For overall health and well-being, fermented foods like sauerkraut and kefir are great. Especially when following a low carbohydrate diet which is generally low in the types of foods which feed the gut microbiome.
For those with gastrointestinal problems, the gut microbiota is probably involved. Whether it is bacterial overgrowth or dysbiosis, gut bugs are usually the culprit. Treatment options vary widely, ranging from global extermination with vinegar & a low fibre diet (as per Jane Plain), or remodeling the microbiome with a prebiotic like galactooligosaccharides. Probiotics like bifidobacteria can help, too, if they’re administered with either prebiotics or fermented foods (they need something to nourish them in transit). Dark chocolate is also an excellent vessel. Resistant starch is another option, although the question remains as to whether or not this is compatible with a low carbohydrate diet.
Resistant starch has been around for a while, and when I was in school it received about 10 minutes of attention during the fibre lecture. But Jimmy Moore and Richard Nikolay have been talking about it a lot lately so I decided to freshen up on the topic. In brief, it can be therapeutic for GI issues, but some studies have shown mixed effects on glucose & insulin metabolism. The former is virtually unarguable, but I found the latter interesting. And the impact of resistant starch on ketosis is included as well.
This is one of the biggest diet studies we’ve seen in a while, and no doubt it was a very good one. It very effectively put the Mediterranean Diet to the test.
I felt compelled to write about this study out of fear for the nutrition disinformation that it would likely inspire. The Mediterranean Diet is associated with all good things, happiness, red wine and olive oil; whereas the Atkins Diet is associated with artery clogging bacon-wrapped hot dogs and a fat guy who died of a heart attack. Nutrition disinformation.
If you ran a diet study with 3 intervention groups for 5 years, and by the end of the study everybody (in all 3 groups) was on more prescription medications, would you conclude any of the diets were “healthy?” If so, then we should work on your definition of “healthy.”
Study details: big study, lasted roughly 5 years, and the diet intervention was pristine. Mediterranean diet plus extra virgin olive oil (EVOO) vs. Mediterranean diet plus nuts vs. low fat control. They even used biomarkers to confirm olive oil and nut intake (hydroxytyrosol and linoleate, respectively). Compliance was good.
While it has a decent amino acid profile, with only 3 grams of protein it’d take a diabetic amount of potatoes to fulfill your daily protein. By “diabetic,” I mean about a thousand grams of starch. potatoes are just as glycemic as white bread.
As a proponent of consuming fatty fish (sardines, salmon, etc.), I was interested to read the new fish oil study; as an opponent of meta-analyses, however, not so much. A meta-analysis is a type of study whereby the researcher thinks of something they want to prove, then cherry picks studies that best support their point. Or perhaps I’m just biased. Nonetheless,
In brief, regarding whole fish consumption, 3 servings per week reduced stroke risk by 6% and 5 servings by 12%. Surprisingly, there was no effect of fish oil pills that contained ~1.8 grams of long chain omega 3 fatty acids. What this study lacks is any information about the dose of EPA and DHA (the major bioactive fatty acids in fatty fish); and with 38 studies analyzed, I’m not about to try to figure it out (sorry team)… a serving of fish can have anywhere from 0 to 1 gram of EPA and DHA; 1.8 grams of long chain omega 3 fatty acids can have anywhere from 0 to 1.8 grams of EPA and DHA. Therefore, I’ll resort to reviewing two of my favorite fish studies of all time: DART and GISSI. For a more detailed review of fish oils and these studies, check out The poor, misunderstood calorie (chapter 9).
Utterly. Shocked. is how I feel gazing upon the ingredients listed on one particular popular snack food. And it isn’t one of those fancy gourmet all-natural whole food snacks, it is a classic that is probably in the kitchen of every child-wielding household.
Corn, corn oil, and salt. And salt doesn’t even count, so it might just as well have said corn and corn oil, which could be summarized as “corn.” Ladies and gentlemen, I present to you, the reigning champion of snack food sorcery, the red-headed stepchild (no offense) of international superpower PepsiCo… Fritos. Using only corn, the wizards of Frito-Lay are turning this:into this:
and that’s without the use of trans fat, gluten, artificial additives, dairy, msg, onions, or soy. They’re Kosher too.
