Last January I reviewed Jonathan Bailor’s excellent book The Smarter Science of Slim, which is very well written and packed with references to research. Bailor will also be a speaker on this year’s low-carb cruise, so I’ll be meeting him in person … after roasting him, of course.
In the meantime, he’s launched a non-profit organization dedicated to providing the public with information about diet and health. Rather than try to summarize their activities myself, I’ll quote Bailor:
Wanted to drop you a quick note as we were fortunate enough to receive VC funding to start up a non-profit ancestral nutrition educational organization we’re calling Slim is Simple. SIS is working to provide compelling multimedia resources—free of charge—that the entire good nutritional science community can leverage to help share the simple lifestyle adjustments that have helped us all help so many people live so much better. We’re working to get this “curriculum” into schools, churches, and etc.
Now and then I receive emails from new readers or viewers with a question that goes something like this:
I’m interested in trying a low-carb/paleo lifestyle, but I’m not sure how to get started. You have a lot of interesting books listed on your Recommended Reading page, but I don’t have time to read them all. If I wanted to start with just one book, which one would you recommend?
I always give the same answer: If you’re only going to read one book, it should be The Primal Blueprint by Mark Sisson. There are some excellent how-to books for starting a low-carb diet (A New Atkins for a New You fits that bill nicely), there are some excellent examinations of the science (Good Calories, Bad Calories would top that list), but of all the books I’ve read, The Primal Blueprint still does the best job of providing an easy-to-read explanation of both how and why a primal lifestyle can give you back your health.
To summarize the book in one paragraph: Millions of years of evolution shaped our genetics. When we eat and move as Nature designed us to eat and move, we express the genes for health. When we don’t … well, look around and you can see the results. Here’s how you need to eat, here’s how you need to move, and here’s the science to back it up.
Sisson’s latest book is titled The Primal Connection, and perhaps the best one-sentence summary would be the line made famous by radio icon Paul Harvey: And now, for the rest of the story …
Sisson realized there was more to the story when he heard from readers who told him how much their health had improved since they began eating and moving like Grok, his mascot for our Paleolithic past … but while they felt better, they still didn’t feel good. They still didn’t feel fully alive and content and happy. Something was still missing. As Sisson explains in the book’s introduction:
That diet and exercise are ways in which we can harness gene expression to rebuild, renew, and regenerate ourselves every moment is obvious to me. But in a short time, I came to believe that there was much more to uncover. Maybe we are wired for happiness and contentment just as we are for fitness and health.
… Moving away from the trappings of and stresses of modern life is one of, if not the, key goal in the Primal Blueprint approach. However, when our relationship with our primal ancestors gets distilled into just how we diet and exercise, we lose sight of that ultimate goal. Considering that our more advanced natures have been evolving over some two millions years, what else might our genes expect from our environment? Specific sleep conditions? Certain models of socialization? Interaction with nature? Play? Beyond these questions of what, there’s the question of how these inclinations unfold in modern humans in a modern world. Are we meeting them? How do our innate expectations conflict with our contemporary lifestyles?
Grok didn’t just eat differently and move differently than we do. His life was different from ours in many ways. He was connected to his neighbors – they were, after all, his tribe. He was connected to his surroundings. He was connected to the plants and animals that fed him. His daily activities were connected to the rising and setting of the sun.
In modern society we’re digitally connected to the entire world, yet disconnected from much of what made us human in the first place. We can’t sell our houses, cash in our 401ks, and go live in small bands in the woods, but we can, to a large degree, reconnect with the rhythms, habits, and experiences that were part of our primal ancestors’ daily lives. That’s what The Primal Connection is about.
The book is divided into six major chapters. Here the titles of those chapters and my (extremely brief) summaries:
The Inner Dialogue Connection. Grok couldn’t survive by spending half his day listening to negative “monkey chatter” coming from his own brain. You need your internal dialogue to work for you, not against you.
The Body Connection. Nature designed us to be active, to touch each other, and to walk barefoot.
The Nature Connection. Concrete jungles don’t provide the sights, sounds, smells and experiences your genes expect. Nature does … and getting down and dirty is actually good for your health.
The Daily Rhythm Connection. Grok didn’t check his friends’ Twitter feeds at midnight and then watch TV for an hour before going to bed. We were designed to wake with the sun and live by its daily rhythms.
The Social Connection. For most of human history, we lived in relatively small, close-knit groups. Having a thousand friends on Facebook won’t do as much for your health as honoring your relationships with the people you actually know.
The Play Connection. All work and no play makes Jack a dull boy. Grok understood that energetic play was good for his body and his brain.
