In the past 30 years there have been many articles written about coffee – initially stating it was associated with higher risks of pancreatic and other cancers.  Cardiologists for years have been telling patients to cut down or eliminate coffee from their diets. But more studies have come out to refute that early data, and coffee appears to be be ok.

The New England Journal of Medicine reported, “the National Cancer Institute researchers turned to data on 402,260 adults who were between the ages of 50 and 71 when they joined the NIH-AARP Diet and Health Study in 1995 and 1996. The volunteers were followed through December 2008 or until they died — whichever came first.” The researchers found that, “compared with men who didn’t drink any coffee at all, those who drank just one cup per day had a 6% lower risk of death during the course of the study; those who drank two to three cups per day had a 10% lower risk, and those who had four to five cups had a 12% lower risk.”

Neal D. Freedman, a National Cancer Institute researcher and the study’s lead author, said, “It offers some reassurance for coffee drinkers,” but “we shouldn’t say coffee is a fountain of youth or anything like that. The biggest concern for a long time has been that drinking coffee is a risky thing to do. Our results, and some of those of more recent studies, provide reassurance for coffee drinkers that this isn’t the case.” Individuals “who are regularly drinking coffee have a similar risk of death as nondrinkers, and there might be a modest benefit.”

Coffee drinkers also were a little less likely to die from specific causes: heart disease, respiratory problems, strokes, injuries and accidents, diabetes and infections. About two-thirds of study participants drank regular coffee, and the rest, decaf. The type of coffee made no difference in the results.

Early on the results indicated that coffee drinkers were at a higher risk, until they removed those patients who smoked. Once that factor was taken care of it appeared that people who drink 4-6 cups of coffee per day had longer lifespan than those who didn’t drink coffee.

As with all population studies correlation does not equal causation – that is, what we know is that coffee consumption doesn’t adversely effect longevity, but it may not improve it either. Nor do we know if there is a single, or multiple factors in the coffee that are responsible for those having less incidence of heart disease, lung disease, infections, or cancer.

Coffee isn't all bad

The Huffington Post is at it again- by promoting a nutrition quiz from the Physicians Committee for Responsible Medicine (PCRM).  One would think that a group like PCRM would be a responsible group, with a website that would have credible information. However, PCRM is a vegan organization that promotes an anti-dairy, anti-meat, anti-seafood, anti-egg diet, and the purpose of their quiz was to help evoke those ideas.  They have also sent out news releases that are bias to  a vegetarian diet and argues for it with half-truths that do little to advance their position, and a lot to reduce their credibility.

Recent breaking news quoted a paper in that indicated that fish oil did not prevent recurrence of heart problems and “evidence fails to support their use.”  PCRM did not include the conclusion:

“However, a diet high in fatty fish (≥2 servings of marine fish per week) should continue to be recommended for the general population and for patients with existing CVD because fish not only provides omega-3 fatty acids but also may replace less healthy protein sources, such as red meat.”

PCRM is anti-fish, as well as anti-dairy, and they fail to note that the American Heart Association recommendations for two meals a day being replaced by fish.

Recently PCRM released another study showing E. Coli was in 48% of chicken bought in 10 cities by their group. What they failed to state was that the E.Coli was not the type that causes humans illness.  Further, the major outbreaks of food-borne illness have recently come from produce and peanuts – as they are grown in soil that contains E. Coli. and can be contaminated with salmonella.  There are many types of bacteria in the soil, and E. coli is a common soil bacteria, but it is not the same type as that which comes from feces.

If you were a Vegan this might be your view of food

Here is their quiz with Science and Evidence based medicine rebuttal:

(1) Skim milk has the same amount of calories as cola

Yes, they are anti-dairy, and this is suppose to scare people into thinking that dairy is bad. For those who can tolerate milk, those who are not lactose intolerant, milk is a great source of nutrients.  Cola, not so much. They say all you need is water, nothing else – and we agree, however,  milk can have plenty of nutrients in them and should not be over looked.

(2) Cheese and steak have the same amount of cholesterol.

The first question you should ask is- so what? Dietary cholesterol has a minimal effect on the blood level of  the body’s cholesterol, we have known this since I was in medical school ( 1980’s). You can see my last post about fats to see more. That different amounts of cheese as well as a porterhouse steak have the same amount of cholesterol means nothing.  Very few physicians look simply at the cholesterol level, unless it is either very high >250 – and then we look at the underlying lipid profiles.