I heard a comedian say he wished exercise was like high school; once you get your diploma, that’s it. You never need to do high school again. Unfortunately, the same isn’t true with artificial nutrition. the mad food scientists are at it again.
Enter: Soluble corn fiber (SCF), mass produced by MegatronPromitor
Over a decade ago, Atkins released low carb bars. Well, they weren’t actually low carb per se, they were low sugar. This was accomplished by replacing sugar with glycerol (a sugar alcohol) and polydextrose (a pseudo-fiber). While their bars are made from cheap ingredients and low quality protein, sugar alcohols and pseudo-fibers are certainly better than sugar.
More recently, the field took a considerable philosophical leap forward and starting using real fiber, good fiber. Inulin appeared in some Atkins bars, VPX Zero Impact, and the original Quest bars. Quest has since switched to another good fiber, isomalto-oligosaccharides. Unfortunately no one is using GOS, yet, but they will … mark my words (that’s a prediction, or stock tip… not a threat).
But now the field has taken a turn and we have another artificial ingredient, a pseudo-fiber, with which to deal. “Soluble corn fiber (SCF)” first appeared in Splenda Fiber packets and then in Promax LS bars.
If you’re like me, you’re asking yourself: what is this stuff? Is it real fiber? Is it like the super fibers inulin and GOS? Hello Pubmed
Divide and conquer
Stewart (2010) compared SCF to 3 other fibers and maltodextrin, 12 g/d x 2 weeks =
Pullulan, a rather potent fiber, is not well-tolerated. Resistant starch (an insoluble fiber), soluble fiber dextrin, and SCF were all OK. The gut microbiota seemed to have no preference, as short chain fatty acid production was similar in all groups (perhaps 12 grams is subthreshold?). Similarly, health biomarkers, hunger levels, and body weight were unaffected.
Boler (2010) compared a commercially available SCF preparation to polydextrose, 21 grams per day for 21 days in 21 healthy men (cute.)
NFC, no fiber control; PDX, polydextrose; SCF, soluble corn fiber
In this study, however, SCF didn’t do so well. It caused gas and reflux. Perhaps this wasn’t observed in Stewart’s study because of the lower dose (12 vs. 21 grams). Furthermore, polydextrose reduced while SCF increased short chain fatty acid production, both of which resulting in a higher acetate:butyrate ratio. So unlike 12 grams of any of Stewart’s fibers (including SCF), the gut microbiota seems to respond to 21 grams of SCF. And they pooped more (both fiber groups).
This same group reported a more detailed analysis of the gut microbiota which unfortunately did NOT exactly confirm their earlier finding (Hooda et al., 2012):
Data presentation is different in the two publications, and if both are true, then SCF selectively increases a few specific strains of bifidobacteria but reduces many others (enough to increase the total amount but decrease the variety). The functional implications of this are unclear (to me).
In the meantime, SCF appears to be at most an OK pseudo-fiber substitute. Megatron Promitor is not likely to test it against the super fibers (e.g., inulin, GOS, etc.) any time soon, so we won’t know if it’s an advance or simply a side-step. Such is life.
Whether it is being used to treat Celiac disease, autism, or Paleo-deficiency, a gluten-free diet (GFD) is probably the most inconvenient diet. There’s no health risk imposed by recreational gluten avoidance; actually, it might even be healthier.
For example, cereal fibre (aka whole grains) provides the majority of gluten in the Western diet. I have not been shy about my stance on cereal fibre in the past. In the seminal DART study (Burr et al., 1989 Lancet), people who were instructed to eat more cereal fibre had a higher mortality rate. There are definitely many nuances and specifics, etc., yada yada yada, but this finding should be your mind’s pantheon for all-things-gluten.
One example of how my brain organizes information: gluten-free diets include GFCF (duh), Paleo, and Atkins. The low FODMAPs diet is indirectly gluten-free because cereals and grains are excluded. N.B. these are all healthy diets… I repeat: GFCF, Paleo, Atkins, and low FODMAPs are all healthy diets. But don’t take my word for it, Miley Cyrus and Kim Kardashian are also gluten-free (so it MUST be true; there’s no hiding from the Glutenista!). No grain, no pain!