The Primal Connection is full of good ideas for living a more fulfilling life by finding ways to reconnect with your primal nature. It’s also a pleasure to read. If you’ve read The Primal Blueprint or Mark’s Daily Apple, you already know Sisson is a gifted writer who can take complex ideas and translate them into clear, easy-to-follow prose. I never find myself re-reading one of his sentences to try to figure out what the heck he was trying to say.
For much of the advice Sisson offers in the book, I don’t have to wonder if it actually works. I know it works. I’ve already adopted many of the habits and practices he suggests — partly because I’ve read books by some of the authors he references, and partly because in 54 years of trial-and-error living, you learn a few things.
My favorite chapter is The Inner Dialog Connection, in which Sisson spells out what he calls The 10 Habits of Highly Successful Hunter-Gatherers:
Build a tribe
Trust your gut
Pick your battles
Get over it
Sharpen your spear
If you read self-improvement books – financial, spiritual, relationships, artistic development, etc. – you’ll see essentially that same advice over and over. (Being selfish doesn’t mean living a me-first life, by the way; it means finding time for yourself and not letting other people dominate your life or walk all over you.) I try to follow that advice because it works. It didn’t really occur to me until I read The Primal Connection that it works largely because it fits our primal template.
I can’t claim that I’ve perfected all 10 habits, but I can tell you that the more I’ve adopted them, the happier I’ve become. To me, a tribe is what author Chellie Campbell refers to as Your People in her book The Wealthy Spirit. If you want to be happy and successful, you need to hang out with Your People. You need to do business with Your People. As much as possible, you need to avoid getting tangled up with people who are definitely Not Your People.
Putting that advice into a primal perspective, you could think of Your People as Your Tribe. If you don’t already have one, Sisson explains how and why you should build one. I couldn’t agree more … and I’d add the suggestion that if you’re in a tribe that doesn’t feel right for you, get out. Get out now. When we lived in Los Angeles, I remember complaining up one side and down another about all the whiny, self-centered, scheming, lying, me-first types I was trying to work with in Hollywood. After listening politely for awhile, Chareva finally said, “Honey, these aren’t Your People.” She was right. That’s partly why we don’t live there anymore. I needed a different tribe.
I learned about trusting my gut the hard way. I once took a job as a software contractor even though I got a bad vibe from the owner of the company. I couldn’t figure out what exactly about the guy bugged me, and the terms were right. So I took the job. Months later I found myself threatening legal action if he didn’t pay me the thousands he owed me. Then, and only then, he admitted he was going bankrupt and couldn’t pay me.
At least I haven’t repeated the mistake. The couple of times since then that I’ve picked up a bad vibe when meeting with a potential client for some software work, I’ve simply turned down the job, even when I didn’t have another one in the works.
In one of his lectures, Tony Robbins asks a question along the lines of “Have you ever found yourself in the middle of a battle, and after awhile you can’t even remember what you’re fighting for, but you keep right on fighting because you just know you have to win?”
That’s a case of not picking your battles. If you’re going to get into a fight, there should be a good reason for it.
Now and then some fan will alert me to a hit-piece about Fat Head or me personally that someone posted on the internet, along with a call-to-arms of “You’ve got to respond to this!”
Respond? Not a chance. To respond, I’d first have to waste some of my valuable time reading the hit-piece, thus dumping someone else’s garbage into my brain. (Good way to start a round of monkey-chatter.) Then I’d have to waste more of my valuable time writing a response. And in the end, it wouldn’t make a bit of difference. The people who’ve already decided they don’t like you or don’t agree with you aren’t going to be persuaded, no matter what you write. I still receive the occasional hate-mail in my inbox, and as soon as I realize what it is, I delete it without reading it. There’s no need to do battle. I don’t care if some goofball who happened to get my email address doesn’t like me.
Or as I put it to my daughter Sara a couple of years ago when she came home all upset because some dumb jock-type was making fun of her, “Sara, you’re a smart girl. Smart people don’t waste time worrying about what stupid people think of them. If he says you’re ugly, or weird, or whatever, just say, ‘Yeah, I know’ and walk away. Trust me, it’ll frustrate him so much, he’ll give up.” (He did, by the way.)
I don’t spend much time going barefoot and I’ve been a night-owl for as long as I can remember, so I’m not good at following Sisson’s advice on those fronts. (Perhaps even in paleo days, there were people like me who stayed up late, tending the fire and watching for predators.) What I have managed to do is arrange my life so I’m not waking up with an alarm clock. The company where I work as a software contractor encourages flextime. So I go to bed when I’m ready, wake up when my body decides it’s had enough sleep, then go to work. If that means working until 6:30 PM, I’m fine with it.