(3) Cheese is 70% fat.

Some cheese is, but again, cheese in moderation is not a bad thing. Some cheese is not  70% fat. By the way, most nuts, which this group advocates, are also 70% fat. They go on to say that Americans are eating three times the cheese we did in the 1970′s – probably not the case for some. Cheese is something that should be used in moderation – as it is dense with calories

(4) Frequent consumption of hot dogs and bacon makes it more likely you will get colon cancer.

In the one study, that has many flaws, if you eat a diet rich in processed meats your risk of cancer is higher- by a small amount. But that is a correlation, and not necessarily a causation, and when you work out the statistics, your chance of eating that much (a lot ) is not much, and your chance of getting cancer from it is – well, we don’t know. We don’t advocate eating a lot of processed any food. They state that the recommended amount of processed meats would be “none” – we would disagree, as do bacon lovers everywhere.  The correlation is so small with this as to be stretched.

(5) Women who regularly eat soy have a lower cancer risk.

This is not necessarily so.   Comparison studies have been mixed- so the answer is, we don’t know.  PCRM based their information about population studies from Asia- but other factors these women have include (a) less obesity (b) more physically active (c) drink less alcohol (d) eat more fruits and vegetables. Until the issue becomes clearer, many doctors recommend that women who take hormonal therapy or who have estrogen-receptor-positive breast cancer avoid soy supplements because they contain high concentrations of isoflavones. But in general, it’s fine to eat moderate amounts of soy foods as part of a balanced diet. One to 3 servings of soy a day (a serving is about a half cup) is similar to an average Japanese woman’s daily soy intake. If you are taking hormonal therapy to fight off a hormone-receptor-positive breast cancer, and you are concerned about any phytoestrogen effects, ask your doctor or registered dietitian about how much soy you can eat.

(6) Salmon has cholesterol and fat

Ah yes it does, and to repeat- consuming cholesterol is not the issue. Salmon fat is high in omega-3 fatty acids and quite healthy. Eskimos and maritime Native Americans had a diet rich in salmon and the lowest rate of heart disease on earth.  There is not convincing evidence to advocate taking fish-oil capsules, there is still evidence that replacing two meals a week with fish is protective for the heart.

(7) An egg has more cholesterol than a Big Mac

Cholesterol is not an issue in diet but the 540 calories in a Big Mac compared to the 90 calories in a large egg is. The calories in a Big Mac come from 29 grams of fat, while only 5 grams of fat from an egg. While PCRM has an issue with dairy, as do some from the Paleo diet, eggs are a healthy source of protein.  If you get rid of the yolk you can get rid of a lot of the calories also. The amount of cholesterol is less important than the lower calories- and you could always use egg whites which have less fat, much less cholesterol, but a great source of protein.

(8) Milk, Beans, and broccoli are all high in calcium

This is true, and for those who need a good source of calcium but do not drink milk, there are some good alternatives. They point out that the calcium in the beans and broccoli is absorbed at a rate of  50-60%, while milk is just  32%. What they fail to point out is that 1/2 cup of broccoli contains 21 mg of calcium while 8 oz of nonfat milk contains 300 mg. That means from broccoli you get 11 mg of Calcium which is about 1 percent of the daily requirement. If you get non-calcium enriched milk you are still getting 100 mg of calcium or ten times the amount you would with broccoli.

Vegetarians may absorb less calcium than omnivores because they consume more plant products containing oxalic and phytic acids . Lacto-ovo vegetarians (who consume eggs and dairy) and non-vegetarians have similar calcium intakes. However, vegans, who eat no animal products and ovo-vegetarians (who eat eggs but no dairy products), might not obtain sufficient calcium because of their avoidance of dairy foods.

In the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition, bone fracture risk was similar in meat eaters, fish eaters and vegetarians, but higher in vegans, likely due to their lower mean calcium intake.  It is difficult to assess the impact of vegetarian diets on calcium status because of the wide variety of eating practices and thus should be considered on a case by case basis.

(9) Fish and Beef have no fiber

Quite true- there is no fiber in meats. This is why a balanced diet contains fruits and vegetables. However, fish and beef contain better sources of fat absorbable vitamins, calcium, B12, protein, and other nutrients than vegetables do.

(10)  A skinless roasted chicken breast has more calories per ounce than soda or white rice

This is quite true- and mainly because of the fat content of the chicken. But chicken has more nutrients than white rice and more than soda.

