Saturday, March 31, 2012

Spark on Taubes/Guyanet

I would argue that the rapidly growing health problem is not simply obesity, but metabolic syndrome (remember obesity is only one symptom, and there are thin people with metabolic syndrome too). We want to understand both how we arrive at metabolic syndrome (so our children can avoid it), and also how to treat it for those who did not avoid it. It is clear "carbohydrates" across the board are not causal in the development of metabolic syndrome. Stephan provides several counter-examples; another is the Tarahumara, who like the old-school Pima subsist largely on corn, beans, and squash, but who have one of the lowest rates of Type 2 diabetes in the world.
But the cure is not necessarily the reverse of the cause when it comes to disease. Metabolic syndrome brings a whole host of issues, not the least of which is broken carbohydrate metabolism. So while carbs in general may not lead to metabolic syndrome, once you've arrived dumping carbohydrates on your broken carbohydrate metabolism is tantamount to doing jumping jacks on two broken legs. I believe the science (along with a massive stack of anecdotal evidence) is pretty clear here, in that the most successful treatment for metabolic syndrome is carbohydrate restriction.
http://sparkofreason.blogspot.com/

I've enjoyed this reconciliation of the work done by Taubes and Guyanet, along with what I heard from Matt Lalond on a recent Jimmy Moore podcast (well worth listening to). 

In short, the author posits that they may both be right, and wrong.  That is to say, carb restriction may be the only and best treatment for those with metabolic syndrome and it's manifestation as the "pot belly" which is so closely associated with non-alcoholic fatty liver disorder.  That does not mean that we should conclude that carbs are bad for everyone at every time. 

More from the pithy Spark:  "It is important to remember that carbohydrate restriction is successful as a treatment for a disease, but it doesn't necessarily follow that all carbs are bad for everybody."

However, even Spark is willing to bite on the problems associated with, in particular, modern wheat.  Which is to say, as regards wheat, just say no.

I have begun to form a concept of how Guyanet and Taubes may be right, with Guyanet's work applying more to how the metabolic system "should" work for healthy folks.  I have wondered, for example, how some folks can run well and perform well on well under 10% body fat, and others need more.  There are too many variables to be certain of any one answer - variables such as macronutrient ratios, genetics, type of exercise, prior metabolic injury, climate, exposure to cold water, and micronutrient intake to name just a few.  But one model that seems useful is simply that the body adapts to what is demanded of it - so if one demands that one's body run on fat, the body might become more adept at giving up fat for fuel at every lower body fat levels.  In other words, if you run well at 15% body fat, that means the body is at least capable of liberating the body fat you need - amount X per minute - to feed your cells in the event you don't have carbs for several hours.  If you stay in that state - a carb fast so to speak - for longer, you may be successful in getting your body to the point that it can liberate 1.1X per minute.  Etcetera.  And I could very easily see that the "ponderostat" powered by leptin as posited by Guyanet and his mentors might have a role in that process. 

But, what do you do if you have glucose regulation issues?  What do you do if you have the signs and symptoms of metabolic syndrome (big belly and one or more of:  high average glucose, hypertension, dislipidemia)?  Restrict your carb intake, please, since it is the fastest way to right the wrongs you've put your body through (and pay particularly close attention to reducing fructose intake to a MAX of 15g/day).

If you want to fool around with Guyanet's "plain food" ideas after that - low fat, low salt, low sugar - be my guest!  For my money, I can manage eating high fat and high salt just fine, it's the sugars that buggar my appetite, metabolism and health.

Friday, March 30, 2012

Coffee consumption and risk of chronic disease in the European Prospective Investigation into Cancer and Nutrition (EPIC)–Germany study


