Wednesday, September 15, 2010

Robb Wolf's Paleo Solution (Book Review)

When attending Robb Wolf's seminar in Brooklyn earlier this month I received a copy of his excellent new book which was released yesterday. This is my review. /CW

Today’s world of preventive medicine, dietetics, and health is a bizarre, and often life-threatening mess.

A major cause of this situation is ”trickle-down” stupidity where most health scientists, commentators, and practitioners still 150 years after the publication of Darwin's "On the Origin of Species" have not fully recognized that the fields of medicine and dietetics are derivatives of the science of biology, and that biology's integrating principle is Darwin's theory of evolution.

To paraphrase the evolutionary biologist Theodosius Dobzhansky: Nothing in medicine, or dietetics (or, really, within any of the life sciences) makes sense except in the light of evolution.

Indeed little make sense today in the world of mainstream health advice, dietary theories, and medical practices.

Most people thus have their concepts of how to attain and maintain health distorted by infantile, impractical, and often dangerous advice from the government, the pharmaceutical lobby (part of which is arguably organizations such as the American Heart Association), and the obfuscation from activist-"scientists" and pundits who cleverly tap into the cultural-dietary neuroses of contemporary society ("dietary fat is the root of all evil", "eating animal products is a sin against Mother Gaia", etc).

More tragically, we have a situation where the great majority of people are selling themselves short in terms of what kind of vibrant health and well-being is actually possible at any age.

Few people know that health and youthfulness are attainable by consistently applying a set of simple dietary- and lifestyle interventions; that what's generally considered inevitable diseases of aging- or lifestyle can be significantly reversed or even cured within months; that diseases such as cancer, heart disease, diabetes, strokes, and Alzheimer's all share certain ultimate causes rooted in lifestyle; and that the accelerating downward progression into disability starting at age 35 (or at age five as is increasingly the situation in the United States) is not the planned obsolescence built into the design of our species.

Most people (and most doctors) have concluded that Hippocrates' dictum of "let food be thy medicine" apply marginally at best and have thus retreated to sticking their heads in the sand while hoping for the next pill to provide salvation when it becomes acutely necessary. These people have waited in vain for decades now, while having had to redefine health as being kept alive in a disabled, dysfunctional state until the bitter end.

We clearly need to take back our birthright to health and help those we care about to do the same.

The power to do so comes from being armed with unbiased knowledge of how the human body works, what its design characteristics are as an evolved biological entity (not what it is supposed to be according to, for instance, pressure group agendas), and what lifestyle features are compatible with those characteristics, and which ones are not.

The power to achieve our health also comes from having the emotional certitude that health and its rewards are not elusive pies-in-the-sky, but that these can be had or re-regained with defined steps beginning today, and from knowing that their pursuit can be immediately rewarding, and, yes, fun.

With his timely new book ”The Paleo Solution”, Robb Wolf (who is an unlikely combination of research-scientist and foul mouthed athletic coach) enters the public square and hands out precisely the knowledge-ammunition and emotional encouragement that we and the rest of the world so desperately need.

Robb takes us through scientific boot camp, showing us how the connections between health and lifestyle factors (including diet, exercise, sleep, and stress) and are laid out inside our bodies; he shows us the evolutionary perspective on health and how our bodies must be viewed as hunter-gatherer bodies if we want to understand their workings; he shows us why certain foods such as meat, seafood, and vegetables are good for us, while others are harmful (a whole chapter is devoted to the huge inflammatory- and auto-immune issues connected with grains).

Now, Robb doesn’t ever let us think that his mission is merely to prove a few counter-establishment scientific points. No, he seriously wants to save our lives, just as he saved his own slightly more than a decade ago, and just as he proceeded to save and enhance the lives of thousands of clients as an athletic coach and teacher of paleolithic nutrition.

In this regard, the deepest emotional chord struck in the book is that from someone who has found the road to a new world (in this case a world of sustained- and vibrant health) and who now by whatever means possible wants to take everyone he knows along to that new frontier - one that has been hidden behind fog-shrouded mountains.

One of Robb’s methods to get the reluctant and disillusioned to follow along on this trail is his patentable sense of humor that stands out on virtually every page. To this end, one chapter is characteristically named ”Grains and Leaky Gut or Keep Your Poop Where it Belongs”, and another ”Why This Book Should be Titled: Sleep You Big Dummy”.

”The Paleo Solution” takes on its subject matter from multiple angles and leaves no perspectives uncovered: The book shows the rationale for the paleo lifestyle in terms of inspiring stories of personal transformation. It covers theory from a broad macro perspective to more detailed information about bio chemical mechanisms. It describes the day-to-day practice as in what foods to eat (recipes included) and how to exercise (exercises for complete beginners are covered as well as instructions for more advanced people). Psychological issues and hurdles are treated with both compassion and the stern voice of a no-nonsense coach who wants his clients to succeed.

It is hard to think of a diet- and lifestyle book of over 300 pages with such scope and density of information that is simultaneously so easy and enjoyable to read. Robb’s personal writing style, deep knowledge, and quirky humor, should take anyone who wants to live a healthy and long life (and who is willing to think and act towards those goals) to Robb’s desired endpoint: that is to try his ”Paleo Solution” for one month, and then very possibly feel how it is to live in a human body again (or for the first time).




Thursday, August 12, 2010

Supplements: Pros & Cons Brainstorm

People familiar with the paleo diet know that a diverse whole-foods based diet really is the most powerful and comprehensive foundation of a healthy lifestyle, but sometimes we may feel the itch to supplement with that vitamin X, nutrient Y, or mineral Z that the new hot study touts as the key to health, longevity or sports performance, or because we feel that our diet may not be up to par in all areas of nutrition.

Certainly the issue is not black and white.
Are there any broad principles to apply when considering supplementation?
My aim is to write something more structured on this subject, but for now I'd like to just submit a few of my one paragraph notes on the subject. I'd be happy to hear readers' thoughts about these points, and if I have missed some important aspect.

So, in a relatively random order here goes:

1) Taking a supplement is often easier behaviorally than changing one's diet towards a more appropriate one, but even when a supplement works well in the short term the practice of relying on supplements may induce a psychological attachment to an unsustainable approach in the long run.

