Monthly Archives: March 2012

the other liquor, Op. 67

Posted on March 30, 2012 | 1 comment

First pizza became a vegetable, now chocolate cures obesity, what’s next, cigarettes are the fountain of youth?

The publication that spawned the recent news flurry:  Association between more frequent chocolate consumption and lower body mass index (Golomb et al., 2012 JAMA)

The humble title doesn’t come close to the media’s interpretation, which included such deluded phrases as “A chocolate a day to get slimmer?” and  “Is chocolate the secret to a skinny waistline?”

While a chocolate bar isn’t the most nutritionally offensive dessert, it is neither a panacea of health nor a cure for obesity.  Chocolate 101: milk chocolate is loaded with sugar; dark chocolate usually has a little less sugar, it’s “dark” because it has less milk and more chocolate liquor (no, not that kind of liquor); unsweetened chocolate has no added sugar and is usually reserved for baking.  If you think you’re having a genuine chocolate craving, you, like many others, may have been beguiled by the serpent sugar. want proof? next time you’re in the mood, try some high-cocoa unsweetened chocolate; it’s the purest chocolate that chocolate can be.   While it can be rich and delicious in its own unique way, even the fanciest stuff tastes little like “chocolate”

And this “high-cocoa unsweetened chocolate” (shown on the bottom of the figure below) is probably the only kind that can be remotely called “healthy.”  The chocolate mentioned in this study was probably a blend of this, milk, and a ton of sugar (aka “milk chocolate”).

High-cocoa unsweetened chocolate is less sweet, higher in fat, and has more health-promoting compounds than any other type.

Back to the groundbreaking study for a moment:The third line of the results says that people who ate more chocolate were more depressed and ate more calories, both of which were associated with higher body weight.  But two lines later, we are told increased frequency of chocolate consumption by itself was linked with lower body weight…  let me get this straight: the people who ate more chocolate were fatter because they were depressed and ate more calories, not because they were eating more chocolate …? sounds like statistical sorcery of the highest degree.

On the other hand, a much more convincing study specifically on dark chocolate:  Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons (Grassi et al., 2005 AJCN)

These lean (~140 lbs) healthy subjects were given, in a randomized crossover study, 100 grams (~3.5 ounces, 480 kcal) of dark or white chocolate for 2 weeks.  Dark chocolate contains all the health-promoting compounds (e.g., flavonoids, like those found in red wine and green tea); white chocolate has none.  The subjects were apparently prescribed a 1,400 kcal/d diet (semi-starvation) but didn’t lose any weight over the entire period.  So unless they were bedridden, this is probably not true.  But I’ll admit, the effect on insulin sensitivity was quite remarkable:White chocolate (open circles) was health neutral or even slightly modestly detrimental (all of the sugar, none of the flavonoids).  But dark chocolate profoundly enhanced insulin sensitivity-

Flavonoids: 1

Sugar: 0

(granted, this was probably the healthiest dark chocolate in the world…)Although this was a high quality study design (randomized crossover), I will [stubbornly] wait for independent confirmation before making any heretical paradigm shifts.

… uh-oh

High-cocoa polyphenol-rich chocolate improves HDL cholesterol in Type 2 diabetes patients (Mellor et al., 2010 Diabetes Medicine)

In contrast to the first study, this study didn’t use chocolate per se, but rather polyphenol-rich high-cocoa solids which is probably more similar in flavonoids to high-cocoa unsweetened chocolate.

Again, the results were fairly outstanding:Flavanoids: 2

Sugar: 0

Consumption of the regular (low-polyphenol) chocolate induced a pro-diabetic phenotype (increased glucose & insulin; decreased HDL), while the super-chocolate was potently anti-inflammatory (reduced CRP and increased HDL).  While these findings are indeed impressive, sorry, but the inconsistent effects on insulin sensitivity still give me pause (markedly effective in the Grassi study with dark chocolate vs. no effect at all in the Mellor study with polyphenol-rich cocoa solids).