But since moving to our little farm in Tennessee, I have spent much more time following Sisson’s advice of getting dirty, enjoying natural surroundings, and engaging in energetic play. I’m definitely happier now than we lived in Los Angeles, but I figured that was simply the result of leaving an area I grew to loathe.
That’s probably part of it, but as Sisson explains, happiness is (like health) often a matter of gene expression. Sunlight, grass, soil, and the sights and sounds of nature trigger specific biological reactions that enhance our health and our moods. Perhaps those chickens are providing me with more than just high-quality eggs. Perhaps those weekend rounds of disc golf in the front pastures are giving me more than just some fresh air and exercise – and if they aren’t, I’ll pretend they are. “Chareva, I need to go play another 18 holes. My happiness genes need expressing.”
The chapter on social connections ought to be required reading for the wired-in generation. It annoys me when I’m in a restaurant and see four young people sitting at a table, with three of them texting or checking their Facebook pages while the fourth sits staring off into space, ignored. To get in on the conversation, the ignored friend would have to go outside and send a text. A buddy of mine (a wise father) doesn’t let his teenage daughters take their iPhones into restaurants or social gatherings. As he tells them, “You’re going to talk to the people you’re with, not people you know on Facebook.”
I’m a blogger and I enjoy the ongoing conversation with people from all over the world. (So does Sisson, obviously.) I also like being able to catch up with friends across the country. But sometimes we need to pull away from our electronic tethers and connect with people who aren’t currently in a different zip code. I mean seriously, has anything you’ve ever experienced online even come close to the happiness you feel after a lively dinner conversation with a small group of good friends? Have you noticed that no matter how much you enjoy watching a performer on TV, it never quite matches the experience of actually being there?
Being there was something Grok understood because it was just part of his life. Being with friends, being with family, being with nature, being in the moment, and being with himself, comfortable in his own skin.
The Primal Connection doesn’t urge you to throw away your iPad or move to the country and raise chickens. But it does encourage you to be more like Grok. We don’t know for sure if Grok was content and happy, but I bet his vocabulary didn’t include a word for “angst.”
Fat Head: It’s clear to me after reading your book that you jumped head-first into a lot of heavy-duty medical and biological science while educating yourself about health. Was that intimidating, or did you find the science fairly easy to grasp?
Angelucci: I think my interest in science started when I first discovered Star Trek at age five! I was a science fiction geek most of my young life, and my passion for sci-fi spawned an interest in real-world science and medicine. In retrospect, it’s not surprising that I migrated in the direction of science, academically and professionally.
Fat Head: One of the reasons I recommend the book is that you explain the science clearly to a lay audience. Does that come naturally to you? Did your background prepare you to interpret science for non-scientists?
Angelucci: I’ve always enjoyed learning a complex subject and then conveying it to others. My background is as a technical writer in various fields, including biotech, medical devices, nanotechnology, and software. I studied the life sciences at the University of Maryland in my younger days and more recently have been studying mathematics at the University of Texas.
Fat Head:Don’t Die Early is about more about health than weight loss, although you cover weight loss in one chapter. At 20% body fat before you changed your diet, you weren’t exactly a fat guy. Were you motivated to lose weight after the heart-arrhythmia incident, or was the weight loss more of a side-benefit of becoming healthy?
Angelucci: I certainly wasn’t trying to lose weight. The weight loss was purely a positive by-product of a healthier lifestyle. That’s part of the message I convey in Don’t Die Early: don’t fixate on weight—just adopt a healthier lifestyle and eat the proper foods and your body will achieve a consistent weight.
Fat Head: You fly from Texas to Milwaukee once per year so Dr. William Davis, the author of Wheat Belly, can be your cardiologist. That’s quite a trip. Why is it worth the travel to see him specifically?
Angelucci: I first found Dr. Davis through his blog, then got to know his attitudes better through my interactions with him on the Track Your Plaque forum. After realizing that my cardiologist in Dallas seemed uninterested in taking an investigative, detailed approach to cardiac care, it was an easy decision to make the trip. Dr. Davis, more than any other cardiologist I’ve encountered, focuses on root cause and prevention. Most of my visit with Dr. Davis entails spreading a year’s worth of lab tests and self-collected data across the exam table while we look for patterns, anomalies, and opportunities for further improving my cardiac health. It’s worth far more than the price of a plane ticket and a day’s vacation to know that I’m seeing such an engaged, prevention-minded cardiologist. Not to mention that I get a perverse thrill out of having a cardiologist who advises me to eat more fat!