2) Supplements can be used appropriately as diagnostic tools (for instance to determine dietary deficiencies) or as training wheels (think for instance acetyl-L-carnitine to aid in becoming fat-adapted in the early stage of low carb dieting).

3) Is your supplement really bioactive? A lot of substances just can't be effectively delivered orally in a pill.

4) Supplementing with a "pre-formed" desired end product may bypass the body's own checks and balances. Examples: Taking pre-formed vitamin A versus the precursor beta carotene can induce toxicity. Vitamin D from supplements bypasses the negative feedback that ensures appropriate serum levels when getting vitamin D from sunshine.

5) Dosage is difficult when taking supplements. Does a thin woman need as much of nutrient X as the 400 pound wrestler?

6) Interactions abound, and not all are known. Calcium + Vitamin D can induce toxicity, but on the other hand D + Calcium can be synergistic for fat loss. If you supplement with both, how do you determine the sweet spot?

7) Well considered supplementation can indeed be an insurance policy against a less than optimal diet. Vitamin D, magnesium, iodine... Most people are probably deficient.

8) Nutrient X may be beneficial for one health aspect, but detrimental for another. Vitamin C (@ 1000 mg/day) and E (@400 IUs/day) while suppressing oxidative stress have been found to blunt some of the positive effects from exercise. Resveratrol hinders some cancers but may promote others.

9) Supplements derived from naturally occurring substances are indeed generally less prone to harmful side effects than pharmaceutical drugs. This is because the body typically has evolved pathways to deal with them (including getting rid of excesses). Sometimes the body is so darn good at getting rid of the "natural" stuff you supplement with that all you get in the process is "expensive urine".

10) Binder/filler material in supplements: Problematic for absorption or may contain downright harmful material (toxins, gluten).

11) Sometimes a supplement restore the body's production of a desired substance by creating a positive feedback loop. Example: HCl supplementation. However there are also examples of where supplementing may shut down the body's own production. (For instance, some hormone related herbals such as testosterone boosters can have this effect.)

12) How to scale into and out of a supplementation regimen may have to be considered carefully. Example: Rapid withdrawal from a high dose Vitamin C regimen can induce scurvy like symptoms.

That's all for now! I hope I didn't just make your life more difficult.

Wednesday, August 11, 2010

Leg Cramps, Electrolytes, and Pickle Juice

Some people suffer from leg cramps, particularly at night. I got some quite nasty ones going after switching to barefooting shoes. I suppose that hitting some previosuly underused muscle fibers was part of my problem. (Fortunately my problems are now gone.)

While the precise causes of muscle cramps are not totally known, a widely suspected factor is depletion of one or more of electrolyte minerals such as sodium, potassium, calcium, and magnesium.

In athletic- and paleo circles magnesium has the most solid reputation as a muscle relaxing electrolyte and many of us supplement with magnesium through for example fizzy magnesium drinks before bed time.

However supplementing magnesium doesn't always seem to help. I for one had supplemented for months with magnesium and tested high normal on a magnesium RBC test before I had my leg cramp episode. (A clinical study also failed to find magnesium helpful.)

Now some reports have come up pointing out pickle juice as being very effective against leg cramps, and some experts speculate that perhaps the active factor may be the vinegar in the juice because drinking it had such a rapidly relieving effect that any electrolytes in the liquid would not have had time to hit the muscles.

So in the light of the somewhat contradictory reports on how to prevent- or releive leg cramps, I would suggest the following arsenal of potential remedies:

1) Pickle juice. To be taken when cramps occur - keep a glass at the ready on your bed stand. Vinegar might work just as well.

2) Make sure to eat a diet high in electrolyte minerals. Even if this may not be a complete guarantee against muscle cramps, these minerals are beneficial anyway, and most people are deficient because of eroded soils. Sea weeds and bone broth are effective ways to add minerals to your diet.

3) Possibly supplement with a magnesium citrate drink at bed time. This has worked for some people as a preventive measure against cramps and is also a nice sleeping aid. Magnesium also has other beneficial effects on the body, including increasing insulin sensitivity and normalizing blood pressure, and is very safe in people with functional kidneys. (By the way, I rinse my mouth with baking soda after taking magnesium citrate as a way to protect my teeth from the acidity of the preparation.)

Monday, July 12, 2010

Are We Programmed Inside the Womb?

Loren Cordain recently linked to this paper which adds to the evidence that we are significantly affected in adulthood by the diet and metabolic condition of our mothers during pregnancy.

In this case, the paper shows a correlation between excess protein intake in pregnant women and elevated cortisol (a stress hormone) in their offspring as adults.

The findings are correlations, but there is a straightforward theory of causation which is that if the developing fetus is exposed to high cortisol concentrations (as occur after the mother consumes a big protein meal) its cortisol-setpoint may be affected to program lifelong hyper-secretion of cortisol, potentially leading to disease later in life.

If this hypothesis is true about cortisol, then very likely other hormonal setpoints are affected as well during gestation, explaining some of the differences we see in people's ability to handle excess calories, carbohydrates, stress, etc, as well as how easy it is to correct health problems related to such metabolic- and hormonal issues.

(The environment that we are exposed to during childhood is of course also important.)

Now, to a somewhat philosophical question: If there is such a thing as a "setpoint", where is it located, and can it be changed once programmed in the womb?

I tend to think that physiological setpoints are not like the programmed setting on a mechanical thermostat, or the contents of a computer's ROM (read only memory), but should rather be viewed as regulatory equilibriums that are emergent phenomena. That is, setpoints don't exist as physical entities, but are rather an effect of physiological processes aiming for homeostasis in each transition from one state to another. (The whole chain of transitions beginning at conception - or earlier if we want to be precise.)

It may be difficult to change these equilibria because of the negative feedback loops involved in homeostasis. For example, if we try to affect our fat set points by diligent fasting, the body may respond by making us hungrier and up-regulate fat storage.

On the other hand, I don't think that we should throw in the towel on affecting our setpoints.

If setpoints are indeed expressions of equilibria let's, for instance, learn how to push the underlying hormonal- and biochemical processes in a desired direction without triggering negative feedback such that a reorientation around a new equilibrium (setpoint) is achieved.