PCRM also was responsible for the comments that E. Coli was found in many of the chicken products.  What they didn’t say was that the E. Coli they found were not the same as responsible for food borne illness.  In fact, the E. Coli they found was the kind commonly found in the soil, where the very plants grow that they advocate consuming. The pro-Vegan group also neglected to mention that the majority of Salmonella infections that have caused major outbreaks have come from agricultural products, including peanuts, that they advocate for a healthy diet.

It appears that PCRM is more propaganda than science. If you are going to advocate for a position, your position is diminished when you don’t tell the full story. If cornered in press conferences they avoid the answers to the questions. This is not a place to get information at all.

In the case of diet and lifestyle, there is a lot we do not know- but PCRM as a source of nutritional information is less than adequate, in that often it does not tell the whole story.  As a website for health and information it is more like a political party than a resource for those looking for evidence based medicine or science based medicine.

One of the misleading advertisements from PCRM

Do you think you know which of these is best for you?

What do we really know about fat?  About how fats react in the human body when they are eaten?  Government agencies make a lot of assumptions about fat, and they base that on the popular opinions of physicians and scientists who serve on their advisory committees.  Those recommendations are published, and then are used by many physicians, dieticians, nurses, and other health care professionals as a basis of what to recommend to patients.

But what if those experts got it wrong? When the latest data about fats is examined critically we find out that the recommendations made by those government agencies has no basis in the literature.  However, you will find those recommendations repeated as gospel in almost every website about what to eat and what is healthy for you, even the highly respected websites such as WebMD.com

In the March issue of Nutrition, a highly respected, peer-reviewed, academic publication,  Robert Hoenselaar outlines how the advisory committees not only got their advice wrong, but how they cherry-picked the data (Nutrition 28 (2012) 118-123, Saturated fat and cardiovascular disease: The discrepancy between the scientific literature and dietary advice).

Recommendations from the United States Department of Agriculture (USDA) and European Food Safety Authority (EFSA) regarding consumption of fat are similar

(a) Consume less than 10% of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids

(b) Keep the intake of saturated fatty acids as low as possible while consuming a nutritionally adequate diet

(c)  Saturated fat intake should be as low as possible

In 2003, a meta-analysis of over 50 trials was published examining the relationship of dietary fat to serum cholesterol levels (Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serumlipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003;77:1146–55.).  The conclusion was that saturated fat increases the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) but without changing the ratio of total to the HDL cholesterol.   They concluded that using cholesterol alone as a marker of risk was unreliable. This was because if you replace the saturated fat with carbohydrates or tropical oils if you examine the effects on HDL and apolipoprotein B. They concluded that “… we can never be sure what such fats and oils do to coronary artery disease risk.” To translate that from doctor-scientist language: we can improve some laboratory markers, but really not by any mechanism that makes a difference from what we know.

While a systematic review of randomized trials showed that when saturated fats are replaced by polyunsaturated fats there is a reduction in the laboratory marker for risk of heart disease, there was no association with mortality from heart disease.  To emphasize this: the laboratory values of the patients studied improved, but their mortality didn’t. The review also showed that monounsaturated fat intake significantly increased cardiac events, but no effect from the intake of saturated or polyunsaturated fat. Let me emphasize that: Monounsaturated fats, by at least one study, not only didn’t improve issues with the heart- the patients in that study did worse.

When examining other prospective studies about the risk of saturated fat and cardiovascular disease, there has been a consistent lack of an association between fat intake and heart disease, stroke, or total cardiac events.

Cohort studies show that by replacement of saturated fats with unsaturated fats, or carbohydrates – and examining the hazard ratios for heart attacks and deaths from heart disease were as follows: 0.87 for polyunsaturated fat, 1.19 for monounsaturated fat, and 1.07 for carbohydrates.  For those not familiar with statistics, these are essentially no difference, and if these small statistical numbers are accepted than polyunsaturated fat shows an alarming trend. So here is a study that indicates (with as much precision as most studies these days) that polyunsaturated fats are worse for you than saturated fats.