Fat Head: You recount in the book how your health markers have dramatically improved since you changed your lifestyle. That’s great, of course, but how about the benefits we don’t measure? How do you feel? What improvements have you seen in your life besides lower triglycerides, reduced coronary plaque, etc.?
Angelucci: The less tangible benefits were plentiful. Eliminating wheat from my diet caused my decade-old acid reflux disease to disappear in a matter of weeks. That was remarkable. Gone, too, was my frequent congestion and malaise, leaving me with more energy during the day.
Perhaps the most amazing change is my relationship with food. Previously, if something delayed lunch or dinner for an hour or two, I was miserable, focusing only on my gnawing painful hunger and wondering when I could finally break away and eat something. That has all changed now. Food is no longer the demanding taskmaster that it once was because skipping a meal, or even multiple meals, is a trivial inconvenience. Most importantly, I now enjoy eating for the pleasure that delicious, real food brings. I’ve become more of a foodie than I ever was before.
Fat Head: I’ve had the experience of friends and acquaintances basically deciding that since I’m not a doctor and their doctors are still telling them to eat low-fat meals with plenty of whole grains, I must be wrong. Have you had the same experience?
Angelucci: Absolutely. I’m constantly reminded of the “Marcus Welby” halo effect that causes so many people to follow medical advice unquestioningly, while so quickly rejecting even the most well argued opinions from people like us who are not “experts.” If our health improves on this unsafe, low-carb diet it’s because we’re an anomaly. Thousands upon thousands of us reporting better health absolutely must be an anomaly because, dammit, grains are good for us!
Even in the face of considerable contrary evidence, I think it’s human nature to believe that our physicians have the correct information and know exactly how to do what’s best for us. Unfortunately, a trivial amount of research reveals many examples from present day back through history where an accepted medical opinion was blatantly wrong, caused untold deaths, and took a decade or more to change. Recognizing the fallibility of the medical system, and the individuals within it, is an important part of being a thoughtful and critical advocate of one’s own healthcare.
Fat Head: How do you deal with it?
Angelucci: At first I wanted to stand on a soapbox with a megaphone and just start shouting, “Eureka! I’ve found the answer! The experts are wrong! We don’t have to be unhealthy any more.” But I quickly realized that would just scare people, get me arrested, and cause me to miss a bunch of work. After a period of frustration, I realized that there are enough people in the world who are receptive that I’d rather focus on them and not spend time shouting at the rest.
Fat Head: One of the sections in Don’t Die Early is titled Prepare To Be An Outcast. How much of an outcast are you in your social group?
Angelucci: Two years ago I would have said I was a complete outcast. After Don’t Die Early was released and I guilted my friends into buying it, 75% of my closest friends have now adopted a healthier lifestyle and are raving fans. At work, however, where I’m compelled to be far more restrained, I’m still largely an outcast, surrounded primarily by two groups: the “healthy” low-fat, whole grain crowd and the younger ones who still think they’re immortal and don’t even think about preventive health yet.
Fat Head: Don’t at least a few people see how much better you look and feel and think, “Maybe this guy’s onto something”?
Angelucci: Some have approached me after seeing the “strange” way that I eat or after hearing through the grapevine that I’ve written a book on preventive health. I think that no matter what evidence is available, each person needs to reach a personal tipping point where he or she is compelled to change. Until a person realizes that there’s a better path for them and truly wants to change, it’s little more than interesting conversation.
Fat Head: Don’t Die Early focuses a great deal on testing, assessing for heart disease, and reducing inflammation. It seems to me it’s mostly we middle-aged types who care about those issues. Why would, say, a 25-year-old want to read this book?
Angelucci:Don’t Die Early has something for everyone, whether they’re 40-something and wanting to understand or prevent diseases or a 20-something who is interested in knowing why a certain lifestyle makes the most sense for optimum future health. By focusing on the science of a healthy lifestyle, instead of just preaching my opinion of what’s healthful and what’s not, I give the reader the tools to refute the hype and chart a personally tailored path towards optimal health. Even if you’re 18 years old, eating Paleo, and on your way to a 110-year lifespan, you can still buy the book for your parents, who have probably been following well meaning, but misguided, advice for the past 30 years.
Fat Head: Suppose you meet someone in a social setting who’s interested in becoming healthier, but you’ve only got a couple of minutes to give advice. What would you tell that person?