I think that this can be done at least with some setpoints. For instance Martin Berkhan at Leangains seems to have found a program for getting quite obese people down to single digit fat percentages and to keep them there. Perhaps this involves re-setting the set point of leptin (a hormone regulating our fat stores).

Another way to handle one's setpoints is of course to acknowledge them and adjust our lifestyles to make the best possible out of our individual configurations.

Tuesday, June 22, 2010

Avoiding the Micronutrient Madness

Nutrient X has been found good for Y, therefore eat foods that have X!

Really?

We all know the drill. Another article such as this is published that discusses some study linking certain micronutrients (minerals, vitamins etc) with protection from certain diseases. The enthusiastic reporter writing the piece invariably includes a list of foods (usually skewed towards politically correct foods) that have significant amounts of the wonder-nutritent under discussion.

Sure, it's great that the link beteween diet and health outcomes are made visible to the general public. Food is medicine. This message is important.

However, the big elephant in the room is never acknowledged:

The question that is always evaded is how a person could possibly access all of these super-important nutrients without having to make skewed or unhealthy trade-offs, or without having to hedge by stacking up 10000 calories per day of various food items listed in the reports, plus an array of supplements.

It is an optimization problem of potentially mindboggling complexity.

However in reality the answer is staring us in the face, and it is very easy:

Eat a diverse and as nutrient dense diet on a per calorie basis as possible, based on whole foods.

Let's look a bit on what this statement implies.

First we must add the qualification that since some foods contain anti-nutrients or toxins (gluten, lectins, saponins, etc) or other stuff that we want to avoid such as excess sugars or omega 6 fats, we must also make sure that we get as much of valuable nutrients per unit of undesireable content in our foods as possible.

To stay on a desired level of caloric intake and to otherwise preserve health, this means not eating foods that have a scarcity of micronutrients per calorie and/or mess with our health in other ways, and instead eat a variety of foods that have a maximum amount of nutrients per calorie, and a minimum of the stuff that we want to avoid.

Also, it must be a whole foods diet, and not a bunch of supplements (though I'm not against well considered supplementation) and not franken-foods like Atkins bars. The reason for this is that without a whole foods approach one will add another layer (if not several layers) of complexity in regard to how various nutrients interact when eaten together (or when not eaten together). There are also factors such as bio-availability and absorption that impact what actually happens when we ingest a nutrient in a processed form versus what happens when we eat it as a part of a whole food. (A great paper on food synergies here.) As evolved animals we are undeniably adapted to nutrient clusters delivered in the form of whole chunks of plant matter or whole chunks of animal tissue, not to nutrient molecules as such. (Each individual cell might not care if we ate a bunch of molecules or a steak, but each separate cell has no clue about our overall health, and doesn't care either.)

In practice things actually get quite simple: Eat a diet consisting of primarily meats (yes, meats including seafoods, and organ meats are the most nutrient dense foods that one can find) accompanied by a somewhat smaller amount (calorically speaking) of eggs and a variety of vegetables and perhaps some nuts and fruits thrown in occasionally.

In other words, the rational way to be nutritionally aligned in real life with the advice coming in from all of these micronutrient studies without going either crazy or become sick (or both) is to eat according to [drum roll] a paleo diet!

Who would have known?

PS. Great paper by Cordain showing more details on the supreme nutrient density of a contemporary paleo diet here.

Thursday, June 17, 2010

De-caffeinating My Life

Don't get me wrong. I think that coffee is great - almost as great as Ray Peat thinks.

Even so, I have decided that I can't allow my caffeine intake to dictate my mood and energy anymore. I want to troubleshoot why I feel so slow and grumpy in the AM, particularly until I have had that first cup of joe. Another issue is that I have noticed how caffeine seems to make my heart rate go into overdrive with a lag of a few hours and I suspect it messes with my blood sugar too. (To be accurate, it seems like decaf coffee has somewhat deleterious side effects as well on my mental- and physical state.)

On a more general level, I want to see how far a clean paleo lifestyle can take me in terms of day to day well being and energy. I got a great energy boost from going paleo in mid 2008, and I think that, inherently, the human body, given an optimal supply of nutrients, should be able to produce just the right amounts of neurotransmitters and feel-good-chemicals in order to not need supplemental stimulants like coffee.


In any case, I'm not set to take coffee out of my life; I just don't want to be a slave to it. I'd like to rewind the clock 20 years or so, to the time when having a cup of coffee did something tangibly positive for me rather than just picking me up to baseline (combined with a cluster of side effects).

So, a couple of weeks ago, I begun cutting down on coffee by only drinking just enough to satisfy cravings and mitigate withdrawal symptoms. I might now toss away half a cup of espresso at the point where I feel that I've had the "right" amount. This has worked quite well, particularly in terms of my subjective experience of less feelings of stress and unduly raised pulse. A side effect in the first week was a bit of dizziness in the late afternoon, and in later weeks some headache - classic caffeine withdrawal symptoms.

Two weeks ago I also wanted to start addressing my grumpy morning mood and remaining afternoon coffee cravings. For that purpose I got a supply of supplements to use for troubleshooting and as training wheels. The book The Mood Cure (HT: Cheeseslave) and Poliquin's seminar on brain nutrition provided some tips in regard to which ones.

Coffee has multi-pronged effects on the psyche. It stimulates the release of dopamine (the "go-do-something" neurotransmitter), it releases endorphins (feel good chemicals), and it impacts serotonin (a neurotransmitter related to mood and a range of other things).

So I wanted to try some supplemental compounds that might also impact the same brain chemicals in order to perhaps discover why I crave coffee in the morning, and to mitigate whatever deficiency might be implied by that.

At this point I've tried the following in a preliminary way - one compound per day, except for #4 which I've taken almost every day:

1) DLPA (DL-Phenylalanine) - Impacts both dopamine and endorphins levels positively. This is the one that Cheeseslave reported great results with.
2) L-Tyrosine - Impacts dopamine.
3) 5-HTP - A precursor to serotonin.

4) R-Lipoic Acid + Acetyl-L-Carnitine . (I'm not sure how related it is to what caffein does, but I threw this into the mix because it's a tried and tested combo for clearing "brain fog" in the morning.)

