Archive for the “Random Musings” Category
So far I’ve only read about 2/3 of Keto Clarity, Jimmy Moore’s recent book. (As usual, I’m behind on my reading. The book was released three weeks ago.) Since the book is about nutritional ketosis, naturally I’ve been replaying the debates about ketosis in my mind as I read. I don’t want to clutter up my soon-to-appear review of the book with those debates (the book, after all, is mostly a how-to guide for people who have already decided to try a ketogenic diet) so I thought I’d chime in with some thoughts on ketosis now and review the book on its own merits.
I’m not a fan of caustic debates among bloggers and authors who all advocate a more-or-less paleo, whole-foods diet but disagree on safe starches or ketosis. I explained why in my post about Differences, Commonalities and the Judean People’s Front. We agree far more than we disagree, but when the topic of ketosis comes up, you can almost sense some people wanting to yell “Splitters!” across the coliseum.
Depending on which splitter has the floor, nutritional ketosis is either the natural human metabolic condition and should be sought by everyone who wants to be lean and healthy, or it’s an emergency-only condition that will ruin your metabolism and possibly kill you. I don’t buy either argument, at least not as a blanket statement for everyone. I believe achieving ketosis could be beneficial or not, depending on the individual. So I’ll just toss out some of the arguments I’ve come across recently in books, blogs and podcasts and respond with what went through my head when I heard them – and that’s all these are: my personal reactions to those arguments.
Ketosis was the natural metabolic state of our Paleolithic ancestors.
I used to believe that, but I don’t anymore. I think paleo people probably drifted in and out of ketosis, depending on the season and what foods were obtainable. Fossilized bones and fecal samples tell us that many if not most early humans consumed a wide variety of plants, including starchy plants, and a whole lot of fiber. We call them hunter-gatherers for a reason. If all they ate was meat, they’d just be hunters.
As Jimmy’s book and others point out, to achieve and maintain nutritional ketosis, you not only have to restrict carbohydrates, you will probably have to restrict protein as well. I don’t think paleo people would have restricted either. As the Jaminets discussed in their Perfect Health Diet book, the hunter-gatherer tribes whose diets were documented typically consumed somewhere in the neighborhood of 15 to 30 percent of their calories as carbohydrates. That alone would prevent nutritional ketosis for most of us. Meanwhile, the Inuit – our poster-boys for a carb-free diet – apparently consumed rather a lot of freshly killed seafood that contained perhaps 20 percent of its calories in the form of glycogen, otherwise known as muscle starch.
But let’s suppose for the sake of argument (since the point has indeed been hotly debated) their seafood didn’t contain that much glycogen. It’s been documented that adult male Inuits consumed an average of 240 grams of protein per day. That’s not exactly what I’d call protein restriction, and I find hard to believe anyone would stay in nutritional ketosis while eating that much protein.
Paleo humans only ate plants as a fallback food if there wasn’t enough meat available.
I know that one isn’t true. At least it wasn’t true for many Native American tribes. I just recently read that in areas where hunting tribes and farming/gathering tribes lived near each other, they got together for food swaps. The hunters traded meat for maize, beans, squash, etc. I don’t think they’d voluntary trade away precious meat for what they considered a desperation-only food. They must have liked those starchy plant foods. As someone who enjoyed fresh squash from Chareva’s garden with dinner a couple of nights ago, I can tell you I’d happily swap some excess meat for it.
If you’re not in nutritional ketosis, it means you’re still a sugar-burner.
Simple math says otherwise. I believe (as do the Jaminets, by the way) that we should get most of our energy from fat. But you can get most of your energy from fat without being in nutritional ketosis, which is defined as a reading of 1.0 or higher on a blood ketone meter. Let’s look at some numbers.
Suppose I consume 2,000 calories in a day, including 100 grams of protein and 100 grams of carbohydrate – in other words, roughly what I consumed during my Fat Head fast-food diet. That would be 800 calories from protein and carbohydrates combined, plus 1200 calories from fat. My brain would have used up much of the carbohydrate, and since my muscles didn’t shrink, I certainly wasn’t converting all that protein to glucose and using it for fuel. But what the heck, for the sake of argument, I’ll say all 800 protein and carbohydrate calories were used for energy.
With me so far? Good.
