recently finished his follow-up book, Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain–for Life. I can’t quote from it directly because I listened to the audiobook instead of reading a paper copy. (That’s what I do while spending five hours at a time behind a lawn mower on our property: listen to books.) But I can tell you I consider this book a must-read, especially for low-carbers.

I say “especially for low-carbers” because there’s a belief in the low-carb community (which I once shared) that fiber is useless. That belief stems from studies showing no relationship between fiber intake and rates of colon cancer – and that’s why most of us were told to eat our fiber: to prevent colon cancer.

However, the fiber in those studies tended to come from whole grains – which Dr. Perlmutter of course doesn’t want us to eat in the first place, since grains can damage our intestines. Perhaps other fibers do protect against cancer.

But even if they don’t, cancer isn’t the whole story. Not by a long shot. The real benefit of plant fibers is in feeding our gut bacteria. Dr. Perlmutter pounds home that point over and over in Brain Maker: if you want to be healthy, both physically and mentally, you have to feed your beneficial gut bacteria — period, end of story. Those gut bugs want to eat plant fibers. They need to eat plant fibers. In fact, Dr. Perlmutter recommends you fill two-thirds of your plate with plant foods.

Since he’s a hero in the low-carb community, I’m delighted to see this message coming from him. Perhaps some people with a nyaaa, fiber, who needs it? attitude will be inspired to change their minds. As I wrote in some posts last year about why I started adding resistant starch to my diet, if there’s a potential danger in a very low-carb diet, I believe it’s in not feeding the gut bacteria. Dr. Perlmutter is very much on board with a carb-restricted diet, but teaches the reader how to add those all-important fibers without relying on high-starch or high-sugar foods.

As the title suggests, much of the book explains the connection between a healthy gut and a healthy brain. Dr. Perlmutter recounts a number of cases where rebuilding the gut microbiome (with diet or, in a few cases, a fecal transplant) cured patients of depression, or ADHD, or autism, or Tourette’s Syndrome. In some cases, the gut-cure worked after everything else had failed.

But I’m guessing the title is also partly the result of marketing. When your runaway best-seller is named Grain Brain, you’d best put Grain or Brain in the title of your next book. Brain Maker is really about the profound effect the gut microbiome has on the entire body, brain included.

Let’s take an example near and dear to the heart of many readers: weight loss. Dr. Perlmutter describes experiments in which gut bacteria were transferred from thin mice (or thin people) to obese mice. The obese mice became lean. It works the same in reverse, too. When researchers disrupt the gut microbiome of lean mice and transfer gut bugs from fat mice, the lean mice become fat.

As Dr. Perlmutter explains, there are strains of gut bacteria that seem to induce obesity and strains that seem to protect against it. Eating fermented vegetables and other fermented foods helps to populate our guts with protective bacteria.  If they’re fed the right kinds of plant fibers, they flourish. But without the right fibers, their numbers dwindle. They can, of course, be devastated by antibiotics. There’s also evidence that certain pesticides and even artificial sweeteners like aspartame can either diminish the number of good gut bacteria or encourage overgrowth of the bad bacteria.

Listening to the book got me thinking about two classes of people: lean vegetarians and low-carbers who lose weight but stall well above their goal. Don’t worry, I’m not going to suggest low-carbers become vegetarians instead. As I explained in Fat Head and quite a few posts, I grew fatter on a vegetarian diet, not thinner. But my vegetarian diet included lots of grains and few of the types of plant fibers Dr. Perlmutter recommends. Perhaps the vegetarians who really and truly eat lots of vegetables (as opposed to grains and soy) stay lean partly by maintaining a healthy gut microbiome – not because they give up meat, but because they eat lots of beneficial plant fibers.

On the flipside, perhaps some low-carbers stall well above their goal weight because they don’t eat beneficial plant fibers. (For the record, I also believe some people are metabolically damaged to such a degree, they can never be lean without starving themselves, which is unhealthy.) If your diet consists of meat, eggs, butter, cream, more meat, a broccoli sprig here and there, plus a side of meat, there’s not much there to feed your beneficial gut bacteria. Toss in some diet sodas with aspartame, and you could be starving the gut bugs that protect against obesity while encouraging the proliferation of gut bugs that induce it.

So what should you be eating to feed the beneficial bacteria? Like I said, I don’t have a paper copy of the book, but the audio version came with a PDF file of recipes. The common ingredients Dr. Perlmutter recommends include onions, garlic, jicama, blueberries, chick peas, Jerusalem artichokes, leeks, fibrous green vegetables of all kinds, plus plenty of pickled and fermented foods. (Apparently the Scandinavians knew what they were doing when they came up with pickled herring.)

I’d add one suggestion of my own: tiger nuts. I understand why people with blood-sugar issues are hesitant to eat the cooked-and-cooled potatoes or green bananas recommended by Paul Jaminet and others as sources of resistant starch, but I doubt tiger nuts will take anyone’s blood sugar on a roller-coaster ride. They’re 40% fat by calories, with lots of fiber and resistant starch — the type of starch your gut bugs love to digest and turn into short-chain fatty acids in the process.

I’ve been eating a small dish of tiger nuts almost daily for a year or so, and I’m pretty sure my gut bugs have never been happier. My digestion is the best it’s ever been, on any diet. I also sleep more deeply, dream more vividly, and wake up more rested than I used to.

But wherever you get your plant fibers, please get them. (Well, not from grains, of course.) As the book explains, gut bacteria account for 90% of all the cells in your body. We evolved with them, and they evolved with us. They’re as much a part of you as your heart and your liver, and nearly as important. Take good care of them, and they’ll take good care of you.

Brain Maker is an excellent guide for doing just that.

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