A downside? One possible side effect of gluten avoidance is potentially detrimental alterations in gut bacteria. For example, de Palma and colleagues (2009) showed that a strict GFD significantly reduced bifidobacteria (one of the good guys) in healthy adults. A GFD is the only clinically effective treatment for Celiac disease, but my gut tells me (no pun intended) that the beneficial effects are not due to reduced bifidobacteria… I’m waiting for a study where a GFD is supplemented with bifidobacteria and inulin/GOS to test this.
On the bright side, the anti-bifido effect of gluten avoidance is not universal. De Cagno and colleagues (2009) showed that children with Celiac disease have less bifidobacteria in their gut and this is reversed by a GFD (phew!).
gluten - hiding in plain sight... everywhere
Crackpot theory of the week: could inulin/GOS increase gluten tolerance? He and colleagues (2008) gave lactose-intolerant patients supplemental bifidobacteria in the form of capsules (1.8×10^9 cfu B. longum) and yogurt (3×10^10 cfu B. animalis) which significantly improved their lactose tolerance (it nearly cured them). In this study, yogurt provided the prebiotics necessary to ensure survival of the supplemental bifidobacteria. I imagine inulin or GOS
would’ve had a more profound effect.
Celiac disease, lactose-intolerance, IBS, and veganism are all associated with reduced bifidobacteria and could theoretically benefit from inulin/GOS supplementation. You could try a diet high in onions, garlic, and breast milk, but cost, availability, and potential for halitosis favor the supplemental route (finally found a source of high quality GOS). And it sure as hell beats eating shit.
FODMAPS – Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. Basically, FODMAPs are a bunch of sugars that are poorly digested in some people and cause a fantastic variety of health problems ranging from bloating and abdominal pain all the way to chronic fatigue and anxiety. AND a low FODMAPs diet seems to provide some relief (Ong et al., 2010; Staudacher et al., 2011).
Just like it’s weird name, it’s difficult to simplify the rules of the low FODMAPs diet, so here it is graphically:
Grains are excluded from GFCF due to gluten and from FODMAPs due to oligosaccharides. Dairy is excluded from GFCF due to casein and from FODMAPs due to lactose (not sure where FODMAPs stands on fermented dairy like kefir or FAGE). Thus, both GFCF and FODMAPs exclude grains and dairy. However, GFCF doesn’t restrict fructose, which is excluded in FODMAPs (monosaccharide). And last but not least, GFCF but not FODMAPs allows polyols, but as I’ll explain later, I don’t think polyols belong on this list (perhaps “FODMAPs” was just more pleasant-sounding than “FODMAs”).
FODMAPs vs. low carb
A low carb diet is low in both FODMAPs and gluten. But perhaps similar to polyols, some leniency should also be applied to casein, as standard low carb diets don’t restrict casein but still improve a variety gastrointestinal symptoms (and quality of life in IBS patients; Austin et al., 2009). Alternatively, a dairy-free low carb diet would cover all your bases.
or you could bring a gun to a knife fight, part I.
Alterations in gut bacteria are frequently associated with gastrointestinal problems, and two classes of nutritional supplements aimed at modifying the gut flora seem to help. “Probiotics” contain the buggers themselves, while “prebiotics” contain their fuel.
Personally, I’d recommend a blend like that found in Jarrow Bifidus Balance (which comes preloaded with its own stock of prebiotics, to be discussed later).
Back to the paradox (or a shameless teaser for next week’s episode): the low FODMAPs, GFCF, and low carb diets all have beneficial effects on gut health but reduce bifidobacteria. Bifidobacteria supplements and bifidogenic prebiotics are also good for the gut.
a far more enigmatic paradox than the French one, IMO, to be continued…
Affiliate links: still looking for a pair of hot blue blockers? Carbonshade and TrueDark are offering 15% off with the coupon code LAGAKOS and Spectra479 is offering 15% off HERE. If you have no idea what I’m talking about, read this then this.
on the chopping block:To recharge between hunting, gathering, and avoiding predation, our Paleolithic predecessors snacked on gluten-free energy bars comprised of a variety of fruits nuts, and vegetable oils all stuck together with Mother Nature’s sweet sticky honey and dates. <end sarcasm>
For the record, I’m not a card-carrying member of the Paleo community; just looking out for a respectable nutrition movement.