Given the weight I lost during that month, I was burning at least 3,000 calories per day, possibly more. That means I was burning 2200 calories or more in the form of fat … which means even if every gram of carbohydrate and protein was used for fuel (which it wasn’t), 73% of my energy needs came from fat. So I obviously wasn’t a sugar-burner. But I can tell you from my own n=1 attempt at maintaining nutritional ketosis that I can’t do it while consuming 100 grams of protein and 100 grams of carbohydrate in a day.
Here’s another recent example: as I recounted on the blog, I spent five hours last Saturday clearing the brush from our fields. It was hard, physical work that no doubt burned rather a lot of calories. For breakfast (my only meal before all that work), I had four eggs fried in butter and two pieces of gluten-free toast slathered in butter. The toast provided 22 grams of carbohydrate, or a whopping 88 calories. If I wasn’t burning mostly fat during the day’s labors, I would have keeled over. And yet I wasn’t in nutritional ketosis. I checked out of curiosity and registered 0.4 on the meter.
If you don’t feel good or experience health problems while in a constant state of ketosis, there’s something wrong with you and you need to fix it.
I disagree completely, and when I hear that one, it sounds eerily like vegan-think. Tell a vegan you felt lousy while trying to give up animal foods, and she (because most vegans are she) will reply that meat is evil, we know it’s bad for you, so if you don’t feel good without meat in your diet it means you’re addicted to meat, or you’re not doing your vegan diet correctly, or there’s an underlying health problem you need to identify and fix so you can give up meat.
Nonsense. If you feel lousy on a vegan diet but then feel better after eating a steak, it means you should eat the steak. That’s how any proponent of a paleo diet would reply.
But if you tell some people in the everyone should be in ketosis crowd that you felt better and saw some health problems disappear after eating two or three potatoes per week, suddenly the potato becomes like meat to a vegan. No, no, no, the potato is bad! If you feel better after eating the potato, it means you’re not doing your ketogenic diet correctly. You need more fat. You need to eat nose-to-tail. Something is still broken in your metabolism, so you need to dig deeper and find the underlying issue and fix it.
No, it means you should eat the potato.
The whole premise of paleo diets is that the ideal human diet was shaped by evolution. The diet that kept our paleo ancestors healthy is the diet that will keep us healthy too. For reasons I explained above, I don’t believe our paleo ancestors lived in a state of chronic ketosis. There’s no reason we should all be genetically geared to thrive on a diet that none of our ancestors actually consumed. In fact, adopting that diet might be a bad idea for some people.
But once again for the sake of argument, let’s suppose that with enough diligence and determination, you could identify that deep, underlying problem that’s causing you to feel lousy when you stay in ketosis for weeks on end. Here are your options:
- Spend months of your life and hundreds if not thousands of dollars undergoing tests, waiting for results, undergoing more tests, digging and researching and visiting specialists and perhaps finally identifying that deep, underlying metabolic problem that caused you to feel good after eating a potato … but feeling like crap until you do identify the deep, underlying metabolic problem.
- Eat the potato, feel good, and go on your merry way.
Pretty easy choice, if you ask me.
Ketosis will ruin your metabolism.
Like I said, I believe staying in chronic ketosis could be a bad idea for some people. That doesn’t mean it’s bad for everyone. Dr. Jeff Volek has lived on a ketogenic diet for decades. So has Nora Gedgaudas. Dr. Andreas Eenfeldt has been measuring ketones and maintaining ketosis for (if memory serves) at least two years now. If their metabolisms are broken and their health is going down the tubes, you sure as hell can’t tell by looking at them.
Back during the raging safe-starch debate on this blog, I mentioned that I’ve heard from people who lost weight and felt better after adding some starch back into their diets, and that I believe them. I have no reason not to believe them. I’ve also seen posts and read comments from people who were able to lose weight and keep it off for the first time in their lives after going ketogenic. I believe them too.
A ketogenic diet has clearly been a godsend for Jimmy Moore. Yes, you could argue (as so many internet cowboys have) that if Jimmy can’t keep his weight down on anything other than a strictly ketogenic diet, it means his metabolism is broken. Fine. Drinking a 12-pack of Coca-Cola per day and ballooning up to over 400 pounds by age 30 probably will break your metabolism.