There is a difference between protection against what we define as risk of heart disease and death from heart disease.  Risk reduction means that we lower the laboratory values of factors we associate with risk – but the end point is death.  In a meta-analysis published in 2010 (Ramsden CE, Hibbeln JR, Majchrzak SF, Davis JM. N-6 fatty acid-specific and mixed polyunsaturated dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. Br J Nutr 2010;104:1586–600.) examined seven different trials, they found that there was a risk reduction but no change in mortality.  Another study (Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomized controlled trials. Ann Nutr Metab 2009;55:173–201.  ) had eight trials found “There is probably no direct relation between total fat intake and risk of CHD (heart disease).”
The advise of the USDA is reflected in places like WebMD, recounted in public service commercials, and recited as gospel by health care workers everywhere.  Giving false impressions about what an appropriate diet is.

Many of us constantly look for the right things to eat, the right food to feed ourselves and our families.  For that information we choose what we consider informed sources about risk reduction. What we discover is that there is not a clear answer, at least not yet. The differences between these ingredients are not large enough in the studies performed for a reasonable person to make blanket statements.

The only statements about fat that can be made are that trans-fats are bad for a person.  Trans-fats are the fats found in stick margarine, most pastries, and fast foods – but rapidly being eliminated because of their clearly demonstrated bad effects.

Here is what we do know: eating too many calories, be it of fat, carbohydrates, protein, or alcohol will lead to excess weight, and excess weight is a contributor to heart disease, diabetes, and joint problems.

Eat healthy, fresh, delicious food — all in moderation.

For real science- we are juggling what we eat to find the best fit

Re-reading the study about red meat and its increase in mortality, I continue to go back to the gold standard of lifestyle epidemiology- smoking.  People who smoke one pack of cigarettes a day have a 20-fold increase in lung cancer. 86% of all lung cancers in the United States occur with smokers, or ex-smokers.  One can reverse prove this- people who quit smoking decreased their risk of heart disease as well as lung cancer for every year they had stopped. This was the gold standard that all other lifestyle researchers are trying to find. After smoking the next great one was second-hand smoke, and sadly the correlations between mortality and second-hand smoke fell apart – although that did not stop public statements.

Still others try to find that meat, or fat, or carbs, or something causes an increase in the rate of death. So what did is the real red meat of this study (sorry).

What this paper discovered was that the increased risk is that less than one person in one hundred died (less than 0.2% with heart disease and 0.32% with cancer – as opposed to the gold standard of a 20 fold difference).  Let us put this into the context that the article did not, and that most media did not – that one person in one hundred over a 28 year period who died also smoke more, drank more, had less physical activity, and was obese.

The article states they did a multivariate analysis to adjust for age, race, smoking, drinking, activity, caloric intake, and obesity – and removing those factors they still have, in the highest quartile, the increased rate of death with less than a 1.2 fold difference (compared to 20 fold for smoking and lung cancer).  For those of you not statistically or mathematically prone, this simply means they found a way to negate the influence of each of those factors so that the simple and singular analysis of each quartile (quartile one being the lowest meat eaters and quartile 5 being the largest consumers of meat) stands alone. They do not show us this data – we just take them at their word that this person who died, the one person in 100 in 28 years, who drank more, smoked more, was obese, did minimal physical activity, and ate more meat- died because they ate more meat.

Some nutritionists think we should graze on plants

Does this study really tell us that substituting one meat free meal a week will decrease mortality? Not really.  This was a statistical trick to take the people from one quartile to another- and in that they reduced risk.

If you examine the raw data, without statistical manipulations- you find that death rates go down with increased meat consumption until the fourth and fifth quartile.

Does this article shed light on how we should eat or what we should eat? No, it does not. In fact, this article is a statistical nightmare of a piece that gained attention because of its conclusions.

Take heart, there have been prospective studies of diets to see how they work, and these have been short-term studies, but they were corrected for variables. The diets examined include low-carbohydrate diets, Mediterranean diets, the Ornish diet, and others (Gardner CD, Kiazand A, Alhassan S, et al.: Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women. JAMA 297:969–977, 2007) and Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction: A Randomized Trial Michael L. Dansinger, Joi Augustin Gleason, John L. Griffith, Harry P. Selker, Ernst J. SchaeferJAMA. 2005;293(1):43-53.)

We have moved beyond poorly done population studies – and are into trying to determine what is the best diet for people to consume.  We have more questions than answers – but the science tells us a few things:

Weight loss is good for all of us

(a) No matter which died patients are placed on, if it yields weight loss (probably meaning people are compliant on the diet)  reduced the cardiac risk factors including C-reactive protein, insulin levels, and reducing the low-density lipoprotein/high-density lipoprotein ratios.