I wish I could announce a miracle cure at this point, but so far I can't say that any of the above has made any significant difference. This actually makes sense because a paleo diet, after all, supplies these compounds naturally through food given good digestive function, and I don't have any overt digestive problems. (By the way, carby foods can create a temporary release of serotonin that probably beats a typical low carb paleo meal, but that's more of a transient effect.)

I will probably try the supplements a bit more systematically in another round of testing, while continuing to reduce my daily dose of coffee.

The goal is to go to zero, and to stay there for a couple of weeks with more troubleshooting of my morning grumpiness, and then to go back to drinking a small amount every day.

Tuesday, June 1, 2010

Short Notes on Saturated Fats and Coffee

Two short notes on subjects that I've been thinking about lately.

Saturated fats

Some evidence point to the fat palmitic acid as the type of saturated fat that one might want to avoid over-eating rather than saturated fats in general. Palmitic acid has been shown on a mechanistic level to make scavenger macrophages gulp up oxidized LDL which is believed to be an important step in the process of atherosclerosis.

Another issue with palmitic acid is its role in leptin- and (temporary, "physiologic") insulin resistance.

Somewhat as a confounding data point, I can report that my own brief experiment with consuming a large amount of heavy cream and butter for a couple of months before a blood test, and then dropping the extra saturated fat and do a comparative test after a month revealed a higher total cholesterol number on the diet high in saturated fat, however with a corresponding rise in HDL, while triglycerides stayed constant. (The informal experiment probably also led to a significant shift in total calories between the two "diets" which could have impacted the result.)

In terms of looking at formal risk metrics such as the ratio between HDL and triglycerides and HDL to total cholesterol, the cream and butter diet was a notch better than the diet without those items. (Though again, there may be confounding factors such as calories and the fact that adaptations to a specific regimen can take much longer than a month.)

I think the jury is still out on this, but the idea proposed by Cordain that modern grain fed animals have a higher proportion of palmitic acid in their meat than the animals consumed during the paleolithic provides a further clue to the effect that we might not be well adapted to "modern" levels of palmitic acid. This would of course include the palmitic acid that is released from the liver when we overeat carbs!

Coffee

I sometimes feel that my heart rate is inexplicably high at times during the day, and if I just get the slightest stressed, the rate can sky-rocket. (I can feel the veins in my neck just pound like crazy.) I also suspect that I have a lack of really great blood sugar control, despite eating a low carb paleo diet.

I have come to suspect that coffee is one of the culprits in these problems (under-eating may be another). A weird thing with coffee for me is that it has some sort of delayed action, such that it can cause an explosion in adrenaline (and cortisol?) release hours after I've actually consumed the coffee.

I'm therefore experimenting with reducing my coffee intake so that I would only drink enough caffeinated coffee such that I precisely avoid withdrawal symptoms. This sometimes means that I drink just half of a cup of espresso and then I throw away the rest. I may do this two times a day.

So far I'm quite pleased with the results. Subjectively I experience a calmer mood and less of those undue fight-or-flight moments.

Monday, May 31, 2010

Esther Gokhale on Spine Health

This is an excellent presentation by Esther Gokhale about natural- and healthy spine position as induced from observations of children, cultures without back pain, ancient sculptures, and a functional view of human physiology.

Gokhale's method is also a great example of proper epistemology in medicine (inductive, integrative, and informed by evolution) as opposed to disconnected rationalistic deductions about the workings of the human body, or the inappropriate use of the average (typically unhealthy) person as the norm for health.





Tuesday, May 18, 2010

Fasted Training, Cortisol, and Stress

It has been proposed that performing intense workouts (such as weight training) in a fasted state is a particularly efficient way to ensure that muscle glycogen reserves are emptied during training, and that achieving this state magnifies the metabolic benefit of increased insulin sensitivity in muscle tissue that comes from high intensity training.

The concept of fasting in combination with exercise also neatly fits with the quite plausible idea that paleo-man probably hunted when he was hungry, which would indicate that perhaps some beneficial gene expression is associated with this approach.

I have found these ideas quite compelling, and I have worked out this way myself for quite some time, but I have learned about some qualifiers (from Robb Wolf and others) that one might want to take into account before rushing headlong into fasted training, particularly if one's mode of training entails frequent- and/or intense workouts added to a perhaps already somewhat stressful life situation.

The physiologic reasons for being cautions are the following (in my somewhat crude understanding):

Even in a person who has adhered to a low carb paleo diet for a long time, the brain never becomes completely independent of glucose as a fuel source, and there are also other tissues such as red blood cells that need glucose as fuel, so after muscle- and liver- glycogen has been depleted during a training session the liver must begin to convert other energy stores (fat and protein) to glucose. This process of fuel conversion is called gluconeogenesis, and in the context of a glycogen depleted state, it is tied to the release of the stress hormone cortisol.

This is all fine if it happens occasionally and acutely, however if more cortisol is added on top of an already elevated cortisol level, the result may be a cascade of unwanted side effects such as fat accumulation (typically around the waist), poor blood sugar control, and lowered sex hormones. (Cortisol is made out of the same precursor hormone as testosterone and estrogen, and thus "competes" with them for the same building material.)

Elevated background cortisol can be caused and exacerbated by chronic stress, lack of sleep, high coffee intake, and other stressors - unfortunately, few of us doesn't have at least a few of such in our lives.

Having cortisol out of control can actually lead to the paradox of a lot of sugar floating around the blood stream, even if one eats as little as zero carbs.

An example from real life is my recently measured fasted morning blood sugar of 95 after spending weeks in ketosis. This high reading might be benevolently explained by my generally up-regulated gluconeogenesis from being very low carb, elevated morning cortisol levels, and a bit of acute stress before the blood test, but I think the lesson is that the body can very well produce a lot of glucose with just the right hormonal inputs, and we don't particularly want something like this going on chronically.

Where the exact sweet spot lies in terms of fasted training vs. cortisol and stress likely (as all things health related) varies a lot from person to person, and according to each particular individual's total life situation in terms of stressors.

I think that if one lives a relatively stress free life, gets a lot of sleep, and doesn't work out intensely for more than say 45 minutes at a time, fasting both for several hours before and for an hour or so after a session of intense weight training may be the way to go. (Classic De Vany style.)