NoGii proudly advertises “NO HIGH FRUCTOSE CORN SYRUP” and “ALL NATURAL,” but this is despicable, ESPECIALLY because these are targeted at children.
Divide and conquer
Agave syrup has MORE fructose than high fructose corn syrup (it’s like higher fructose corn syrup). Why brag about “no high fructose corn syrup” if you’re only going to include a higher fructose substitute?
Invert sugar is chemically virtually identical to high fructose corn syrup. This is deceitful… it wouldn’t be so bad if they didn’t advertise (in all capital letters) “NO HIGH FRUCTOSE CORN SYRUP” directly on the website.
Lastly, there’s nothing “Brown Rice” about “Brown Rice Syrup.” It’s just plain syrup. It may not have fructose, but it’s still just a blend of simple sugars.
NoGii is pulling no punches, so neither am I: they are trying to trick parents into feeding their kids something that they may not have had they known what was really in it.
NoGii. Worst company of the week. No, of the month, because they are targeting children.
Diabetic diet (this week; see below): vegetables, root vegetables, dietary fibre, whole-grain bread and other whole-grain cereal products, fruits and berries, and decreased intake of total fat with more unsaturated fat.
Paleo vs. the “diabetic diet” in type II diabetics (Jonsson et al., 2009 Cardiovascular Diabetology). Lindeberg designed this particular Paleo diet with a much lower carb content (32% vs. 40%) than in the previous study with CHD patients. A cynic, who might think that some of Paleo’s benefits are due to its low carb content, might think that since traditional Paleo and the comparison “diabetic diet” have a similar carb content (42% and 40%, respectively), Lindeberg intentionally modified Paleo for this study to make sure carbs were significantly lower than in the “diabetic diet” (stacking the deck in Paleo’s favor, according to the cynic). I can’t find any reason to disagree with the cynic, but it didn’t work out so well for Lindeberg et al.
As detailed in a series of posts about crossover studies (part I and part II), this one was botched due to: 1) what appears to be improper randomization (baseline glucose values were 7.1 and 8.6 mM); and 2) a washout period that was too short to allow one of the primary endpoint variables (HbA1C) to return to baseline. As such, data presentation was convoluted, which said cynic might think was intentional. But if we take it at face value, Paleo still fails. For example, according to this figure (which is NOT crossover data), although Paleo has a lower final HbA1C, the HbA1C reduction is much greater on the diabetic diet.Paleo: 0
Diabetic diet: 1
AND weight loss was similar despite Paleo dieters consuming significantly less food (1581 vs. 1878 kcal/d):So yes, in accord with the Jonsson study (above), Paleo may have been more satiating (i.e., spontaneously lower food intake), but no, this didn’t translate to greater weight loss. Someone needs to measure energy expenditure in Paleo dieters because it looks like this pattern of food intake either lowers basal metabolic rate or simply makes people tired (though this conclusion would be vehemently denied by Paleo loyalists). The reduced leptin levels (Jonsson study) may have caused lower energy expenditure, but this would not entirely align with my lower-leptin-equals-higher-leptin-sensitivity hypothesis and thus cannot POSSIBLY be true :/ Alternatively, perhaps the Paleo diet really does lower energy expenditure; this would’ve been irrelevant and possibly even beneficial in Paleolithic times because: 1) they would’ve conserved more energy for “hunting” (hunter-gathers) or fleeing; and 2) weight loss was much less a concern compared to starving or being predated.
The Paleo diet is interesting in that it eludes low-carb status by selectively excluding grains, and I’m pleased that high quality studies (randomized crossover) are at least being attempted, but data thus far suggest we haven’t found anything magical about Paleo (yet)… just need better studies, especially those controlling for total carb content.