(b) We really don’t know about fats, as much as we think we do

(c)  No one seems to like bread these days

(d) We all like grass fed beef, flaxseed fed chicken eggs, and anything that is free on a range (home on a range).

(e) We all like whole plants- but some of us like them more than others

(f)  Exercise is universally associated with better results, and you cannot exercise your way out of obesity.

To paraphrase Gary Taubes of “Good Calories, Bad Calories”- nutritional epidemiology is closer to pseudoscience than it is to science.

When the Archives of Internal Medicine published the article “Red Meat Consumption and Mortality” all I could think of is “here we go again.”

First to go through this paper- which is a statistical population study from the Health Professionals Follow-up Study (HPFS) and the Nurses’ Health Study (NHS). Of the 140,000 combined participants they tossed out 20,000 because of a history of the diseases reported or those who did not fill out the forms perfectly.

To start with – this is not a study where people were followed from baseline to death to see if what they ate contributed, and determining amounts along with following other variables as they progress (lifestyle issues with exercise, smoking, etc). This instead is a study based on food questionnaires, and statistical analysis. Correlation does not imply causation.

One has to be careful with epidemiological studies, as they are not  proof of a cause, rather they point to a number of variables that might be involved to form a hypothesis. It is these same types of statistical studies that told us that women should use hormone replacement therapy because it prevents heart attacks in 1991, only to be told 11 years later that it might cause heart attacks. It is a sampling bias of those individuals who choose to participate in the studies that led to the erroneous conclusions.

The second issue with these studies is the ability of the food questionnaire and its accuracy. This has been studied – that is, the ability of people to recall and fill out what they ate. We do this in our office all the time- ask people what they eat—and since we are involved in weight loss and healthy lifestyle here is what we can say: people have no ability to remember what they ate, how much they ate much beyond the last day. When studied by others, looking at the questionnaire (FFQ or Food Frequency Questionnaire) in the Nurses’ Health Study was found to be useless. As reported by others, the accuracy of the questionnaire compared to reality was unacceptable.

For example, 20 per cent of the nurses reported living on 1200 calories per day or less, and low intake of red meat, and 20 percent report over 2000 calories a day.

In the study the first table showed that the highest reported red meat consumption was associated with smoking, drinking more, obesity, and higher calories. Oh wait- have you ever heard that smoking, obesity, eating more calories, or drinking more might lead to an early death? Perhaps you have, in fact, there are some correlations (which don’t imply causation) for these, and there are some great prospective studies showing that obesity leads to early death.  Of course, in any statistical paper you can remove the confounding factors – and THEY DID NOT in this paper.

One other cute correlation- in the data, those who report eating the most red meat had the lowest cholesterol levels. Yes, that is odd isn’t it. Readers of this blog know that cholesterol and meat have less to do with one another – and that isn’t a statistical issue, that is just basic biology.  Eating more meat does not mean you will have a higher cholesterol – having bad genetics does.

Here is what three systematic reviews of prospective studies show in the relationship between saturated fat and heart disease- zip. There has been a consistent lack of an associated between saturated fat intake and heart disease. While this new study statistically makes the argument that changing diet would decrease events from heart disease and cancer, when looked at (references below) none of the pooled studies show a change in that risk relationship. And, when some studies have shown a change in risk, when the data was examined there was no difference in mortality. While some say red meat clearly is bad, the evidence is anything but clear. Proving again that population studies, without isolating the variables, without having a scientific basis, are worthless.

Finally, the science of red meat—what do we know? Red meat is a large category of meats includes everything from bacon (considered “processed” by some and delicious by others) to cows raised on grain, and cows raised on grass. Grass fed beef have higher levels of omega-3 fatty acids. Consuming different red meats mean you are consuming different levels of ingredients. Lumping them together is just sloppy science.

Nothing like great grill marks on a steak

Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab 2009;55:173–201.

Mente A. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169:659–69.

Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 2010;91:535–46.

While there is a lot of controversy about what diet is best for a long and healthy lifestyle- there is no doubt about things that you can do to stay healthy into the golden years. We want them to be golden years, not rusty years.

So here are things that all of the medical community agrees with- and things that my 87 year old father do:

Lose weight– as you age most appetites decrease a bit, and habits change. If you lose weight it is a lot easier on your joints, your heart, and your back. Take advantage of the diminished appetite – my parents skip dinner most nights, or just have a snack. My dad has gone from 185 pounds when he worked to 150 pounds now — a nice slow weight loss over the last twenty years.