But if going ketogenic allows you to feel great and lose nearly 80 pounds and keep it off, then go ketogenic … unless, of course, you believe it’s better to remain obese while spending years of your life and hundreds if not thousands of dollars undergoing tests, waiting for results, undergoing more tests, digging and researching and visiting specialists and perhaps finally identifying that deep, underlying metabolic problem that prevents you from losing weight while eating potatoes.
Ketogenic diets are stupid because everyone apart from diabetics should be able to consume at least 150 grams of carbohydrate per day.
I don’t think the everyone should eat starch argument makes any more sense than the no one should eat starch argument. All humans have the AMY1 gene, which makes it possible to digest starch. That’s one of the many reasons I believe our paleo ancestors ate starchy plants. But some clearly ate a lot more than others. Let’s review a quote from Denise Minger’s book Death By Food Pyramid:
It turns out the number of AMY1 copies contained in our genes is not the same for everyone. And the amount of salivary amylase we produce is tightly correlated to the number of AMY1 copies we inherited. AMY1 copy number can range from one to fifteen, and amylase levels in saliva can range from barely detectable to 50 percent of the saliva’s total production. That’s a lot of variation.
It sure is. And that means some people can handle a whole lot more starch than others. Research shows that people with fewer copies of the AMY1 gene are more likely to be obese. To quote a study I mentioned in a previous post:
The chance of being obese for people with less than four copies of the AMY1 gene was approximately eight times higher than in those with more than nine copies of this gene. The researchers estimated that with every additional copy of the salivary amylase gene there was approximately a 20 per cent decrease in the odds of becoming obese.
That’s why when people have pointed to the Kitavans as examples of people who are lean and healthy despite a diet very high in starch, I’ve replied, “Good for them. But I’m not a Kitavan.” I haven’t had a genetic test to determine how many AMY1 copies are floating around in my DNA, but given the difference in my weight and health on high-starch vs. low-starch diets, I suspect I’m in that under-four-copies group.
I usually eat two meals per day. To get 150 grams of carbohydrate into my diet, I’d have to consume 75 per meal. Not a chance. After supplementing with resistant starch, I’ve found I can have that potato or squash with dinner and end up with a post-meal glucose peak in the 125-135 range. I’m fine with that. So now I have a potato with dinner a few times per week.
But when I consumed two potatoes (i.e., about 70 grams of starch) awhile back as an experiment, my glucose ended up at 195 and stayed high for two hours. I’m not fine with that. And no, I don’t think it’s because I need to eat more starch to raise my tolerance. That’s just another version of the if you can’t be healthy on this diet, it means you’re not doing it right argument. If I’m in the low-amylase group, there is no way for me to do it right. Yes, I can eat some starch – but only some. Based on my experiences and n=1 experiments, I’d say 100 grams is the upper limit for me. Your upper limit may be higher or lower. We’re all different.
A ketogenic diet will starve your gut bacteria and ruin your gut health.
If there’s one warning ketogenic dieters should pay attention to, I’d say that’s the one … although I think the possible danger lies in a lack of fiber, not ketosis per se. I recently watched a two-part series on the gut biome produced by ABC Catalyst in Australia. The bottom line is that our gut bacteria need fiber, period. It’s their food. I no longer buy the notion tossed around by some low-carbers that fiber is useless. It’s not only useful, it’s probably crucial for long-term gut health.
In part one of the series, researchers did some blood work on a young, very fit gymnast after feeding him a meal of French fries and other junk food. He was surprised to learn that his body was pumping out a higher-than-average level of insulin to normalize his blood sugar – in other words, he was at risk for developing diabetes. (The doctor/journalist who hosted the episode only pumped out half as much insulin after the same meal.) In part two, after a month on a high-fiber diet, the same gymnast ate the same junk-food meal. This time his body required only half as much insulin to do the job. Fiber has been shown in research to improve insulin sensitivity – and since most of us who adopt low-carb diets want to lower our insulin levels, fiber should be part of the diet.
That doesn’t necessarily mean the fiber has to come from starchy plants, but if were on a ketogenic diet, I’d sure as shootin’ be loading up on as many high-fiber vegetables as I could. I’d also try supplementing with resistant starch as soon as possible.