Angelucci: One look at today’s rapidly advancing healthcare costs and at the skyrocketing rates of modern disease and it’s obvious that we are not spending our way into becoming a healthier nation. More than ever, busy physicians, pressured by frugal insurance companies, are focusing on treating symptoms, not on prevention. If you want make sense of the confusing, conflicting medical and nutrition advice that bombards us daily, and truly understand what being healthier means, read my book. Don’t Die Early will help you understand how a loved one can be facing a heart attack or a stent, even though the checkups and stress tests were normal. Don’t Die Early will help you understand why more of us are diabetic than ever before, yet the tools to predict and prevent diabetes are cheap and easy to use. If you want to assess your health and optimize your lifestyle using objective tests and real data instead of generalizations and hyperbole, read my book.
And while you’re waiting for the book to arrive, watch Fat Head. It’s by far the best overview of what has gone wrong with nutritional advice over the past 50 years.
Fat Head: What kind of response is the book receiving? Is the word getting out?
Angelucci: It’s early in the book’s life but I’m thrilled at the response so far. The Amazon reviews are very positive and the direct feedback I’m receiving from readers is that the book conveys a lot of information in an easy to understand, enjoyable way.
Fat Head: One of the real joys for me after releasing Fat Head was receiving emails from people who told me that the film changed their lives. Have you heard from people whose lives were changed after reading your book?
Angelucci: I have and it’s immensely rewarding. To see that x number of people have bought my book is nice, but when I receive an email saying that someone used my book to change his or her life, that’s priceless and the ultimate motivation for writing the book.
Fat Head: So what’s next? Any plans for a follow-up book or another related project?
Angelucci: I’m working on a more interactive version for the iPad but my primary focus right now is spreading the word about Don’t Die Early!
Fat Head: Thanks for taking the time for the interview, Rocky. Don’t Die Early is an excellent read, and I hope you sell a million copies.
Angelucci: Thank you, Tom, for being such an incredible beacon of sanity in the crazy world of nutrition advice and for your support of Don’t Die Early.
Last month I reviewed and highly recommended Don’t Die Early, an excellent book by Rocky Angelucci about how to measure and improve your health. I recently sent Rocky a list of interview questions. We covered quite a few topics, so I’m posting the interview in two parts. Here’s part one.
Fat Head: Your passion for health began when you found yourself in the emergency room after suffering a bout of heart arrhythmia. How scared were you during that incident? Were you thinking, “Well, this is it, I’m about to die”?
Angelucci: I think a cardiac event brings much bigger implications than, say, a serious injury or an unexplained pain in the abdomen. Instead of thinking “Darn, I’m going to need stitches or maybe some surgery,” the finality of a cardiac event immediately takes us to a far more frightening place. Even though I knew what atrial fibrillation was, I had no idea why it was suddenly happening to me at such a relatively young age. My immediate thought was “What has gone so horribly wrong that my heart is doing this?” followed closely by, “Is this just the tip of the iceberg? Is my heart going to end up so damaged that I can barely climb a flight or stairs or I may never again walk faster than a decrepit shuffle?” And, yes, mixed in with all that were quite a few thoughts of “I really don’t want to die tonight.”
Fat Head: Did you any have clues before that incident that you were in bad health? Had you been warned by your doctors that your test scores weren’t so hot?
Angelucci: Nothing other than being told during my annual physicals that my cholesterol and triglycerides were “a little too high.” Thinking back on the failure of my regular physicals to reveal anything was the first step in realizing that physicians tend to treat symptoms instead of focusing on detection and prevention.
Fat Head: After a brush with heart failure, most patients are told by their well-meaning doctors to go on a low-fat diet, cut back on cholesterol, maybe take statins, etc. Is what you were told? If so, why didn’t you follow that advice?
Angelucci: Fortunately, I avoided the dreaded “statin speech” in the ER because my high triglycerides prevented them from testing my LDL. As you know, instead of measuring LDL directly, traditional cholesterol testing estimates LDL to save the insurance company a few dollars. If triglycerides are too high, the commonly used LDL estimation fails.
In the days after being released from the ER, I found a local cardiologist for follow-up care. His first suggestion was a statin and he initially seemed receptive to my first trying lifestyle changes to improve my situation. Oddly enough, during every subsequent follow-up visit I was seen by a nurse practitioner instead of the cardiologist. It’s as though the cardiologist had nothing else to offer me after recommending the statin (until it’s time to sell me a stent, that is). Even at this early point I wasn’t keen on taking a statin because I had already learned of the harm that statins cause and of the dangerously oversimplified advice that we are receiving today regarding cholesterol and the prevention of heart disease.
Fat Head: So you were recovering after the incident, determined to become healthier and you decided to educate yourself. How did you get started? Where did you go for information?