However, for many people it may be better to prioritize cortisol control before aiming for the boosted insulin sensitizing effect from fasted training, because elevated cortisol can negate many benefits from the paleo lifestyle, including exercise.

If one is already stressed out right out of the gate, yet aims for a prolonged monster work out, then eating a little something (not a gigantic meal, but perhaps a few low GI carbs - I really have no detailed idea) before going to the gym may be a good idea.

Another implication from the above is that in a person with an intense life style (career, kids, mortgage, etc) the infrequent, brief, yet intense style of workout offered by the Body By Science protocol may provide a reasonable "island of safety" in terms of cortisol, while achieving the insulin sensitizing benefits from fasted training. BBS seems to allow for fasted workouts without the risk of adding that much extra stress and cortisol. (This is also part of the strategy behind De Vany's training style.)

Note: I have no particular axe to grind when it comes to training styles, so my general point is only that the stress impact from exercise is something to consider when choosing what kind of exercise to engage in.

Thursday, April 29, 2010

Learning From the Kitavans

Sometimes we paleo folks cringe a bit in our seats when the Kitavans of Papua New Guinea are brought under discussion. The existence of the Kitavans seems to somehow challenge some of our assumptions about what aspects of a paleo diet really drive its health benefits, or even what a paleo diet is.

The Kitavans is a hunter-gatherer/semi-agriculturalist population whose members eat a diet composed of a whopping 70% of calories from carbs, only 20% from fat, and the remaining 10% from protein.

Yet with this high carb diet, the Kitavans are exhibiting the absence of obesity and disease that we associate with our standard paleo template which typically prescribes a diet much lower in carbs, much higher in fat, and higher in protein than the Kitavans' standard fare.

Further, as we tend to be fans of Gary Taubes' meticulously worked out thesis that carbohydrates drive insulin, and that insulin drives fat storage and obesity, we might be tempted to pull an Ancel Keys on the Kitavans and relegate them to some sideshow of "irrelevant" outliers.

So what's really going on with the Kitavans and how do they fit within our paleo world view?

The following discussion doesn't try to cover all the factors that may be at play, but I think that it will illustrate how the integration of observations of the Kitavans into our big picture actually deepens and strengthens our understanding of the virtues of a paleo approach to diet.

In order to proceed we need to recognize that Taubes' carbohydrate hypothesis must be interpreted within the context of additional hormonal- and environmental factors besides insulin and carbohydrates.

One of the most important factors in this regard seems to be hormone leptin, and the ways by which its function may be interfered with.

Leptin is a hormone secreted by the fat tissue which speeds up metabolism and acts as an appetite suppressant. Leptin also helps to ensure that fat is neatly stored in our fat cells, and that it is not instead packed between- or inside our organs, which is a very disruptive situation associated with Western disease.

One could say that leptin is the fat tissue's way of ensuring a peaceful relationship with other tissues in the body so that an appropriate amount of spare calories can be stowed away as fat, but no so much that the fat deposits grow dysfunctionally large.

Now, quite unfortunately, there is such a thing as leptin resistance, which makes our brains deaf to the fat tissue's leptin signal. This deafness to leptin in turn makes us hungrier than we should be, and thus allows fat deposits to expand more readily, and also into places, such as the liver, where we absolutely don't want any fat. (With a nod to Tabues, I must say that eating insulin-spiking carbs certainly doesn't help in this situation, but there is such a thing as over-eating fat and protein too, especially in the context of a slowed down metabolic rate.)

Leptin resistance can be caused through different avenues (one of them over-consumption of carbs, particularly fructose), but more to the point in our discussion of the Kitavans is that certain proteins (lectins) in grains may be a powerful causal factor in leptin resistance through blocking leptin receptors in the brain.

This potential for grains-induced leptin resistance helps to explain why Westerners eating a 60% carb diet based on a large amount of grains become leptin resistant and wind up with obesity and associated metabolic problems, whereas the Kitavans who might consume the same proportion of carbs in their diet, though from non-grain sources such as root vegetables, instead maintain leptin sensitivity, a lean body composition and the absence of disease .

The above line of reasoning is put forth and supported by two very compelling papers by Staffan Lindeberg, et al, and Tommy J├Ânsson, et al. (The latter is a particularly excellent example of a carefully constructed hypothesis that integrates observations from epidemiology and evolutionary biochemistry - highly recommended for the science geek.)


Another set of hormonal- and environmental factors that potentially have bearing on why the Kitavans are so healthy may be the hormone adiponectin and the nutrional factors that impact its production.

Adiponectin is a hormone that (as is the case with leptin) is secreted by the fat tissue, which quenches inflammation and increases insulin sensitivity. Adiponectin thus acts as the body's own antidote against the metabolic syndrome's hall mark symptoms which are precisely insulin resistance and inflammation. Similar to leptin, adiponectin is likely one of natures' way to make sure that we can expand our fat stores without adverse systemic side effects.

In people with metabolic disease, the levels of adiponectin have been found to typically drop off rapidly as the affected individuals become more obese, though this doesn't happen uniformly from individual to individual. The correlation between a given person's level of obesity and corresponding drop in adiponectin (and associated rise in metabolic problems) seems to be determined by genes and gender (women tend to produce more), but levels of adiponectin have also been positively correlated with the presence of the minerals magnesium and calcium in the diet.

Interestingly, a dietary factor that is recognized as interfering with the absorption of magnesium, calcium, and other minerals is the lectins and phytic acid present in grains and legumes.

In other words, foods that mainstream Westerners tend to eat as dietary staples (particularly grains) block the minerals that promote adiponectin, while the Kitavans do not eat these mineral blocking foods!

I haven't seen any data on this, but I would not be surprised if it is the case that to the extent that the Kitavans actually become a little chubby (such as the individual to the right in the picture above), they probably also have higher levels of adiponectin compared to Westernes with similar body composition, and that one potential explanation for this is that the Kitavans are less prone to mal-absorption of crucial minerals. (Of course the absence of mineral deficiency also has other wide ranging positive effects.)