Okay, those are my thoughts about the ketosis pro and con arguments. You may now proceed to the comments and yell “Splitter!”
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When we got the brush-cutting mower we’ve since nicknamed The Beast, Chareva’s first request was that I clear an area around the chicken coop so she could expand the chicken yard. A day or so later, she put up the electric fence that had previously surrounded Sara’s goats. The idea, of course, is to discourage raccoons or bobcats from treating themselves to any more chicken dinners.
Here’s more of the fence, from the other side of the coop:
I hope it works. If it comes down to a choice between losing chickens or killing a predator, I’ll kill the predator. One chicken produces 250 eggs or more per year. Rocky Racoon killed four of them, so he cost us 1,000 eggs over the next year — and all we got in return was one raccoon-stew dinner. The bobcat cost us another 250 eggs per year. But as several readers mentioned, that bobcat is a beautiful animal, and I’d rather just convince him to go away.
The chickens won’t be wandering the expanded chicken yard until we put some nets over the area. Hawks aren’t impressed by electric fences.
I got home from work on Friday with about two hours to go before sunset, so I released The Beast and tackled the section of the side field you see below:
That gave me more of a workout than I’d expected. It’s difficult to appreciate the slope of these hills unless you’re standing on them, but this picture taken soon after we bought the land should give you an idea:
That was the area I cut on Friday, and I found that my usual method of cutting around the perimeter wasn’t possible. The mower wanted to tilt and turn downhill if I tried cutting across the slope. So my only option was to guide it downhill, make a 180-degree turn, and go straight back up the hill – over and over. The back wheels are powered, but there are no front wheels, which means I have to push down on the handles and keep the front slightly elevated, especially when cutting uphill. It wasn’t quite like pushing a heavy weight uphill each time, but close. So let’s just say I slept amazingly well on Friday night. This is the after picture:
Same area, but looking up from near the bottom of the hill:
That left these two big sections of the side field still to be cut:
I figured I’d tackle those next weekend. I was more interested in clearing the area behind the house, which had grown to look like this:
When I finished my morning coffee on Saturday and starting pulling on my work clothes and boots, it occurred to me that I was actually looking forward to the work.
What the …? Is that my brain getting all happy about a day of manual labor?
Yes, this is your brain.
But the whole two years we rented a house in a suburb, I never even mowed the lawn. Mowing a lawn is drudgery. That’s why I paid a service to do it. Why the heck is this fun all of a sudden?
I don’t know. I’m only a brain. You figure it out.
So I spent two hours pushing The Beast around the area behind the house (only about a third of which is visible in the picture). Now it looks like this:
I planned on calling it a day after that and working on a music project. Then my brain started up again.
You know, you still have plenty of daylight left. You could knock down one of those two sections in the side field.
Why on earth would I do that?
Because you want to. You know you do.
Look, buddy, I do not want to spend the entire day … holy crap, the brain is right. I do want to. Okay, I’ll take down one of those two remaining sections. Then I’m going inside.
So, despite being drenched under my shirt from the afternoon heat, I took down another section. Then I turned The Beast towards the garage.
Hey, remember me? It’s your brain again. You know, that last remaining section really isn’t that big if you think about.
But I’ve already been doing this for nearly four hours, and it’s ninety-some degrees out here and … okay, I’ll get the gas can.
My muscles were tired and I was huffing and puffing at times as I hit the steeper slopes. And yet I had to admit: I was enjoying myself. I don’t know if was endorphins from the work, the pride of accomplishment, or what Charlie Daniels called Dog-Tired Satisfied in one of his songs, but after spending five hours working outside on a hot, humid day, I felt terrific.
It occurred to me that this is one of the unexpected benefits of living on a small farm. I’ve been a software programmer for years. I’m good at it, I like it, and it pays well. But of course, I sit down for that job (and for blogging). The whole time I lived in Chicago and Los Angeles, I didn’t even have a yard. I knew it was important to get some physical exercise, so I took long walks and worked out in a gym. I still do. A good workout in a gym is satisfying, but it’s not like this. It’s not the joy of being Dog-Tired Satisfied. I get that feeling when I spend a day tearing down a briar jungle, or cutting up a pile of wood, or pounding fence posts into the ground.
