28 January 2014 guest author orthopaedic surgeon and instructor Dr Jon Driver-Jowitt FRCS orthopaediciq.org opined:
This is not scientific precision. This is not peer reviewed. This might not resist the rigor of an editor. These are simply observations intended to spur thought and look laterally.
Much advice about food appropriate for health has been given. Much of that has been based upon (often marginal) statistics. Many are deduced from self-reporting surveys. However the variables are so great that it is impossible to accommodate these into meaningful statistics. A few of these variables include quantum of food, types of mixtures of food, frequency of these foods, plus multiple variables related to micro-nutrients ingested simultaneously, and more.
When in doubt, it has been said, look in the instruction book. The instruction book for animals (including the human) exists in the animal. It is the inclination to eat some foods and the abhorrence of others.
Without the instruction book, one has to look at design specifications. Unfortunately the animal-machine-design did not consider the possibility of limitless food, or great food variety, or types of current cultivars. So selection by appetite might be flawed, and one is left guessing (somewhat) about the design specification. That is what is addressed here.
But before that, if one wants to live longer, the method has been (scientifically) available for the better part of a century. Simply, eat less. Eat less than your appetite drive. Eat less than your cohorts.
But let us look at design. Suppose humans were to be designed from scratch, which fuels (i.e. foods) should be selected, bearing in mind the limitations of availability, and knowing that the human is a mobile device with defined functional requirements and a limited life-span? Consider these options, and consider how they fit with current eating patterns:
Fat is probably the most desirable and quintessential food for humans. It is the supreme appetiser. It carries essential vitamins. Fat the highest calorific gain of all foodstuffs whilst it has a low energy cost for ingestion and digestion. It is the most cost effective source of energy. Yet fat has powerful negative feedback mechanisms. Therefore, although fat stimulates appetite it also produces satiation relatively rapidly. Rapid satiation allows food to be spread to the entire pack, in keeping with expectations of le milieu exterior which demands survival of the group, not the greedy individual. However the satiation of fat can be strongly altered by salt. Therefore, salted fat and perhaps salted protein can become “compulsive” foods, inducing the eater to keep eating until gorged. So we have yet another factor, the “additions” to food which induce compulsive feeding, prompted by those intent on making money out of food.
Protein is probably neutral tasting without the fat and salt, is not particularly palatable and does not have the “addictive” quality of carbohydrate. But it contains “essential” components which the human cannot manufacture, including amino-acids and vitamin C (curiously a “water-soluble” vitamin). It is also heavily mechanically bound to fat, and often inseparable.
Carbohydrate, on the other hand, was never particularly attractive to early humans. Yes, I know well enough that some carbohydrates, the sugary carbohydrates, are exceedingly attractive. But in primitive societies, all carbohydrates were not attractive. Pure sugar is a relatively new evolution. The current sweet fruits and even potatoes are the product of intentional selective breeding to make those carbohydrates more palatable.
The metabolisms of carbohydrate, the sugars, are again very different from fat, in that the same metabolic pathways are used for both the anabolism and the catabolism of carbohydrate. The control of carbohydrate metabolism lies outside the direct metabolic pathways, relying on end-organ control. These includes insulin receptors. This is distinct from fat where the anabolic and catabolic pathways are different, and so allowing feed-back to curb appetite and metabolic direction.
Carbohydrate’s prime quality is that it is cheap. As a consequence commerce has “wrapped” carbohydrate in both fats and sugar in order to make it compulsive eating at a cheap price. Amongst the most tempting ingestants are those that have both sugar and fat, as in chocolate.
Refined and manufacturer altered carbohydrate once ingested, prompt the desire to keep on eating it. Carbohydrate can have a long shelf life, is easily stored and so lends itself to easy snacking. No surprise that it is perfect to fuel “habituation eating”, and ultimately obesity.
Sugar is impregnated into cake carbohydrate or spread on the top as icing. Fat is used as a layer to make bland carbohydrates or even carbohydrates and protein more palatable, as in deep fried foods – where salt is added for good measure. Cheap beans are made more palatable for sale by adding the salt and sugar of ketchup.Salt is impregnated into carbohydrate ( chips and French fries).
Water, the foundation nutrient. Many children are metabolically confused because the water offered to them is laced with calories, primarily sugar and some metabolically noxious colourants. They then lose the distinction between thirst and hunger. When thirsty they might attempt to satisfy themselves by choOsing “food” rather than fluid (sugar laden drinks, iced cream ). The outcome is hypercaloric habituation.