Angelucci: My first priority was learning more about the cardiac arrhythmia that took me to the ER. After noticing that one of the first things they attached to my IV was a bag of magnesium sulfate solution, a quick bit of research revealed that most of us are severely deficient in magnesium, which often causes atrial fibrillation. It didn’t take long for me to dispel the cardiologist’s claim of “once a fibber, always a fibber” by implementing a successful plan to increase my intake of magnesium.
The blogs of cardiologist Dr. William Davis dispelled the next myth: that stress tests show blockages as small as 15%. His blogs, and the Track Your Plaque online community, opened my eyes to the importance of testing, not speculating, about the presence of coronary plaque. About this same time, I discovered the Fat Head segment on You Tube. Fat Head’s discussion of glucose and insulin reawakened my appreciation for the hormonal effects of the foods we eat, something I remembered from reading Dr. Barry Sears’ Zone Diet books some years ago.
All of these insights, combined with a newfound appreciation for not being dead, formed a “perfect storm” that led me to quickly consume everything I could find from writers like Gary Taubes, William Davis, Jenny Ruhl, Richard Bernstein, and their ilk. Dr. Davis’ Track Your Plaque forum is a wealth of prevention-minded cardiology enthusiasts who were, and still are, an incredible source of knowledge and inspiration. Some person-to-person exchanges during all this were also invaluable, including email discussions with Dr. James Otvos, medical school professor and CTO of LipoScience (a lipid subfraction analysis company). Dr. Otvos was kind enough to serve as a sounding board when I was crystallizing my thoughts on lipid particles and their role in the formation of cardiac plaque.
Fat Head: There’s so much conflicting advice on internet for people who want to avoid heart disease … eat low-fat, eat low-carb, go vegetarian, go paleo, etc. How did you decide which advice to follow?
Angelucci: By sticking to the fundamentals, always bringing the discussion back to “what is the effect of this advice on me?” and trusting my BS detector!
For example, once I better understood the role that glucose and insulin plays in our bodies and realized the importance of preventing my blood glucose levels from spiking, it was very clear that any foods that cause glucose spikes are unfavorable. Once I had grasped this simple concept, the claim that whole grain breads are good for reducing diabetes risk or for lowering glucose levels didn’t survive the simple effort of squeezing a drop of blood from my finger and seeing that a grain-laden, low-fat meal spiked my blood glucose to over 200 mg/dL. The understanding that excessively high glucose levels are harmful, combined with a $15 glucose meter and some test strips, allowed me to dispel an avalanche of assertions that low-fat carbohydrates are healthful.
Similarly, after learning about how lipid particles really affect the formation of cardiac plaque, it was clear that the “LDL=bad, HDL=good” model of cholesterol health is dangerously oversimplified. This allowed me to see the flaws inherent in any advice that tried to equate lifestyle with total cholesterol or LDL.
Fat Head: When I was doing research for Fat Head, I was constantly surprised by all the evidence out there that much of what we’ve been told about healthy eating is wrong. Did you have that same experience?
Angelucci: Absolutely. Today’s nutritional advice reminds me of the game I played as a kid where we lined up and whispered a secret from person to person, watching how a simple phrase like “a stitch in time saves nine” turns into “a penguin ate my underwear” by the time it reaches the end. Health advice today travels along a chain of individuals and organizations, each with a very pointed agenda and their own incompetencies.
Scientists, as you are so skilled at observing, frequently fall in love with their theories and ignore compelling evidence to the contrary. Funding agencies like the grain industry or the pharmaceutical industry have a clear agenda when hiring researchers to perform a study. Public universities in agricultural areas are often very careful not to conduct research that casts an unfavorable light on grains or certain farming practices for fear that industry lobbyists will bring pressure on the politicians who fund their institution. As a former journalist, you’re well acquainted with the news media’s reluctance to deviate too far from mainstream nutritional dogma. It’s shocking how politics, deception, ego, and greed permeate every link in the health and nutrition chain.
Fat Head: What was the biggest surprise for you during your research?
Angelucci: The biggest surprise was just how wrong nutritional “experts” are. The general public doesn’t have the time or the inclination to closely follow scientific research, so we trust these so-called experts to summarize for us the content and implications from key studies as they are released. Reading nutritionist’s reports and then comparing their interpretation to the original studies showed me very quickly that the nutritional experts are very good at adding 1 plus 1 and getting 3.
For example, the experts read a very narrowly focused study that shows, unsurprisingly, that whole grain rice is slightly less likely to induce Type 2 diabetes than refined rice, but instead of reporting that whole grain rice causes Type 2 diabetes but refined rice does so more readily, these geniuses advise that we all need to eat plenty of whole grains so that we avoid Type 2 diabetes. This sort of twisted logic, coupled with an inability to cry “foul!” when a blatantly flawed study crosses their desks, is rampant among nutritional experts today and was the most surprising, and infuriating, thing I learned.