To wrap up this discussion, we can see that qualitative aspects of a diet (such as, in this case, the presence or absence of grains) may quite dramatically condition how our bodies deal with a particular ratio of macro nutrients, or availability of calories for that matter. (A person with his leptin receptors blocked by grain lectins tends to be a hungrier person! )

This in turn hints at a really cool epistemological aspect of the paleo dietary approach: Paleo doesn't focus on individual nutrients in a narrowly mechanistic manner. Instead it provides us with a integrative framework that isn't at all threatened by new observations or the presence of unusual cases. I don't know of any other dietary- or lifestyle approach that accomplishes this.

PS. Eating 60% of calories from carbs may not be for everyone. Those who struggle with obesity and/or insulin resistance should try low carb paleo.

Wednesday, April 7, 2010

Carb Cravings - Type 1, 2, and 3.

This is a discussion about some distinctions that I think are helpful when discussing carb cravings on paleo, and how to address them.

First of all, I'd like to mention that a paleo diet doesn't necessarily need to be ultra low in carbohydrates, but it is definitely low in refined- and "neolithic"- carbs. Candy, cake, grains, and legumes must go!

Secondly, from a health effect point of view, the difference between a moderate carb paleo diet and lower carb paleo diet is that the former prevents and cures the metabolic syndrome and numerous related diseases, while the lower carb variant does all of this plus helps you burn your subcutaneous body fat to a larger degree.

Now with this out of the way let's look at three common categories of carb cravings.

Type 1 - Energy dependence.

This type is about running out of fuel for the brain because one's body simply hasn't yet adapted to burning fat effectively. This is likely unavoidable for most people transitioning from the USDA-diet to proper eating during at least the first six weeks.

Symptoms: Light-headedness, irritation, fatigue, blurry vision, headache. In other words, the classic symptoms of low blood sugar: "hypoglycemia".

Panic cure (e.g., behind the wheel): dextrose tablet.

General short term cure: A few pieces of dark chocolate, a small serving of fruit. Nuts may also work for some. The principle is to get a little pick-me-up to a comfortable baseline without causing a dramatic sugar-shock. (We don't want shocks, because those cause the body to think that more of the same will be coming and thus it may resist normalizing its hormonal regulation.)

Long term cure: Continue to eat paleo. Eventually the need for carbs will be zero to moderate from an energy standpoint (special cases, such as endurance athletes, aside). Include fruits and veggies for the micro-nutrients in them, not because your brain stops without sugar. Though also allow for the observation that some people function better on a slightly higher carb diet. (Experiment!)

Type 2 - Chemical addiction.

This is about an addiction to carbs' secondary effects on brain chemistry, particularly their triggering of a temporary surge in the feel-good neurotransmitter serotonin, as well as cravings for addictive compounds (for example opioid peptides) that are found inside some carby foods (for example wheat).

Most USDA-eating individuals probably suffer from a bit of both type 1 and type 2 cravings, but, fortunately, a paleo diet (including supplementation with omega 3 oil, and vitamin D) also inherently addresses both types.

As stated above, type 1 is primarily an issue of one's body's fuel preference, and goes away over time as one's metabolism adapts to fat utilization.

Type 2, on the other hand, is primarily a neurotransmitter issue, and a bit more tricky (chemical addictions tend to be), but is typically addressed by the paleo diet's serotonin promoting properties (specifically, for example, the presence of serotonin precursors in meat, and omega 3's and vitamin D's beneficial impact on serotonin production and utilization).

One should, in fact, expect a better general mood after some time on the serotonin boosting paleo diet versus a USDA type diet which only produces brief surges in serotonin followed by slumps. (If this doesn't happen for you, check out Nora Gedgaudas' blog post for some troubleshooting hints.)

As a short term fix (slightly mimicking the boom-bust effect of carbs on serotonin), I think that coffee might do the job for some.

Type 3 - Psychological addiction.

When intermingled with type 1 and type 2, psychological addiction seems to be a very problematic aspect for a lot of people. The thought of Mom's savory fudge, newly baked scones at Hotel Claridges in London, Pedro's heavenly burritos, etc can trigger formidable cravings.

Unfortunately, I don't have that much to say about how to deal with this aspect, which seems to be more problematic than anything else for some, but wasn't an issue in my own case.

So far, I think that Rick Kiessig's recommendation in regard to retraining oneself represents the best shot at this issue:

"… to find something that I liked as well as carbs, that was an acceptable Paleo food, but that had also been considered relatively taboo previously. In my case, that ended up being cream, in several different forms (plain, mixed with a little milk, mixed with baking cocoa, whipped, etc). If I had a carb craving, I trained myself to have a cup of cream instead."

We will hopefully have posts in the future that deal further with the psychological issues related to switching to a new way of eating.

Thursday, April 1, 2010

Healthy BMI from a Paleo Point of View

A recent Canadian study has found certain BMI ranges to be more or less correlated with mortality, and quite counter-intuitively the study found that being overweight to mildly obese is the least risky - even somewhat less risky than having a normal BMI.

Here is a summary of the findings: ("Normal weighted" individuals at a BMI of 18.5 to 25 were assigned a risk score of 1.00.)
  • Underweight, BMI less than 18.5; relative risk (RR) = 1.73, a significantly increased risk of death
  • Overweight, BMI 25-30; RR = 0.83, a significantly decreased risk of death
  • Obesity class I, BMI 30-35; RR = 0.95, neutral
  • Obesity class II+ , BMI over 35; RR = 1.36, an increased risk of death
Since BMI doesn't distinguish between fat- and muscle mass, theoretically some athletic people in this study may have been mischaracterized as obese, but I think that it is safe to assume that the majority in the higher BMI groups were carrying more mass as fat than subjects with lower BMIs.

So, what's going on here? Should we interpret this study as a license to be flabby?

Not quite, I think.

I believe that such a blunt measure as BMI (or similar ones that ignore body composition) may only be valid as a predictor in a population with epidemic overt-, or borderline metabolic syndrome.

[Note: "The metabolic syndrome" is the name of a cluster of pathologies such as type 2 diabetes and CVD resulting from insulin resistance in the liver caused by excess fructose, gut irritants (e.g., gluten), and omega 6 fats in the diet. See Peter's blog for all about this.]