It therefore might not be what you eat, but which combination one eats, that influences the health or disease of individuals. There is some evidence that individuals like to eat the same food and will repeat eating that ingestant by choice.
“Humans like variety, humans need variety, and humans need a balanced diet”. This may not have been the case with evolutionary man and it is certainly not the case with many animals. Those animals can adapt to a particular foodstuff (obviously one that is available) and then continue eating that foodstuff by choice, even where alternatives become available.
The legend has arisen that individuals need a “mixed and balanced” diet. As far as I am aware there is no evidence that this mixing needs to occur in the same meal. True enough, one needs the vitamins and one needs the different proteins, fat and carbohydrate. But does one need them simultaneously, wrapped around each other and made into tempting compotes?
Editorial comment: The science concurs:
The evidence for higher water intake, moderate protein and low sugar/salt no-smoking intake is self-evident except to sugar, beverage and cigarette manufacturers, marketeers and addicts. But the fraudulent promotion of the low saturated fat (ie meat), low-cholesterol , high carbs regime for all remains a big problem.
Dr Ancel Keys PhD (1904-2004) was a revered polymath traveler, oceanographer biologist turned physiologist nutritionalist (Biology of Starvation; the K Ration) , who correctly recognized and promoted the Mediterranean Diet (>35% fat), and long outlived his critics. But he and his followers set USA-led nutrition and health back 50 years with his wrongly interpreted Seven Countries study claiming that atheroma was caused by saturated fat- related hypercholesterolemia, thus promoting the Omega6PUFA low cholesterol diet and cholesterol-busting statins- but not explaining the question of fatal sudden death- coronary thrombosis posed by Sir George Pickering in 1964.
Keys may still be laughing his head off at the $billions he made for the Fast-Food industry & Big Pharma, and the millions of quality health years he cost gullible Americans and their ilk with his wrong high-omega6 diet and thence the money-spinning statins-for-all poison myth.
After the decades of derision poured as a result on the ketogenic high-fat-protein low sugars Atkins diet, the Disease-monger (Food, Sugar, Disease, Big Pharma) Industries will scoff, as they recently mocked sports physiologist Prof Tim Noakes’ conversion to high-fat ketogenic diet for those with the appropriate physiology, his Real Meal Revolution . . Some cardiologists and dieticians even attacked him publicly for promoting scientific evidence against the high-carbs lowfat diet, including the Womens Health Initiative , not Big Pharma wishful thinking taught by the academics and clinicians whose livelihoods depend on their promoting Big Pharma and other new-tech products..
Read Noakes’ modern nutrition bible, the American science writer Gary Taubes’ The Diet Delusion(2009); and read the British Dr James le Fanu’s earlier Rise and Fall of Modern Medicine (1999 London pp 323-376), that dissected Keys’ toxic cholesterol-busting mythology, including statins that are now promoted for all seniors.
Its not a question of statin denialism since such drugs may have an appropriate place in severe hypercholesterolemia. Over all, the majority of hypercholesterolemic and CVD patients will do better on multisystem-beneficial metformin (antioxidant, antiinfective, antithrombotic, antidiabetic, insulin-sensitizing, appetite-reducing, weighloss-promoting), titrated to tolerance; with modest other essential multibeneficial supplements- (water; fish oil, coconut oil, DMSO, all vitamins especially BCo, C,D and K2; minerals especially magnesium, zinc, chromium, selenium and iodine; and other aging-and -diet-conditioned deficiencies of eg CoQ10, arginine, alphalipoic acid, carnitine, ribose, carnosine, acetylcystine, garlic, cinnamon, proline etc. ) than a multisystem-toxic statin.