Background: Early studies suggested that coffee consumption may increase the risk of chronic disease.
Objective: We investigated prospectively the association between coffee consumption and the risk of chronic diseases, including type 2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer.
Design: We used data from 42,659 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)–Germany study. Coffee consumption was assessed by self-administered food-frequency questionnaire at baseline, and data on medically verified incident chronic diseases were collected by active and passive follow-up procedures. HRs and 95% CIs were calculated with multivariate Cox regression models and compared by competing risk analysis.
Results: During 8.9 y of follow-up, we observed 1432 cases of T2D, 394 of MI, 310 of stroke, and 1801 of cancer as first qualifying events. Caffeinated (HR: 0.94; 95% CI: 0.84, 1.05) or decaffeinated (HR: 1.05; 95% CI: 0.84, 1.31) coffee consumption (≥4 cups/d compared with <1 cup/d; 1 cup was defined as 150 mL) was not associated with the overall risk of chronic disease. A lower risk of T2D was associated with caffeinated (HR: 0.77; 95% CI: 0.63, 0.94; P-trend 0.009) and decaffeinated (HR: 0.70; 95% CI: 0.46, 1.06; P-trend: 0.043) coffee consumption (≥4 cups/d compared with <1 cup/d), but cardiovascular disease and cancer risk were not. The competing risk analysis showed no significant differences between the risk associations of individual diseases.
Conclusion: Our findings suggest that coffee consumption does not increase the risk of chronic disease, but it may be linked to a lower risk of T2D.

http://www.ajcn.org/content/95/4/901.abstract?etoc

By the Paleolithic Model, one would have to conclude that sucking down pots full of coffee is bound to cause trouble at some point.  But I'm not ready to cross that bridge - yet.  So I drink quite a lot and even if I cut back by half, it still might be "too much."  That said, the conclusion is comforting.  One day I will tackle the coffee cutback campaign because I think I'll feel better when I do.

Today, it's my birthday (48th) and I'm drinking all the coffee I want, and will relish a cheesecake later today also!

Thursday, March 29, 2012

Big Kill, Not Big Chill, Finished Off Giant Kangaroos: Scientific American

So, uh, I guess this means The Matrix was right, we are like a virus.
http://www.scientificamerican.com/article.cfm?id=hunters-killed-off-big-animals-australia

Interesting to see how they teased apart the sequence of events to try and determine what caused what.

Wednesday, March 28, 2012

Minger via Sisson on the Red Meat Scourge


We’re already 74 days into the new year, which can only mean one thing: it’s high time for our latest episode of Science Says Meat Will Kill You, complete with a brand new study and commercial-free viral media coverage! Have a seat and tune in (or at least set your DVR for later viewing).
If you haven’t had at least one family member, coworker, or soon-to-be-unfriended Facebook acquaintance send you this study as a reminder that you’re killing yourself, you’re either really lucky or your inbox is broken. Thanks to an observational study called Red Meat Consumption and Mortality freshly pressed in the Archives of Internal Medicine, a slew of bold headlines exploded across every conceivable media outlet this week:
Media sensationalism aside, the study does seem to spell trouble for proud omnivores. Unlike some similar publications we’ve seen on meat and mortality, this one says that red meat doesn’t just make you die of heart disease and cancer; it makes you die of everything.
Read more: http://www.marksdailyapple.com/will-eating-red-meat-kill-you/#ixzz1q3Bl9idu



Read on at Mark's Daily Apple" if you have not had your fill yet of epidemiological beat down.  I like Minger's style!

Those numbers thrown around in the fear-mongering news clips—20% increased risk of death from all causes for processed meat and 13% increased risk of death from all causes for unprocessed meat—are classic examples of how even the most ho-hum findings can sound dramatic if you spin them the right way (and remember to attribute them to Hahhh-vard). If your risk of dying from a particular disease is 5% to start with, a “20% increased risk” only bumps you up to 6% in the grand scheme of things. That’s a lot less scary. Especially when delectable foods are involved.

Tuesday, March 27, 2012

Epidemiology 101

The figure is pretty self-explanatory, so let me get to the part where nutrition science is making the biggest mistakes: “Conduct an experiment.”  There is no shortage of observations, questions, or hypotheses in the nutrition science world – so we’re doing well on that front.  It’s that peskyexperiment part we’re getting hung up on.   Without doing controlled experiments it is not possible to distinguish the relationship between cause and effect.  [Just a heads up – this is going to be a recurring theme this week.]
http://waroninsulin.com/nutrition/is-red-meat-killing-us


In response to the "red meat is killing you" study which has received so much press, Attia makes the case for why observational/epidemiological studies can't tell us "what causes what."  