Exercise – one simple thing- walk every day. Thirty minutes – it makes a big difference. When I visit my parents my dad can out walk me. Both of my parents are as sharp as ever.

Keep your mind occupied. The golden years do not mean settling down and watching television. Keep up with something- my parents have a wide range of interests, my dad still serves on a board – and they always discuss politics (I might disagree with their views at times).

Simple formula: Eat less, walk a bit, and keep your mind occupied.

I’m glad my parents are happy and pretty healthy for being in their 80′s, and my son (18 months old now) has a great set of grandparents to enjoy (he’s their first grandchild).

My 87 year old dad, and his first grandson -JJ- keeps you young

One of my favorite chefs – Gordon Ramsay, talking about eggs and a few other things.

Scrambled eggs:

When I first started out in life working in a kitchen one of my jobs was to crack eggs and put them into a large container and then when someone ordered eggs they would be ladled onto a hot griddle and in a minute an order of scrambled eggs would be ready. Turns out, most kitchens make eggs the same way — a hot griddle, very little time, and a fast breakfast.

Fast food eggs are made over too hot a griddle yielding rubbery consistency

Two problems- the eggs have been heated so fast, that the proteins have lost most of their water giving the eggs the consistency of rubber and second, the eggs don’t taste that great.

When my patients who had LAP-BAND surgery complained that eggs became stuck above there band – it was quite clear- they were either making them to hot and fast, or getting them from a restaurant that was doing the same.

Here is the secret to all eggs — think of eggs like sex – you want it slow. When you were a kid, fast may have been ok but now you are an adult- time to earn how to make them.

The perfect scrambled egg has the consistency of custard or yogurt. They are not hard, rubbery, or dried out. Egg whites are a protein called albumin – and like all proteins, when given a high heat they tend to denature (our scientific term) — or lose their water and become curdled, hard, and more akin to eating a wad of bubble gum than the nice custard we desire.

Ingredients:

4 large Eggs
1 T butter – UNSALTED

First DO NOT whisk the eggs together ahead of time. Do this under some heat – and gently. Whisking eggs together begins a mechanical breakdown of the proteins that will result in more rubbery consistency.

Place a non stick fry pan on a low heat. Take a teaspoon of butter and gently coat the bottom of the pan. If the butter can melt – then place four eggs in the pan. Using a silicone spatula gently break the yolks and fold the eggs together. Gently stir the eggs – and every minute take the pan off the heat and continue to stir the eggs. Once the eggs “set” – or are a wet consistency when they are giving off a bit of steam – take them off the heat for the last time. Take the remaining 2 teaspoons of butter and fold them into the eggs. You will see the heat from the pan will continue to SLOWLY cook the eggs. As you stir in the butter the creamy texture of the eggs will form- once they are to that point, remove them from the pan and serve them.

At this point add salt and pepper to taste – not before. If you add salt to the eggs before the mechanical action of the salt, combined with the drying property will pull the water out of the eggs.

There you have it- the pefect scrambled eggs. Want to add some ingredients – I recommend Salsa instead of cheese- more flavor, and far fewer calories than fat.

Two servings if you are trying to lose weight and one serving if you want to gain weight.

Bourdain calls out Deen

Paula Deen who crafted a remarkable, high profile career with her Southern style of cooking, delivered with Southern style charm, announced her diagnosis of  adult onset diabetes (type 2). Now the judgments are pouring in: her food and lifestyle led her to this diagnosis and the pundits are asking for her to “repent.”

As a physician let me be clear here:

Paula Deen’s diabetes is not a deserving fate for what she cooked, it is more a matter of genetics than anything else. For those who are unlucky enough to have the genetic code that predisposes them to diabetes, the odds are they will become its victim, as they get older.  Even the most “in shape” individual, who eats “right” who has the genetics for diabetes can no more avoid that than you can avoid a car accident  if someone misses a stop sign because they are texting.

Perhaps I am jaded – as someone who researches diets and performs weight loss surgery- I’m reminded that HL Mencken said that physicians are not suppose to offer repentance but absolution.  But a body never lies, and while we don’t know the “right” diet,  we do know that  certain foods can kill you.