My primary reasons for the above assertion is that when looking at such populations (virtually all in the West) we can be certain that…

1)…many of those individuals who are classified as "underweight" or normal weighted are either sick and malnourished or, most importantly, "skinny-fat". Being skinny fat (as I used to be, and as are most of those who "can eat anything without gaining weight") may be especially dangerous because this condition indicates a lack of protective fat cells. Yes, it is becoming clearer and clearer that people who grow obese are protected by their own fat cells against the effects of bad diets compared to those who don't.

[Digression: The fate of the skinny-fat after, say, the age of 35 is a gradual descent into accelerating metabolic derangement which is at first smartly hidden from sight, but then later may manifest as one or more of the following: high blood pressure, migraines, cancer, hormonal disturbances, mood disorders, pre-mature aging, puffiness in the face, a hint of a double chin, and systemic inflammation. The irony is that these folks believe that they are successfully living the "healthy whole-grain" lifestyle. I know because I was one of them.]

2)…the "overweight" are either muscular (rare) or in the sweet spot of temporarily being protected from the metabolic syndrome by their fat cells (this is the typical chunky guy on the street); and that those who are fatter than that, "obesity class II+", are beyond protection (which only goes so far) and die early because of it.

However, and this is the kicker, once one has controlled for the metabolic syndrome (or put everyone on a paleo diet for 12 months), a different health equation goes into effect, which kicks these Western BMI studies in their soft underbellies.

Hunter-gatherers' BMIs are typically in the lower range of what's considered normal in Western contexts, and their body fat is roughly 10% for males, and 20% for women.

However, given hunter-gatherers' gold standard health (as documented for example here recently, and in numerous other places) wich by far surpasses what's considered normal in Western populations, it would be absolutely wrong for these hunter-gatherers to conclude that they should pack on extra weight (aside from muscle), say by eating some pasta or bread, to reach the BMI range with the lowest observed mortality risk by the standard of studies on Western corn-fed, metabolically deranged, people.

Conversely, what non paleo people in general should do is to rid themselves of the metabolic syndrome by adopting modern paleo principles including some high intensity exercise, and let their BMIs go wherever they need to go in that process. (Fat loss towards aesthetic satisfaction is usually part of the same package, but may require more tweaking.)

To sum up: Having a BMI in the "healthy" range according to Western epidemiological studies, yet with the metabolic syndrome still brewing, is not good enough if long term health is one's goal.

[Editor's Note: Whereas BMI is flaky at best, A1C or "glycated hemoglobin" may be a good marker for one's general health status.]

Tuesday, March 23, 2010

Muscle Mass for Health and Longevity

A new study fresh off the press as of March 4, 2010:

"The underappreciated role of muscle in health and disease" by Robert R Wolfe.

This is a good scientific overview in regard to the utmost importance of maintaining muscle mass for health and well being, particularly as we age.

Some points made in this study are not particularly revolutionary for paleo folks, but I think that it is an important step forward that this type of material is entering the scientific mainstream, especially since it also ties into the debate about diets. Eating according to the USDA's pyramid is almost as "catabolic" (muscle atrophying) as a diet can get, whereas a paleo diet combined with high intensity resistance training can help even skinny nerds (like myself) to put on muscle.

Here are some key points from the article according to my reading. (My own conjectures are between parentheses) :

- The availability of muscle protein (and its amino acid constituents) is the number one limiting factor in whole-body metabolism and maintenance. Essentially: When one has lost enough muscle mass, vital processes in the body cannot be maintained. For this reason, muscle mass is strongly positively correlated with survival of severe trauma and disease, and the recovery after such events.

- Muscle mass is strongly correlated with bone strength and bone mass. (The implication being that loading the bones through muscle contractions of sufficient intensity will strengthen the bones.)

- Sarcopenia, that is loss of muscle mass in old age, has a devastating effect on survival and quality of life - a quite obvious point. Further, it is much more difficult to adequately recover lost muscle mass in old age than it is to mitigate the harm through acquiring muscle mass while still young - a less obvious, but IMPORTANT point. ("Muscle is metabolic currency, so go to the gym and make a deposit today!’" as Carl Lanore, host of "Superhuman Radio", puts it succinctly.)

- Muscle, even when idle, helps to burn fat and excess calories. (Also, intense exercise has been shown to facilitate the body's adaptation to fat burning. Of course, this doesn't work well in the presence of insulin elevated by a high carbohydrate diet.)

- One's dietary intake of protein must be adequate to fuel muscle repair and growth. (Duh! But tell this to the whole grains crowd. Fortunately, the article's author goes on to criticize current dietary dogmas that recommend against foods, such as meat, that are particularly good sources of complete protein.)

In addition to these points, the article also provides a somewhat difficult discusion of how impaired metabolic function in muscle tissue is an important factor in type 2 diabetes, and it hints that such metabolic impairments may be due to lack of physical activity. A paleo-ish macro perspective on this is that, of course, physical activity of a certain intensity and frequency is what our genes "expect" in order to express the healthy bodies that our genetic blueprints were designed to deliver. I'm expecting tons of research to come out that will confirm this. (This important paper provides an intellectual framework for this revolution.)

In summary, we can add Robert R Wolfe's article to the growing pile of compelling arguments submitted by Doug McGuff, Arthur De Vany and others in regard to the importance of acquiring and maintaining muscle mass for overall health and longevity.

[Editor's note: Yes, this info applies to women too. Women need to get off the tread mill (a proven tool for becoming skinny-fat and a metabolic basket case by 40, especially if combined with a grain laden diet), and add to their 24/7 fat-burning reserves of muscle. A bit of definition on a woman in an evening gown looks good too.]

Thursday, March 18, 2010

Why the Paleolithic? (Or "Why Can't We Just Eat Like the First Cell?")

Ari on the OEvolve list asked:
Paleo people themselves had ancestors. If our goal is to eat like the Paleos ate, should Paleos have eaten as their ancestors ate (for optimal health)? Moreover, how do we know that any particular food that a Paleo person ate was optimal for that person's biology? Maybe the Paleo diet was partly or largely non-optimal.

Let's pose the question in an even broader way: How do we know that the Paleolithic era (roughly 2.5 Ma to 100 ka) should be the template for our diet when our ancestors have evolved for 3.8 billion years since the first life on earth? Why can't we just eat like the first cell?