Fat Head: There are a lot of good books out there on how a better diet can produce better health. What made you decide to write your own? What unique or different information did you want to add to the mix?
Angelucci: Rather than focusing on “how to lose weight” or “how to have buns of steel,” I’ve tried to fill a niche that nobody else has addressed: how to have the best chance at avoiding the diseases that steal our quality of life as we age. Losing weight certainly has its benefits, but too many people, even practitioners, overlook the fact that excess weight is not a disease, it’s a symptom of a greater problem.
I wrote Don’t Die Early for people who want to be healthier but who don’t want to put their lives on hold to critically examine dozens of books, hundreds of research reports, and a seemingly endless parade of blogs and web sites. I wanted to create the one book that bridges the gap between wanting to be healthier and knowing how to go about it. Not in some vague, generic, unsubstantiated way, but in specific, measurable ways that anyone can understand and apply, no matter their age or condition.
Fat Head: In the first part of the book, you tackle what you call The Major Players: heart disease, diabetes and inflammation. Why did you pick those three over, say, cancer or Alzheimer’s?
Angelucci: By virtually every analysis, heart disease is the #1 killer today. This, and the fact that heart disease is the T-Rex in my rearview mirror, affords heart disease a prominent place in any discussion of preventive health. The other two major players, diabetes and inflammation, are at the root of virtually every disease we face as we age. I use the term “diabetes,” but it’s really about effective glucose control. Even if a person is never compromised enough to be diagnosed as diabetic, decades of poorly controlled glucose levels give rise to heart disease, neurological damage, dramatically increased risk of cancer, and a laundry list of other maladies. Inflammation, and by inclusion autoimmune disease, has such far-reaching implications throughout the body that inflammation has been called by some “the root of all diseases.”
We tend to think about diseases like coronary artery disease, Adult Onset Type 1 Diabetes, irritable bowel syndrome, peripheral neuropathy, MS, asthma, rheumatoid arthritis and so many others as completely distinct diseases, but ultimately they’re all a product of runaway inflammation within the body. Effectively controlling blood glucose and avoiding inflammation, while devoting as much attention to heart disease as our individual condition warrants, dramatically reduces our chances of a disease-laden adulthood.
Fat Head: You emphasize over and over in Don’t Die Early that it’s important to get some specific tests done, even if you have to order them for yourself. Why is that? Why can’t we just rely on our doctors to monitor our health?
Angelucci: It’s true that Don’t Die Early advises partnering with a prevention-minded physician but the unfortunate reality is that many physicians are not prevention-minded. Instead, they wait until diseases appear and apply whatever FDA-approved medication or procedure is designed to treat the symptoms of that disease. Also, physicians are often constrained by insurance company guidelines that restrict how often certain tests can be run, or if they’re covered at all.
If you’re a 45-year old man with a family history of heart disease who wants to know, not speculate, whether you’ve got coronary artery disease, a closed-minded physician shouldn’t stand in the way of a $49 non-invasive scan. If you want to test your lipids using the most current technology, your physician or insurance company shouldn’t be a barrier to an $85 test just because they still embrace a failed 30-year old HDL/LDL model of lipid health.
If you couldn’t make it to the low-carb cruise this year, you can at least watch the speeches online now. Terry and Pam Young of the Make It Fun And It Will Get Done website videotaped the speeches and just posted them. You can go to this page and click a speaker’s picture to watch his or her speech.
I’ve been following Jimmy Moore’s N=1 experiment with staying in nutritional ketosis on his blog, but it was instructive to actually watch the man eat during his visit last week. His meals are WAY high in fat now and he watches his protein intake. I must admit, despite everything I’ve read about the benefits of ketosis, when I watched Jimmy scooping gobs of butter and sour cream on his cheesy scrambled eggs in the morning, I couldn’t help thinking, “Wait a minute … you’re losing weight eating like this?”
The reason he’s doing this is that he discovered eating low-carb doesn’t necessarily mean being in ketosis, or at least not in the zone that Drs. Jeff Volek and Stephen Phinney call nutritional ketosis: a blood ketone level of between 0.5 and 3.0 mM. As they explain in their terrific book The Art and Science of Low-Carb Living, it’s within this zone that we can easily tap body fat for fuel and keep our brains happily supplied with ketones.