In conclusion: milk chocolate candy bars are still on the list of “clearly unhealthy foods,” especially for anyone with metabolic syndrome or excess body fat; rare European dark chocolate is temporarily classified as “probably not harmful;” and high-cocoa unsweetened chocolate is upgraded to “possibly beneficial.”

unless it explodes(Weinzirl, 1922 Journal of Bacteriology)

calories proper

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Posted in Advanced nutrition, Dietary fat, empty calories, Energy balance, Sugar

Red meat won’t kill you. It will make you stronger.

Posted on March 24, 2012 | 4 comments

While statisticians try to wheedle causation from observational data, they really just end up showing us what health conscious people are like.  They exercise more and smoke less, eat more fruit and less red meat, etc.  This doesn’t “prove” those habits actually make health conscious people healthy.  Intervention studies, where healthy and non-healthy people are randomly assigned one of those habits, are required in order to achieve any reasonable amount of “proof.”  With regard to red meat, findings from such studies frequently stand in contrast to the observational data.
-end soapbox-

Divide and conquer

Serum lipids in humans fed diets containing beef or fish and poultry (Flynn et al., 1981 AJCN)

randomized crossover study: 1 egg + 5 oz. of red meat or fish/poultry for three months

The red meat group ate significantly more cholesterol than the poultry/fish group (540 vs. 477 mg/d), fat (104 vs. 83 g/d) and saturated fat (40 vs. 27 g/d).  Despite these differences, there were no changes in serum cholesterol or HDL.  In women but not men, red meat decreased and poultry/fish increased serum triacylglycerols, an effect that was consistent regardless of the order in which the diets were consumed (it was a crossover study).  This is significant because according to the Framingham studies, serum triacylglycerols are a more important predictor of heart disease in women than men.  And interestingly, carb intake, which usually regulates serum triacylglycerols, was similar in both groups suggesting that red meat has a triacylglycerol-lowering effect independent from simply displacing carbs from the diet.  Furthermore, the red meat group consistently ate about 200 more kilocalories then the poultry/fish group yet body weight was stable and similar in both groups.

Conclusion 1: 5 ounces of red meat (plus more cholesterol, fat, and saturated fat) for three months lowered serum triacylglycerols and didn’t affect cholesterol.  The excess calories consumed in the red meat group (mostly from saturated fat and protein) didn’t cause weight gain.

The effect of short-term diets rich in fish, red meat, or white meat on thromboxane and prostacyclin synthesis in humans (Mann et al., 1997 Lipids)

randomized intervention study: ~8 oz. white meat vs. ~12 oz. red meat vs. ~5 oz. fish for 2 weeks

This study was really trying to compare the effect on inflammatory markers of the high AA content of meat to the high EPA and DHA in fish (AA being pro-inflammatory and EPA/DHA being anti-inflammatory).As expected, the fish diet reduced inflammatory biomarkers (thromboxane and prostacyclin).  The two unexpected findings were: 1) white meat actually increased inflammatory biomarkers, and 2) red meat had no effect.

Conclusion 2: red meat and AA did not impact the inflammatory biomarkers thromboxane and prostacyclin.




Comparison of the effects of lean red meat vs lean white meat on serum lipid levels among free-living persons with hypercholesterolemia (Davidson et al., 1999 Archives of Internal Medicine)

randomized intervention study: ~5 oz/d of red meats (beef, veal, and pork) vs. white meats (poultry and fish) for 36 weeks

As seen in the table below, neither diet had any major effect on plasma lipids.

Fat, cholesterol, and total calorie intake was higher in the red meat group, but again, this didn’t result in any differences in body weight between the groups.

Conclusion 3: red meat had no effect on plasma lipids and the excess calories consumed in the red meat group (mostly from saturated fat and protein) didn’t cause weight gain.

Partial substitution of carbohydrate intake with protein intake from lean red meat lowers blood pressure in hypertensive persons   (Hodgson et al., 2006 AJCN)

randomized intervention study: 2 oz./d red meat vs. starchy carbs for 8 weeks

Conclusion 4: red meat lowered blood pressure and the excess calories consumed in the red meat group (mostly from saturated fat and protein) didn’t cause weight gain.