When we first bought the farm and started cleaning it up, cutting away the rusty barbed wire, digging gardens, reclaiming the jungle, etc., I occasionally grumbled to myself that it seemed the work would never be done.
Silly, silly man, my brain replied when I recalled those complaints as I was falling asleep on Saturday night. Of course the work will never be done. And if it ever is, you should probably buy more land. You’re Dog-Tired Satisfied, and it’s the best kind of tired. Now go to sleep.
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I have to admit, that was kind of fun. See, what I did with the headline for this post was to look at a couple of observational studies and jump to the kind of unsubstantiated cause-and-effect conclusions so beloved by media health writers – and particularly beloved by many vegetarian zealots.
Take T. Colin Campbell – please. He and his vegan pals show up in vegan propaganda films like Forks Over Knives and solemnly inform that world that in countries with high rates of meat consumption, people are more likely to die of cancer. Must be the animal protein causing the cancer, ya see. (Unfortunately, this unscientific claptrap is persuasive to reviewers like Roger Ebert, who apparently knew a lot about good filmmaking but almost nothing about good science.)
There could be all kinds of reasons other than animal protein causes cancer! that people who live in countries with high rates of meat consumption are more likely to die of cancer. I’ll give you just one: Animal protein is expensive compared to other foods, so people in prosperous countries eat more of it than people in poor countries do. People in prosperous countries also have longer lifespans because of better medical care – which means they live long enough to die from the diseases of old age, including cancer.
T. Colin Campbell, Neal Barnard, John McDougall … I’m sure they’re all intelligent enough to understand that correlation doesn’t prove causation. I’m also sure they don’t care, at least not when they can dig up a correlation that supports their vegetarian agenda. That’s because they consider eating animal foods immoral. It’s a sin, you see, so if they need to tell little white lies in order to stop people from sinning, that’s okay. Nothing wrong with portraying correlation as causation if it supports the true cause.
So in that spirit, let’s take a look at the studies that inspired my headline. Here are some quotes from an online article about a study linking vegetarianism to poor health:
Vegetarians may have a lower BMI and drink alcohol sparingly, but vegetarian diets are tied to generally poorer health, poorer quality of life and a higher need for health care than their meat-eating counterparts.
I think the only correct interpretation of that finding is that if you’re going to be a vegetarian, you should also try to stay fat and drunk.
A new study from the Medical University of Graz in Austria finds that vegetarians are more physically active, drink less alcohol and smoke less tobacco than those who consume meat in their diets. Vegetarians also have a higher socioeconomic status and a lower body mass index. But the vegetarian diet — characterized by a low consumption of saturated fats and cholesterol that includes increased intake of fruits, vegetables and whole-grain products — carries elevated risks of cancer, allergies and mental health disorders.
Vegetarians were twice as likely to have allergies, a 50 percent increase in heart attacks and a 50 percent increase in incidences of cancer.
Wow. More physically active, more economically prosperous, less likely to drink, less likely to smoke, and less likely to be fat … yet still more likely to be in poor health, including more likely to develop cancer or suffer a heart attack. Has T. Colin Campbell been informed of this finding?
The cross-sectional study from Austrian Health Interview Survey data and published in PLos One examined participants’ dietary habits, demographic characteristics and general lifestyle differences.
Many past studies have instead put an emphasis on the health risks associated with red meat and carnivorous diets, but this study points the other dietary direction. However, the researchers do caution that continuing studies will be needed to substantiate some of the rather broad dietary distinctions, associations presented in this current research.
No, no, no, we don’t need to be cautious. If we find an association we like in an observational study, we can treat it as cause-and-effect and trumpet it from the hilltops … or in a book called The China Study.
Overall, vegetarians were found to be in a poorer state of health compared to other dietary groups. Vegetarians reported higher levels of impairment from disorders, chronic diseases, and “suffer significantly more often from anxiety/depression.”
So a vegetarian diet will give you mental problems as well. But as a health writer, I don’t want to rely on a single study to reach that conclusion. So let’s look at another one. In this study from Germany, vegetarians were found to have higher rates of depression, anxiety, hypochondria and eating disorders.
Now, if we wanted to be careful, we’d have to consider all kinds of possible explanations. It could be that people who are sick or depressed or have an eating disorder are more likely to try a vegetarian diet, hoping for a dietary cure. It could be that more vegetarians are obsessed with being thin, which makes them more likely to semi-starve themselves, which it turns leads to poor health and depression. Eating or not eating meat may have nothing to do with it, at least not directly.