When Dr. Atkins was practicing and writing his books, he urged people to test their ketone levels with ketone urine strips. That was the technology available at the time. Unfortunately, the ketones in urine aren’t necessarily an accurate reflection of the ketones in the bloodstream, which is the level that matters. The reason for the disparity is that as you become keto-adapted, you tend to use more of the ketones for fuel instead of excreting them. The newer and better technology is a device similar to a glucose meter that tests ketone levels in the blood.
As Jimmy Moore explained on his blog, he was surprised when he first used a ketone meter and saw that despite being on a very low-carb diet, his blood ketone level was only 0.1. After adjusting his diet, he’s hanging around the 2.0 level most of the time – and he’s losing weight again.
For the record, I don’t believe everyone has to be in nutritional ketosis to lose weight. People lose weight on all kinds of diets, including paleo diets that aren’t particularly low-carb. I lost weight on The Zone diet, which at 40% carbohydrates is hardly a ketogenic diet. But for people like Jimmy who are hyper-responders to insulin-producing foods, staying in ketosis may be the key.
People who pooh-pooh low-carb diets like to point out that protein foods raise insulin and therefore the “high-protein” Atkins diet can’t possibly work by lowering insulin levels. Hogwash. When we cut carbohydrates, most of us replace the bulk of those calories with fat, not protein. We’re still consuming fewer insulin-producing foods, and we end up with lower overall insulin levels as a result. But the pooh-poohers do have a point, even if it’s not exactly the point they wanted to make: for some people, a low-carb diet may not work in the long term unless they restrict their protein intake as well.
Let’s return to Jimmy Moore’s experience. We all know (because he’s been quite public and honest about it) that Jimmy lost 180 pounds on the Atkins diet, but then slowly regained about half of that. I’m speculating here, since we don’t have records of Jimmy’s insulin levels during the time he was gaining weight, but let’s suppose for the sake of argument that he was eating enough extra protein to raise his fasting insulin level, despite consuming very few carbs. It doesn’t take much extra insulin to significantly inhibit the release of fatty acids from the fat cells. Take a look at this graphic, which was included in a study by Dr. Volek:
As you can see, the ability to release and burn stored fatty acids falls off sharply as fasting insulin levels increase, even within what’s considered the “normal” range. As the text accompanying the graphic explains:
In fact, adipose tissue lipolysis is exquisitely sensitive to changes in insulin within the physiological range of concentrations. Small to moderate decreases in insulin can increase lipolysis several-fold, the response being virtually immediate. Insulin also stimulates lipogenesis [creating new body fat] by increasing glucose uptake and activating lipogenic and glycolytic enzymes. Small reductions in insulin levels, such as that easily achieved with dietary carbohydrate restriction, remove the normal inhibition on fat breakdown.
Dr. Volek was writing about carbohydrates in that paper, but if excess dietary protein also elevates fasting insulin in some people – even to a relatively small degree – that could cause a similar suppression of ability to burn body fat. That might explain (again, I’m speculating here) why Jimmy regained a lot of weight on his low-carb diet and why he’s losing again now. Restricting calories didn’t work, adding “safe starches” to his meals didn’t work, but lowering his protein intake and getting an even higher proportion of his calories from fat is working, at least so far. He’ll report on his experiment in an upcoming post, so I’ll let him announce the specific results.
Naturally, Jimmy’s experiment piqued my curiosity about my own blood ketone levels, so I bought a meter (a Precision Xtra by Abbot Labs) through Amazon. After a week or so, I determined that on my typical diet, I seem to hang right around 0.8 mM, the lower end of nutritional ketosis. I also learned that I can be pushed out of ketosis more easily than I would have previously suspected.
On Saturday night, Chareva and I took the girls to Red Lobster for a belated anniversary dinner. I ate a lobster, some scallops, two skewers of shrimp, a salad with bleu cheese dressing, three tortilla chips with lobster-cheese dip, two mushrooms stuffed with lobster and cheese, and broccoli drenched in butter. Very low-carb with lots of fat, but also lots of protein. Before bed, I had two glasses of red wine. The next morning, my blood ketone level had dropped to 0.2. Could be high protein intake, could be the wine, could be both.
My belly is almost flat these days, so I don’t have a burning need or desire to lose more weight, but what the heck, I think I’ll experiment with my diet, keep track of my blood ketone levels, and see if it makes any difference. I tried eating more protein and less fat awhile back, and nothing changed. If I get into a consistent state of nutritional ketosis and lose that last little bit of softness around the waist, that would be cool. I certainly have no objection to putting extra butter and sour cream on my eggs.
Below I’ve posted an interview Dr. Andreas Eenfield conducted with Dr. Steve Phinney about why a good low-carb diet should also be a high-fat diet, not (as the goofballs in the media always seem to think) a high-protein diet.