Increased lean red meat intake does not elevate markers of oxidative stress and inflammation in humans (Hodgson et al., 2007 AJCN)

randomized intervention study: 8 oz./d of red meat vs. carbs for 8 weeks

Subjects were instructed to eat their red meat in place of carb-rich foods such as bread, pasta, rice, potatoes, and breakfast cereals.

Conclusion 5: Biomarkers of oxidative stress (F2 isoprostanes and GGT) and inflammation (CRP and SAA) were reduced in the red meat group.




In sum:

WRT plasma lipids: red meat improved some and had no effect on others

WRT inflammation: red meat had no effect on thromboxane and prostacyclin, and decreased CRP and SAA

WRT oxidative stress: red meat reduced F2 isoprostanes and GGT

WRT energy balance: the excess calories from red meat didn’t cause weight gain.  This was the most consistent finding in all of the above studies and may be at least partially explained by the findings of the recent protein overfeeding study by George Bray and colleagues who showed, in brief, that excess protein had no impact on fat mass and actually increased lean mass.  So if you’re worried that fatty red meat might make you fat, don’t be.

The key to these 5 studies is that they are randomized intervention trials.  It’s not simply looking at what healthy people eat, but rather what happens when one specific dietary component is changed in all kinds of random people.  In other words, it’s what would happen in the real world if you made this dietary change.  And red meat consistently improved a variety of health parameters.

I suspect when the value of intervention trials is realized and fully appreciated, the habits of health conscious people will change.  Until then, we’ll just have to take the media’s reporting of nutrition studies with a grain of salt.

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Posted in Advanced nutrition, Energy balance, Protein

Yogurt black belt test, Op. 65

Posted on March 17, 2012 | 2 comments

Proper yogurt can serve as a delicious and healthy addition to any meal of the day.  It contains probiotics, whose role in promoting a healthy gut flora and overall well-being is widely appreciated.  As such, yogurt can be considered an acceptable source of a little bit of sugar in your diet.  (I don’t say that very often… actually, that was probably the first time.)

BUT (you had to know there was a “but”) there are a lot of caveats.  First and foremost is selecting the best yogurt product, since not many people are down with DIY fermentation (which is unfortunate given its tremendous ease).  The yogurt with the most gravitas on the market: FAGE.  It’s supposedly Greek, but I’d say given it’s macronutrient composition, it’s more Spartan.  There are considerable differences between the plain and fruity varieties worth considering.  For example, one serving of plain contains 190 kcal, 10g fat, 8g sugar, and 19g protein, whereas one serving of the blueberry-flavored variety contains 170 kcal, 6g fat, 16g sugar, and 11g protein.  twice the sugar! This is unacceptable, primarily because while I’m not really clear what’s in the “blueberry fruit preparation” that’s listed in the ingredients, I’m sure it’s not real blueberries.  Since real blueberries have negligible protein, we can assume the total protein content of the final product is entirely from the yogurt; therefore, their ambiguously named “blueberry fruit preparation” contributes about 27 grams to the entire 150 gram serving.  This adds 12 grams of sugar, whereas 27 grams of real blueberries would provide only 3 grams of sugar (and some fiber and phytonutrients).

And pass on the 0% fat version; one serving contains all of the sugar but none of  the healthy fats that slow down sugar absorption and contribute to satiation.

On to more pressing, or ‘popular,’ matters.  Dannon is the most widely purchased yogurt on the market.  One serving of plain Dannon yogurt contains 160 kcal, 8g fat, 12g sugar, and 9 grams of protein (less protein and healthy fats, and more sugar than its Spartan counterpart).  Their vanilla-flavored variety has a whopping 25 grams of sugar (and it’s certainly not natural dairy sugar…).  One serving of blueberry-flavored Fruit-on-the-Bottom contains 140 kcal, 1.5g fat, 26g sugar, and 6g protein.  If you added real blueberries to the plain variety this would only yield 15 grams of sugar (still more than FAGE, FTR).  Again, this additional sugar is not coming from real blueberries; unlike FAGE, who disguises their mystery flavor as “blueberry fruit preparation,” Dannon doesn’t even try to hide it.  Right in the ingredients list you’ll find strike 1: sugar, strike 2: fructose syrup, and strike 3: high fructose corn syrup (I honestly don’t know why that’s listed as three separate ingredients.  It’s like they’re trying to boast about it).  I feel pre-diabetic just reading it.  Yoplait is just as bad (high sugar and low protein); come on, Trix -flavored yogurt?  Really?