I think that the general answer to this is that it was during the Paleolithic era that Homo Sapiens' most significant distinguishing traits (large brain + consciousness + upright posture) evolved. It was during the Paleolithic era (2.5 Ma to, say, 100 ka) that Man became Man (as different from an ape) in the sense that the environment in which our ancestors lived then (Africa) provided the bulk of the environmental selection pressures that molded our species' specific characteristics.

The challenge of calorically supporting the energy requirements of a uniquely large brain in a highly mobile animal's body (a lot of muscle combined with a relatively down-sized digestive system) required specific alterations to our herbivorous ancestors' metabolisms and feeding patterns; in particular it required the utilization of the particularly dense sources of nutrients that were the large animals of the Paleolithic eco-system in Africa.

Now, neither our Homo Sapiens body, nor its dietary requirements appeared in one sudden transformation. Our earliest 100% herbivorous genetic ancestor is an African gorilla-type primate from around 7 million years ago. The evolution of such a gorilla into Homo Sapiens took about 250000 to 300000 generations of small incremental modifications to the gorilla-specific physiology, metabolism, and behavior.

Each step on this evolutionary path slightly altered what one could at any given time call "the optimal gorilla/hominid diet". With glacial speed the physiologically optimal dietary ranges for macro- and micro nutrients changed in accordance with corresponding changes in the genome, which in turn changed through selection pressures. Thus an early hominid's "evolutionary correct" diet from 2.5 Ma would differ from both the original gorilla diet (7 Ma) and what would become Homo Sapiens' diet (100 ka).

The characteristics of our physiology and metabolism can thus be viewed as the result of a series of more or less significant modifications on top of our gorilla ancestor's "architecture", and many (if not most) gorilla traits are retained (such as the ability to digest relatively starchy vegetables) as are a broad range of important traits that we share with other organisms ranging from higher animals to single cells.

To summarize a few conclusions that I think follow from (or at least are implied by) this discussion:

1.) It is an understatement to say that pre-paleolithic evolution matters enormously to who we are (for example, we breathe oxygen, and we can digest some plant matter), but a granular look at our distinctive features compared to other animals, including our immediate genetic ancestors (such as gorillas), must particularly examine the Paleolithic era and environment. This is because our species simply did not exist before the Paleolithic era.

2.) Man's genetic evolution did not suddenly stop around 100K years ago, and our species' ancestral lineages that proliferated geographically (or in terms of ways of life) since Paleolithic times have undergone further genetic evolution. For one thing, the differentiation in skin color between individuals is an apparent sign of this, as is perhaps the variations in regard to such things as toleration of dairy or alcohol.

3.) However, genetic evolution is a stupendously slow process, and the dietary requirements for a given species thus evolve in an equally slow manner. The design of our bodies has evolved over millions of years prior to the last 100K years, and thus recent selection pressures account for relatively little when it comes to what our diet should be. This is especially true when making a distinction between what we can tolerate vs. what is optimal. What a "paleo diet" attempts to address is our species' unique capacity to volitionally frontrun genetic evolution by consuming foods that our bodies may not (yet) be adapted to handle optimally.

[Editor's note: The above point should be read over, and over, and over again by people who argue that the paleo diet is wrong because evolution obviously continued beyond the introduction of agriculture.]

Even with all of the above said, I don't want to imply that a look at our Paleolithic ancestors' existence and diet is the final word about how our diets should be. Knowledge about our ancestors (as far as such knowledge can be reliably obtained) must be integrated into a total picture verified by appropriate observations and experimentation.

Tuesday, March 16, 2010

A Few Words From the Moderator

Hi,

My name is Christian. (An admittedly awkward name for an Objectivist. I'm also from Sweden, which neatly completes the irony!)

In my early twenties I was quite puzzled by most peoples' stoic acceptance of living 50% of their lives in a state of rapidly progressing disability and disease, plunging "downhill" from around the age of 30 if not earlier. This apparent "unavoidable" feature of human life particularly didn't fit well with my observations of the relentless progress in technology that would, for instance, double a computer's processing capability every two years.

I thought generally that if the human mind could accomplish such a feat as figuring out how to put a man on the moon, then that same mind should also be able to understand why we get sick and why we age, as well as find ways to extend our disease free years and perhaps our ultimate life spans.

Thus I embarked on a quest for knowledge that I have pursued with varying degrees of intensity for almost two decades while striving to apply what I have learned to my own life and routines.

A transformative event that took my knowledge and applications to an entirely new level was discovering the work of Art De Vany in the summer of 2008. (For those of you who are new to the "paleo-sphere", De Vany is a scientist who has developed a distinct approach to diet and fitness through his refinement of concepts related to evolutionary thinking about the human body.)

Shortly thereafter, I also read the groundbreaking book "Why We Get Sick: The New Science of Darwinian Medicine" by Randolph M. Nesse and George C. Williams. This book convinced me that without an evolutionary perspective on health and medicine, it is very difficult to even begin to ask the right questions about the subject matters.

Most importantly, Nesse and Williams show a way out of the ridiculous atomism and myopic lack of conceptual integration that is plaguing modern health sciences. They do so by providing a perspective on the human body as an adaptive, self-regulating organism whose genetic blueprints have been shaped by Darwinian evolution.

I believe that this perspective is going to completely transform the health sciences. Not only will it put the final nail in the coffin of the fraudulent diet-heart hypothesis, but it will help to restore medicine's proud lineage back to Aristotle and Hippocrates (more on this perhaps in future posts). It is indeed exciting to be one of the first beneficiaries and early adopters of the intellectual products of this trend.

The cool thing about true theories is that they actually work in practice. This has certainly proven to be the case with the evolutionary take on a healthy lifestyle. Not just for myself, but for numerous people reporting astounding results. (We are going to have some exciting reports from Objectivists on that on this blog.)

I would also like to add that Objectivism and paleo concepts go incredibly well together. If Objectivism provides the ethical "user's guide" to how to live a happy, human existence, a modern paleo approach is indeed the "user's guide" to the human body.

/Christian

PS. Incidentally, the Objectivist philosopher Leonard Peikoff, who is a contemporary defender of integration in philosophy and all sciences, has apparently taken an interest in resistance training according to the concepts developed by Doug McGuff, author of "Body by Science". (Hat tip to Kevin Smith.) Doug McGuff is indeed one of the true integrators in the field of exercise science.

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