A gritty summary:
I trust by now you have a better understanding of why the “science” of nutrition is so bankrupt.  It is based on almost a complete reliance on these observational studies. Virtually every piece of nutritional dogma we suffer from today stems from – you guessed it – an observational study.   Whether it’s Ancel Keys’ observations and correlations of saturated fat intake and heart disease in his famous Seven Countries Study, which “proved” saturated fat is harmful or Denis Burkitt’s observation that people in Africa ate more fiber than people in England and had less colon cancer “proving” that eating fiber is the key to preventing colon cancer, virtually all of the nutritional dogma we are exposed to has not actually been scientifically tested.   Perhaps the most influential current example of observational epidemiology is the work of T. Colin Campbell, lead author ofThe China Study, which claims, “the science is clear” and “the results are unmistakable.”  Really?  Not if you define science the way scientists do.  This doesn’t mean Colin Campbell is wrong (though I wholeheartedly believe he is wrong on about 75% of what he says based on current data).  It means he has not done any real science to advance the discussion and hypotheses he espouses.  If you want to read the most remarkable and detailed critiques of this work, please look no further than here (Denise Minger) and here (Michael Eades).




Monday, March 26, 2012

Epidemiology: Killing Thousands With Science

This latest variation does come with a caveat, however, which could have been made at any point in this history. While it is easy to find authority figures in medicine and public health who will argue that today’s version of H.R.T. wisdom is assuredly the correct one, it’s equally easy to find authorities who will say that surely we don’t know. The one thing on which they will all agree is that the kind of experimental trial necessary to determine the truth would be excessively expensive and time-consuming and so will almost assuredly never happen. Meanwhile, the question of how many women may have died prematurely or suffered strokes or breast cancer because they were taking a pill that their physicians had prescribed to protect them against heart disease lingers unanswered. A reasonable estimate would be tens of thousands.

http://www.nytimes.com/2007/09/16/magazine/16epidemiology-t.html?_r=2&pagewanted=all

Does this mean I hate epidemiologists?  No.  Does it mean I think that epidemiologists and the entire medical profession that began selling these "killer" pharmaceutical products hate women and wanted to profit by injuring their health?  No.  It also does not mean that I think there's no role for their work.  I'm also not convinced anyone should care what I think, but what I think is that if you happen to be a highly paid, influential epidemiologist, you can only remain one if you get funding and do studies.  And even if the studies you do are not needed, you will do them.  And having done them, it's not likely that you will then say to the clueless "reporters" (aka those employed by the profit seeking publishers who need a story, dammit, any story) "You know, it's actually not possible to determine causality from this study, and it was really just a waste of time and money, but I sure enjoy these things, it's what I'm good at."

Although, this one sort of did:
Richard Peto, professor of medical statistics and epidemiology at Oxford University, phrases the nature of the conflict this way: “Epidemiology is so beautiful and provides such an important perspective on human life and death, but an incredible amount of rubbish is published,” by which he means the results of observational studies that appear daily in the news media and often become the basis of public-health recommendations about what we should or should not do to promote our continued good health.

In short, it's the misrepresentation that I hate.  Epidemiologists should admit the limitations of their work (as Peto did/does).  Reporters are great, but we should all just call them what they are - information entertainers, hustling for a buck like the rest of us.  Likewise, I'm all good with the "media" being for profit and behaving however they legally can to make a buck - but shame on us for ever thinking they were anything but that.  I remember announcing to a casual lunch conversation the obvious - ""News Company X" is owned by General Electric, and its purpose is to make a profit." The stunned stares followed, and even one awesomely naive person said "You ARE a cynic!"  No, I have the totally unremarkable ability to recognize the blatantly obvious.  For an inexplicable reason, many of our fellow citizens look at the news and believe the claims they make about themselves that they have more than an accidental relationship to truth.  This is as strange to me as believing General Mills' claims that their foods are "healthy".

So when the epidemiologist looks earnestly at the reporter and says "the data say red meat is killing you" take it for what it is worth.  And if you leave all the red meat for me, thank you.

Sunday, March 25, 2012

Wolf River CrossFit

Presenting my training on the Paleo Model at Wolf River CrossFit in a couple hours - can't wait!  It's the best one yet.