With regard to promoting a healthy gut flora:  Dannon contains only 1 probiotic strain: L. acidophilus; Yoplait has 2: L. bulgaricus and S. thermophiles; FAGE has 5, L. acidophilus, L. bulgaricus, S. thermophiles, Bifidus, and L. casei.

FAGE: winner.

 

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Posted in Advanced nutrition, Dietary fat, empty calories, Protein, Sugar, Uncategorized

Volumetrics II

Posted on March 12, 2012 | 1 comment

Volumetrics, take II, Op. 64

Greatest dietary predictors of 2-year weight loss success: increased intake of vegetables and meat and reduced intake of empty calories   (sugars and starchy carbs).

Proponents of the low-fat diet cite the high energy density of fat (9 kcal/g) relative to carbohydrate (4 kcal/g) and claim you can eat more carbs than fat without exceeding your daily calorie budget: 100 grams of carbs = 400 kcal; 100 grams of fat = 900 kcal.  And by extension, you will: 1) feel fuller after a high carb meal; 2) eat fewer calories; and 3) lose weight.  Bollocks, bollocks, and bollocks.  Diet studies that compare low-fat to low-carb impose strict calorie restrictions on the former and unlimited consumption of the latter.

The “energy density of food” theory is about as valuable for weight loss as “eat less, move more,” and “a calorie is a calorie.”  

Fiber  and water, the great filler-uppers, have done nothing in the battle of the bulge.

The figure above is from the now famous (or infamous, in certain crowds) Shai study.  A manuscript was recently published that tried to figure out which foods were most (or least) associated with successful body weight management at two distinct time points: 1) weight loss at 6 months; and 2) weight maintenance after 2 years.

Effects of changes in the intake of weight of specific food groups on successful body weight loss during a multi-dietary strategy intervention trial (Canfi et al., 2011 JACN)

The reduction in food consumed was ~24% on the low fat diet and ~33% on the low carb diet, despite a similar reduction in calories (~22%) in both groups.  The low fat diet was not “more satiating;” both groups were eating the same amount of calories.  Yet the low carb dieters lost more weight.  But the point of the new study was about which foods were the best predictors of success in all of the groups.  Ample information about the dietary intervention, cute food pyramids (see below), and sample meal plans are available in the online supplement.

By and large, the results were similar for weight loss (at 6 months) and weight maintenance (24 months); IOW, whatever helps you lose weight also helps keep it off.  But there some interesting differences. For example, increasing vegetable intake assisted weight loss but was less important in the long-term.  Conversely, reducing starchy carbs (bread, pasta, cereals and potatoes) was moderately important for weight loss but universally important for maintenance of a reduced body weight.  Increased meat intake was one of the best predictors of successful long-term weight loss independent from background diet (it was equally true for low carb and low fat dieters).  In other words, increasing vegetable intake can help jumpstart a weight loss diet, but reducing starchy carbs increasing meat intake need to be permanent lifestyle changes.

And surprise surprise, reducing “sweets and cakes” was also a major factor across all diets.  With regard to weight loss, reducing sweets and cakes was statistically more important than increasing vegetables.  In fact, it was the most important change of all.

In sum, long-term weight loss success includes a diet with more meat and vegetables and fewer empty calories (starchy carbs, sweets and cakes, etc.).