THE SYDNEY HEART DIET STUDY And now the truth emerges yet again, that debunked Keys’ high Omega6 diet theory: as it did in the original ignored but landmark Sydney Heart Diet Study report in an elite 1978 journal (Adv Exp Med Biol.) aboutLinoleic Acid with Low fat, low cholesterol diet in secondary prevention of coronary heart disease. Woodhill JM, Leelarthaepin B, ea) discrediting Keys’ (and the USA Govt) postulate. The new 35year followup 2013 BMJ multicentre paper (Ramsden, Leelarthaepin B ea) from the Universities of Sydney, N Carolina and Illinois and the USA NIH : Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study reevaluated effectiveness of replacing diet saturated fat (from animal fats, margarine, shortenings) with omega 6 linoleic acid Om6LA (safflower oil/margarine ) for a mean of 39months; in a single blind, parallel randomized controlled trial in 1966-73 in 458 men 30-59 years, with recent coronary event. Controls received no specific diet instructions. Non- dietary aspects equivalent in both groups. Results The intervention group (n=221) after only 3.25 years had 62-70% higher rates of death and CHD and CVD than controls (n=237; P=0.04-0.05)) (all cause 17.6% v 11.8%), Conclusions Advice to substitute PUFA for saturated fats is a key component of worldwide dietary guidelines for CHD risk reduction. However, clinical benefits of the most abundant PUFA Om6LA , have not been established. In this cohort, substituting dietary LA in place of saturated fats increased the rates of death from all causes, CHD and CVD. Updated meta-analysis of linoleic acid intervention trials showed no evidence of CVD benefit. These findings (could) have important implications for worldwide dietary advice to substitute Om3LA , or PUFA in general, for saturated fats.
THE MESA STUDY: The Sydney Diet Heart Study outcome has just been confirmed again by the Dec 2013 Harvard USA MESA study (de Olivera, Mozaffarian ea J Am Heart Assoc.) Circulating and Dietary Omega-3 and Omega–6 PUFA and Incidence of CVD in the Multi-Ethnic Study of Atherosclerosis. in 6 USA centres, which confirms that higher intake and levels of fish oil (but not ALA or Om6PUFA) halves CVD: Over 10 years, in a multiethnic cohort of 2837 US adults- mean age 61.4yrs at outset- plasma PUFAs measured at baseline (2000-2002), and dietary PUFAs , through 2010 during 19 778 person-years of follow-up, circulating n-3 eicosapentanoic acid EPA and docosahexanoic acid DHA inversely associated with incident CVD, with extreme-quartile hazard ratios (95% CIs) of 0.49 for EPA (0.30 to 0.79; Ptrend=0.01) and 0.39 for DHA (0.22 to 0.67; Ptrend<0.001). No significant associations with CVD were observed for circulating n-3 alpha-linolenic acid ALA or n-6 PUFA (linoleic acid, arachidonic acid). Associations with CVD of self-reported dietary PUFA were consistent with those of the PUFA biomarkers. Both dietary and circulating eicosapentaenoic acid and docosahexaenoic acid, were inversely associated with CVD incidence. These findings suggest that increased consumption of n-3 PUFA from seafood (but not alpha-linolenic acid or n-6 PUFA), may prevent CVD development in a multiethnic population.
But then we senior medics born around WW2 were schooled in the English /Scottish (not American) medical tradition of Drs Cleave, Burkitt, Painter & Campbell’s Saccharine Diseases, refined sugar, boozing, smoking and physical indolence-TV sloth as the chief causes of the burgeoning post-WW2 epidemic of obesity, diabetes, vascular disease, cancer and violence.
Humans rarely need what Big Pharma, science invents for megaprofits. We have known for 50 years that the current pandemic of degenerative and modern infectious diseases is due to bad diet – fast-food – and slothful lifestyle, tampering for megaprofit with food production and the environment, and reversible by correcting these factors with exercise, fresh whole food and organic farming, and avoidance of boozing, smoking, TV sloth, and continuous wars for profit, especially the Breast-and -Prostate Screening wars for the $billions to be made from screening aging men and women for early ie silent cancer.
The Sydney and MESA studies quoted thoroughly debunk the fast-food high Om6/carbs low fat diet promoted the past 50 years by the Food and Disease Industry, and by the Peskin-Rowen Om6 PEO and the statins-for-all hypotheses; and the nonsensical UK Wald and Law Polypill including high-risk statin-aspirin-betablocker -diuretic-ACEI for all senior citizens. . Even an advertorial Wikipedia entry promoting such nonsense has been allowed…
BALANCING INTAKE OF ANIMAL/DAIRY PROTEIN -SFA WITH MARINE Om3 PUFA, PLANT MCT & Om6, without added refined/concentrated sugars like fructose and cornstarch: As Mike Howard the Health Ranger writes this week, healthful pasture-fed butter is back, and margarine debunked even by its manufacturers; and almost half the USA states moving to enforce labeling of GMO foodstuffs so that consumers can choose what they buy. .