But I’m not in the mood to be careful. I more in the mood to channel the spirits of Campbell, Bernard, McDougall, and the other great vegan zealots. So I’ll just declare that according to the recent research, a vegetarian diet will make you sick and crazy.
Heh-heh-heh … like I said, that was kind of fun.
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After I went from a mostly vegetarian diet to a meat-based low-carb diet and saw my health improve, I swore I’d never swear off red meat. But … uh … (say it ain’t so, Joe) … a run-in with the wrong insect could apparently change all that:
A bug can turn you into a vegetarian, or at least make you swear off red meat. Doctors across the nation are seeing a surge of sudden meat allergies in people bitten by a certain kind of tick.
A tick? You mean those nasty little critters who crawl up my legs while I’m playing disc golf or working around the property? Oh, no …
This bizarre problem was only discovered a few years ago but is growing as the ticks spread from the Southwest and the East to more parts of the United States. In some cases, eating a burger or a steak has landed people in the hospital with severe allergic reactions.
The culprit is the Lone Star tick, named for Texas, a state famous for meaty barbecues. The tick is now found throughout the South and the eastern half of the United States.
Well, maybe the anti-meat ticks are farther south and east than where I live. So if I just stay in my part of Tennessee …
In Mount Juliet near Nashville, Tennessee, 71-year-old Georgette Simmons went to a steakhouse on June 1 for a friend’s birthday and had a steak.
“About 4:30 in the morning I woke up and my body was on fire. I was itching all over and I broke out in hives. Nothing like that had ever happened to me before,” she said.
A few weeks later, for a brother’s birthday, she ordered another steak. Hours later she woke “almost hysterical” with a constricted throat in addition to hives and a burning sensation. She, too, recalled tick bites.
Mount Juliet?! Holy @#$%, that’s not only near Nashville, it’s north of where we live. So the demon ticks are already in our area.
At the University of Virginia in Charlottesville, “I see two to three new cases every week,” said Dr. Scott Commins, who with a colleague, Dr. Thomas Platts-Mills, published the first paper tying the tick to the illness in 2011.
One of the first cases they saw was a bow hunter who had eaten meat all his life but landed in the emergency department several times with allergic reactions after eating meat. More cases kept turning up in people who were outdoors a lot.
People who were outdoors a lot … gulp.
Here’s how it happens: The bugs harbor a sugar that humans don’t have, called alpha-gal. The sugar is also is found in red meat — beef, pork, venison, rabbit — and even some dairy products. It’s usually fine when people encounter it through food that gets digested.
But a tick bite triggers an immune system response, and in that high-alert state, the body perceives the sugar the tick transmitted to the victim’s bloodstream and skin as a foreign substance, and makes antibodies to it. That sets the stage for an allergic reaction the next time the person eats red meat and encounters the sugar.
A reader recently sent me a link to an article about a professor of bioethics who proposed making people allergic to meat to save the planet from climate change. Somebody should investigate and see if this little screwball has been messing around with ticks in his lab.
Doctors don’t know if the allergy is permanent.
Please, God, don’t let it be permanent.
Some patients show signs of declining antibodies over time, although those with severe reactions are understandably reluctant to risk eating meat again. Even poultry products such as turkey sausage sometimes contain meat byproducts and can trigger the allergy.
Michael Abley, who is 74 and lives in Surry, Virginia, near Williamsburg, comes from a family of cattle ranchers and grew up eating meat. He developed the meat allergy more than a decade ago, although it was only tied to the tick in more recent years.
“Normally I can eat a little bit of dairy,” he said, but some ice cream landed him in an emergency room about a month ago.
Okay, so if I get bit by one these little demons, all I’d have to do is give up beef, pork, dairy products, and perhaps poultry products. If you hear a scream loud enough to break windows in Georgia coming from Tennessee, you’ll know I got bit by a Lone Star tick.
Up to this point, I’ve been trying to be judicious in my use of Deep Woods Off before working outside. I believe I’ll start soaking myself with it. And washing my clothes in it. And using it for shampoo.