While the news enjoys the pseudo-feud going on between Deen and one of my favorite writers-chef Anthony Bourdain, we in medicine hope that Paula Deen is using her celebrity to benefit millions who are diagnosed with diabetes. She is also cashing in a check from a sponsoring company;  isn’t that the American way?

The real quote from Bourdain is one anybody can respect, “Honestly, I have no ill will toward her personally. I respect anybody who’s had a trajectory like hers. But I don’t like the brand. If her shtick is food that’s going to rush you along your way to diabetes, then it’s not a brand I particularly like. I am the last person in the world to be advocating for any kind of healthy eating or lifestyle. The only distinction between us, actually, is that my show comes with a parental advisory and hers doesn’t.”

I won’t endorse Paula Deen’s cooking as “healthy” and most of it would cause blood sugar to rise higher than it should.  Food can kill you, but it cannot cure you. Hopefully Paula Deen will use her celebrity to advocate for diabetes education and awareness.  I also wouldn’t mind if she would come out with a few recipes that won’t raise the blood sugar as much as twinkie pie. And just to be fair– eating a little less of poison doesn’t mean it is being “moderate” it just means you are being less stupid. Besides- you can’t eat just one. So, Ms. Deen- lets see some new recipes.

Until then, I’ll be watching Bourdain eat camel cheeks in some far away place, wishing I was there with him.

]]> http://yourdoctorsorders.com/2012/01/paula-deens-diabetes-a-physicians-perspective/feed/ 6 http://yourdoctorsorders.com/2012/01/paleolithic-diet-old-genes-to-fit-in-jeans/ http://yourdoctorsorders.com/2012/01/paleolithic-diet-old-genes-to-fit-in-jeans/#comments Fri, 13 Jan 2012 02:49:23 +0000 thedoc http://yourdoctorsorders.com/?p=1614

The Paleolithic diet presumes that foods eaten during the stone-age (Paleolithic era from 2.5 million years ago to 10 thousand years ago) are optimal foods for humans. The Paleolithic (Paleo) diet includes grass fed beef and other lean meats, fish, shellfish, fruits, vegetables,  eggs, nuts, but no grains, no dairy, no salt, no refined fats (butter or margarine) and no sugar or high fructose corn syrup.

Fanatical Diet (Lifestyle types)
There are three things one should never discuss in polite company, religion, politics, and diet. Getting into an argument with proponents of diets is like a democrat trying to convince a republican that Obama is ok. Each side will quote their own studies, statistics, and population studies. But the key to scientific study of the various diets is not what we presume from correlation, but from what we learn when that diet is placed into patients – in this case, the laboratory values of those who have the diet.

Diet proponents become fanatical about their diet (lifestyle) to the point of religious fervor. Seeking to prove that their diet is backed by science, proponents use population studies with associations that are only suggestive and not proof of causation. These associations become propaganda as the associations are repeated over and over, morphing from a suggestion to “proof.”

The Flaws of population studies or Correlation does not equal causation
The foundation of many diets are based on the correlation of what a population eats and what diseases they suffer from. In the Paleo diet the assumption about what they ate and the diseases they suffered from is a spurious correlation at best, and far from causation.

Population studies are flawed, as often we find that we don’t know as much about the population as the data might suggest. Take the Pima Indians of the Southwest. In 1990 a paper came out stating that the Pima Indians had a low incidence of fatal coronary heart attacks in spite of having a high rate of diabetes. The Pima Indians were called among the most studied populations, with an NIH post in Phoenix, and lots of studies showing the highest rate of diabetes in the world. When the population was examined more carefully, the Pima Indians had plenty of heart disease.

Step back from the most studied group in the United States with great statistics and physicians trained in modern medicine and then imagine making conclusions about what Chinese eat, or Mediterranean’s, or French. Those assumptions are more flawed, as are the statements about what diseases they do or do not have. Now step back further trying to determine what people of the Stone Age ate, what diseases they had, and we leave the tenuous role of suggestion and enter the role of outright guessing. Even if we have reasonable data (and often we don’t – even for the best studied people in the United States) the correlation between what people eat as a cause for what diseases they have is a fundamental flaw. Correlation does not equal causation.

The Best Diet or Lifestyle is?
When it comes to the best diet plan for a person – we just don’t know enough to say that one is better than another. There isn’t enough evidence to state that the Paleolithic (also called Paleo) diet is better than the Ornish, Southbeach, Pritiken, or pick one, or better than how you currently live your life.