and biochemist GD Lawrence from Dept Biochemistry, Long Island University, NY writes in May 2013 Adv Nutr. Dietary fats and health: dietary recommendations in the context of scientific evidence: Early studies showed that saturated fat SFA diets with very low levels of PUFAs increase serum cholesterol, whereas other studies showed high serum cholesterol increased the risk of coronary artery disease (CAD). The evidence of dietary SFA increasing CAD or causing premature death was weak. Over the years, data revealed that dietary SFAs are not associated with CAD and other adverse health effects or at worst are weakly associated in some analyses when other contributing factors may be overlooked. Several recent analyses indicate that SFAs, particularly in dairy products and coconut oil, can improve health. The evidence of ω6 polyunsaturated fatty acids (PUFAs) promoting inflammation and augmenting many diseases continues to grow, whereas ω3 PUFAs seem to counter these adverse effects. The replacement of SFA in the diet with carbohydrates, especially sugars, has resulted in increased obesity and its associated health complications. Well-established mechanisms have been proposed for the adverse health effects of some alternative or replacement nutrients, such as simple carbohydrates and PUFAs. The focus on dietary manipulation of serum cholesterol may be moot in view of numerous other factors that increase the risk of heart disease. The adverse health effects that have been associated with SFA in the past are most likely due to factors other than SFAs. This review calls for a rational reevaluation of existing dietary recommendations that focus on minimizing dietary SFAs, for which mechanisms for adverse health effects are lacking.
The University Oregon Linus Pauling Micronutrient Centre website on EFAs has not apparently been updated with the latest MESA and Sydney trial reports; but it advocates (from Japan, and American Heart Association recommendations) Om3 fishoil intake of 2-4gm/day and Om6LA perhaps three times that- rather than the Keys-based 20:1 Om6:Om3 low SFA high carbs balance that has done so much harm in our lifetime.
BENEFITS OF FISH OIL AND COCONUT (MCT) OIL: are achieved by taking a tsp of clean (eg Baltic) codliver oil or a gm of fish oil concentrate a day; and no Om6LA supplement other than as a salad/pasta dressing; combined with liberal virgin coldpressed coconut oil for massage, cooking, and food dressing, or as a desertspoon+ a day..
The Wiki Health entry for coconut oil usefully still notes the historical deliberate- profiteering- fallacious marketing bias against coconut oil- SFA- which has now been again debunked by the Sydney and MESA studies: Advocacy against coconut and palm oils in the 1970s and 1980s due to their perceived danger as a SFA saturated fat caused companies to substitute trans fats instead of them. Many health organizations (still) advise against the consumption of high amounts of coconut oil due to its high levels of SFA, including the USA FDA & ADA, the UK NHS, the WHO, International College of Nutrition, and American Heart Association, Coconut oil contains a large proportion of lauric acid—a SFA that raises blood cholesterol levels by increasing the amount of high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol. Most of the increase is however HDL cholesterol, hence the ratio of total to HDL cholesterol is decreased. A decreased ratio indicates reduced risk for heart disease. It is also found in significant amounts in laurel oil, palm kernel oil (not to be confused with palm oil), and human and animal breast milk. This may create a more favourable blood cholesterol profile… Because much of the saturated fat of coconut oil is in the form of lauric acid, coconut oil may be a better alternative to partially hydrogenated vegetable oil when solid fats are required. In addition, virgin coconut oil (VCO) is composed mainly of medium-chain triglycerides, which may not carry the same risks as other saturated fats.[36
Similarly, the Wiki entry on Medium-chain triglycerides ie coconut oil- states its nutritional benefits without any harms: MCTs are considered good biologically inert source of energy that the humans find reasonably easy to metabolize. MCTs have potentially beneficial attributes in protein metabolism … and.. their tendency to induce ketogenesis . Due to their ability to be absorbed rapidly by the body, MCT have use in the treatment of malabsorption ailments. and neurodegenerative disorders (e.g. Alzheimer’s, Parkinson’s disease) and epilepsy through the use of ketogenic dieting. Serum high-density lipoprotein is increasingly elevated as the chain-length of triglyceride decreases.
We should not be relying on heavily marketed, factory-processed and poison-laced (margarines, Roundup GMO, exogenous sexhormone -laden meat ) foods, TV-armchair lifestyle; exploiting and burning fossil fuels; and Big Pharma’s synthetic new designer wannabe drug $$$ rainchecks- like statins, antidiabetics, antiobesity, antianxiety, antiosteoporosis, antiplatelet, antidepressant, antiinflammatory, antihypertensive, memory, analgesic and antibiotic drugs for quick fixes, which treat symptoms but not causes, do not reverse the consequences of environmental destruction, bad and deficient diet and unhappy slothful lifestyle.
Dr Driver-Jowitt pragmatically and succinctly puts healthy diet balance in perspective.