 

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Posted in Advanced nutrition, Dietary fat, empty calories, Energy balance, Protein, Sugar

Diet, diabetes, and death (oh my)

Posted on March 6, 2012 | 7 comments

Fatty acid face off: saturation vs. chain length
or
an homage to pioneers of nutrition research

While both fats contain a lot of 8-12 carbon fatty acids (C8-C12), coconut oil contains more of the 12-carbon fatty acid “lauric acid” whereas medium-chain triacylglycerols (MCT) have more of the 10-carbon fatty acid “capric acid.”  Both exhibit remarkably protective effects against diabetes and this has been known for quite a while.  Coconut and MCT oils are also phenomenally ketogenic, which contributes to their healthful effects (although this eluded early researchers).

Experimental diabetes and diet (Houssay and Martinez 1947 Science)

This study used alloxan to deplete insulin-producing beta-cells rendering these rats essentially type I diabetic.  In the first experiment, they injected alloxan and counted how many rats were still alive after one week.  This study is cruel by today’s standards, but things were different in 1947.  It does, however, provide valuable information as the rats were also being fed one of 16 (16!) different diets.  The major finding was that all the rats fed lard died (d, e, and i in the table below), while all those fed coconut oil survived (o in the table).  And additional coconut oil, methionine, or thiouracil, but not protein, sulfanilamide, or choline reduced the deadliness of lard.  Both lard and coconut oil contain saturated fat, but lard has longer chain fatty acids and more unsaturated fat than coconut oil suggesting fatty acid chain length and/or degree of unsaturation may be important.

In the follow-up experiment, rats were rendered diabetic by surgical removal of 95% of their pancreas and fed high carb, high protein, or high lard diets (a, b, and d from the table above).  In agreement with the first experiment, lard is bad news.  On the other hand, whereas a high protein diet wasn’t helpful for alloxan diabetes, it was remarkably protective in pancreatic diabetes. 

Influence of diet on incidence of alloxan diabetes (Rodriguez and Krehl 1952)

These researchers measured mortality and diabetes incidence in alloxan-treated rats and found that: 1) coconut oil is protective against mortality and diabetes; 2) lard is not; and 3) high protein is modestly protective.  IOW, these data confirm Houssay’s from 5 years earlier.These authors added some information to the picture by measuring body weight and showing that the protective effect of coconut oil is not due to reduced body weight, because these coconut oil-fed rats weighed as much as those fed a low protein diet, and low protein diet-fed rats fared rather poorly.

To add yet more information to the picture (kudos!), they fed rats diets containing the most abundant fatty acids found in coconut oil (caprylic acid) or lard (palmitic acid) and showed that coconut oil’s benefits may be due to caprylic acid because this fatty acid alone was similarly protective against mortality and diabetes.  They also showed lard’s malevolence is not due to palmitic acid because these rats were almost just as protected as those fed caprylic acid.  This somewhat excludes a role of fatty acid length as caprylic acid has 8 carbons while palmitic acid has 16, but both are fully saturated (suggesting a possible detrimental role for unsaturated fatty acids [?]).

So why is coconut oil so good?

One possible reason:  saturated fatty acids are protective, which is supported by the beneficial effect of coconut oil, caprylic acid, and palmitic acid.  Similarly, lard and Swift’ning have a lot of unsaturated fats and both were detrimental.

Unsaturated fatty acids and alloxan diabetes (Rodriguez et al., 1953 Journal of Nutrition)

Rats fed saturated fats of varying chain length were remarkably more protected than those fed unsaturated fats.  Lard has a lot of oleic acid, and rats fed oleic acid didn’t do so well; corn oil is predominantly unsaturated fat and rats fed corn oil were phenomenally unhealthy.  They also showed that rats fed stearic acid (18-carbons, fully saturated) were much healthier than those fed oleic acid (18-carbons, monounsaturated). While none of these studies explored the ketogenic effects of C8-12 fatty acids, they clearly demonstrated that saturated fatty acids of any chain length are good for diabetics, while unsaturated fatty acids are bad.  Good sources for C8-10 fatty acids are MCT oil and goat’s milk, and a good source for C12 fatty acids is coconut oil.

As to the role of ketones, which I think is quite important… to be continued

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Posted in Advanced nutrition, Dietary fat, Ketosis, Protein, Uncategorized