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I wasn’t around last night to write a post. Sara took her goats to the 4-H livestock show at the county fair early in the morning, and in the middle of the afternoon, Chareva called to tell me one of the goats won his class, then his division. That meant Sara would be competing for the grand prize in the evening.
So I wrapped up work for the day around 5:00 and took Alana to the fairgrounds to watch. Here are some short video clips of the day:
Alana and I left around 8:30 PM, but Sara and Chareva had to stick around for the auction. We’ll make a bit of profit on the goats (although I wouldn’t want to live on it), and Sara took home some nice prize money to put in her “I want a car when I’m 16″ savings account.
So that’s it. The goats are gone. It was a great summertime experience for Sara, but with school starting up again, plus piano lessons and eventually band-instrument practice, I think she has enough to keep her busy for awhile.
In few more days, she’ll auction off five of her chickens at the fair. Meanwhile, we’re starting to get small eggs from her flock. When her 15 remaining chickens start laying full-sized eggs, it will be time to open that egg stand by the side of the road.
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This article about cigar smokers showed up in yesterday’s online edition of MedPage Today:
Most cigar smokers in America are smoking cheaper, unfiltered versions cigarillos and mass market cigars, a government report showed.
Among the 7% of American adults reporting smoking cigars at least sometimes, 62% said they usually smoked cigarillos or mass market cigars, Catherine G. Corey, MSPH, of the FDA’s Center for Tobacco Products in Silver Spring, Md., and colleagues found.
“These findings underscore the importance of public health interventions to reduce cigar smoking among U.S. adults,” Corey and colleagues argued. “Evidence-based tobacco control interventions such as increased taxes, smoke-free policies, and public education campaigns should also address non-cigarette tobacco products.”
“Regular cigar use is estimated to be responsible for approximately 9,000 premature deaths and almost 140,000 years of potential life lost annually,” according to a conservative estimate, Corey’s group noted.
Cigarillos are little cigars (think Swisher Sweets) made with tobacco filler, and from what I’ve seen, people tend to smoke them like cigarettes – one after another, sometimes even inhaling. Bad idea. Premium cigars, on the other hand, are larger and made from rolled tobacco leaves. Try inhaling one of those, you’d probably pass out.
When we lived in suburban neighborhoods with streets and sidewalks, I used to take long walks three or four nights per week and smoke a premium cigar while listening to a podcast or audiobook. Now that we live in the sticks, I don’t take those late-night walks. So I smoke maybe a couple of cigars per month, usually sitting outside at night after Chareva and the girls have gone to bed. I’ve never smoked them indoors.
By pure coincidence, I happened to stop at a cigar shop the day before the MedPage Today article ran. Even though this particular shop only sells premium cigars, there was a big sign (no doubt mandated by law) on the door to the humidor, warning me that according to the Surgeon General, cigars cause cancer.
Hmmm … I’ve been hearing that one for years. I’ve had people inform me that smoking cigars doubles my risk of mouth and throat cancer. So a couple of years ago, I looked up the actual data. In honor of the MedPage Today article, I thought I’d dig up the data and share it. This isn’t exactly diet-related, of course, but it illustrates how government officials have no qualms about exaggerating risks when they want to discourage us from a habit they don’t find acceptable.
The data I’m quoting here comes from something called the Smoking and Tobacco Control Monograph. I have a PDF that doesn’t specify the publisher, but from what I can find online, it was apparently produced by the National Cancer Institute. The paper is a meta-analysis of multiple observational studies on smoking, mortality and disease. So let’s dig in.
The risks of smoking in the paper are expressed as risk ratios. In case you’re not familiar with what those mean, here’s the lowdown: Suppose in a control population of non-smokers we want to use for comparison, 10% of all people end up with heart disease. That’s what we’d consider normal, so we assign that a risk of 1.0. Now suppose that among cigar smokers, 12% of them eventually end up with heart disease. That’s 20% higher, so we’d say their risk ratio is 1.2. Or we could say for every 1,000 non-smokers, 100 will end up with heart disease, while for every 1,000 cigar smokers, 120 will end up with heart disease — 20 additional cases per 1,000 cigar smokers.
Got the idea? Good. On to the data.
We’ll start with the big one: all-cause mortality. Everyone dies, so I assume they’re talking about premature death. Cigar smokers as a group have a risk ratio of 1.12. So that looks kind of bad, doesn’t it? (Among cigarette smokers, it’s far worse. The premature-death risk ratio for them is 1.66.)
But who are these cigar smokers? If it’s the people puffing away on a dozen cigarillos per day, I’d say we can partly blame the cigars, but we might also be looking at people with bad health habits in general. Not a lot of health-conscious people make a habit of smoking Swisher Sweets.
On the other hand, there are plenty of people like me out there too — health-conscious people who smoke a premium cigar now and then. In fact, based on the fellow cigar smokers I’ve known, I’d say most people who smoke premium cigars smoke one per day, if that. After all, we’re talking about a $10 cigar. Unless you have money to burn (literally), you’re not going to smoke your way through five or 10 of those per day.
The paper doesn’t distinguish between good cigars and cheap cigars, but fortunately it does split out the data by the number of cigars smoked per day, and also by age group. And that’s where it gets interesting.
For all-cause mortality, here are the risk ratios by age group for men who smoke 1-2 cigars per day:
Holy smokes, Batman, look at that low risk ratio among the 35-49 age bracket! If we saw that result in a study of whole grains, there would be headlines splashed all over the media telling us that A DAILY SERVING OF WHOLE GRAINS REDUCES RISK OF DEATH IN MIDDLE AGE BY 30%!
But we’re talking about cigars, and the Surgeon General doesn’t want us to smoke cigars, so this interesting bit of data remains in the research closet, so to speak.
I’m not suggesting cigars prevent early death, of course – and I’m certainly not encouraging anyone who doesn’t already smoke cigars to start. My guess is that people in the 35-49 age bracket who smoke a cigar or two per day are more well-to-do, and people with higher incomes tend to have better health outcomes for all kinds of reasons. But I think we can safely say that smoking a cigar now and then isn’t killing people in that age bracket – and probably not in any age bracket.
Here are the risk ratios for lung cancer among men who smoke one or two cigars per day, divided by the age brackets available in the data tables:
CIGARS PREVENT LUNG CANCER IN MIDDLE AGE, OLD AGE, STUDY SHOWS
Okay, just kidding. That spike in the 65-79 group is interesting, but again, given that cigar smokers in the other two groups have lower rates of lung cancer than non-smokers, I think we can safely say smoking a cigar per day doesn’t cause lung cancer. The combined risk ratio for all groups, by the way, was 0.90, which means we could say that smoking cigars lowers your risk of lung cancer by 10% — which again is what we’d see in the media if we were talking about whole grains or soy milk.
Here are the risk ratios for coronary heart disease – once again, these are only for men who smoke 1-2 cigars per day, not people who puff away on a dozen cigarillos.
Another media headline you’ll never see: A CIGAR PER DAY PREVENTS HEART DISEASE IN MIDDLE AGE
You get the idea. But let’s look at the big one, the disease several people (including my mom) warned me about after learning I smoke an occasional cigar: cancer of the esophagus. We’re talking about men who smoke 1-2 cigars per day, and I smoke maybe two per month now, but for the sake of argument I’ll assume these risk ratios apply to me:
So that’s why I’ve been warned that those Macanudos are doubling my risk of throat cancer. But as I pointed out in my Science For Smart People speech, whenever you’re presented with a relative risk, the question you want to ask yourself is: What’s the absolute difference? In other words, how many actual extra cases of esophageal cancer are we talking about?
I found some data on esophageal cancer in another paper put out by the National Cancer Institute. In the U.S., the incidence rate of esophageal cancer for white males is 8 per 100,000 per year. That number, of course, includes smokers of all kinds, including heavy cigarette smokers. The NCI didn’t list the rate among non-smokers, but from what I can find elsewhere online, it appears to be around 1.5 per 100,000 per year. Smoking 1-2 cigars per day more or less doubles that risk.
So here’s the absolute difference: Among non-smokers, 3 in every 200,000 will develop cancer of the esophagus in a given year. Among men who smoke 1-2 cigars per day, 6 in 200,000 will develop cancer of the esophagus in a given year. That’s one extra case of cancer per year for every 67,000 men who smoke a cigar or two per day.
I think I can live with those odds … no matter how many signs the Surgeon General tries to make me read as I walk into the humidor.
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