We cannot broadly say that any given diet will prevent heart disease, cancer, arthritis, or even obesity. When someone tells you a diet can prevent such, they have gone from the realm of science to the realm of bs.

The Paleo Diet Premise:
The Paleo diet premise is that we should avoid certain foods because our body is not evolved to process those foods, and if it does process them it will lead to the chronic diseases of modern man – heart disease, strokes, cancer. Cavemen didn’t have those diseases, so we should eat like cave men. Of course, we don’t know about what diseases that cavemen had – especially when it comes to organ and soft tissue diseases, we just have a few fossils that we examine and look for evidence of known diseases. Would coronary artery disease show up in a fossil – nope? Would cancer show up in the fossil – bone cancer would (kind of a rare cancer) or cancer that went to the bone might – but it would be hard to tell if the fossil evidence.

We do know, from many hunter-gathering societies, that they live a short life, and not long enough to develop the diseases we associate with aging. All a person has to do to pass on their genes is make it into puberty, and to be effective to nurture the young, into the 30′s, and to see grandchildren and help child raising – into the early 40′s. That is what a simple civilization needs. After that, in any primitive society, the elderly become a burden – perhaps to be placed on an ice flow. People who live into their 40′s and 50′s may die of cancer, heart disease, or obesity- but they will have passed on their genetic code.

The Evolution of Homo Sapiens:
When Homo Erectus came out of Africa, they encountered a world that was much more varied in food sources than Africa. The brain of the human (H. sapiens) evolved, becoming much larger, and utilizing far more energy than the brains of the Australopithecus – about 10 percent more. More than any other species, humans evolved a brain that required more calories- and our brain metabolism accounts for up to 25% of our energy needs. Bigger brains and its increased requirements mean a richer diet- and modern hunter gathering species derive about half of the energy from animal foods – in contrast with other primates that have far fewer animal foods. While our ancestors the Australopithecus dined on plant foods, and had large mouths to grind up fibrous plants – humans are built, with smaller faces and jaws, to dine on energy rich animal foods.

The reconstructed skull of Lucy, Australopithecus- large jar and muscles for eating plants

The Human skull is larger, larger brain- and jaws for more energy rich foods

Humans were successful, as the fossil record shows, because they were “flexible” eaters, using a wide variety of dietary strategies. If there were a lot of Elk, then we ate elk- berries, we picked berries. To state that our digestive system evolved only to eat some few items found in the Stone Age – has been disproven on the face of it. Our ancestors in Africa didn’t encounter Arctic char, whales, seals, salmon – and yet when they moved from that warm climate to the frozen north, they adapted quite well to a very high fat diet of primarily animal based diet that was clearly not available in Africa. The findings of starch grains from wild plants in grinding tools from sites in Italy, Russia, and the Czech Republic from the mid-upper Paleolithic era suggest that the production of flour was present 30,000 years ago.

Contrary to what Paleo proponents state: people made flour 30,000 years ago

How to eat like a caveman
There are some things about the Paleo diet that people avoid:

Excess sugars including fructose
Excess Omega 6 oils – including soy
Processed wheat, grains, and gluten
Dairy

What is the scientific evidence for this? It’s the simple premise that modern man has lifestyle illness from altering food, taking in too many calories, and if we would return to our ancestors roots (pun intended) we would avoid these highly processed foods and not suffer from the holy trinity of diabetes, obesity, heart disease, and maybe even cancer. There is not a single shred of evidence to support the premise of this diet.

An entire dietary regimen has been formed with plenty of books and websites to guide you through this. It has become so popular that the question becomes not the flawed premise for the diet, but rather how the diet would compare to other diets. If you want to eat like a caveman, then shop on the outside of your grocery store.  Everything on the inside of your grocery store is generally processed foods, and everything on the periphery of the grocery store is generally not processed.  On the periphery you will find the vegetables, fruits, meat counter, fish counter – although you might get in trouble with dairy, and before you check out they might have a cookie or two – or there might be a bakery (a big no no among the non-Geico types). But lets be clear- whatever the caveman could get that they could eat- they would eat, and if a caveman were to be around today- wait, we have them – well, they eat Poptarts.

In one real scientific study patients with known heart disease who were randomized to either the Mediterranean-like diet (based on whole grains, low fat dairy products, fish, fruit, and vegetables) or the Paleolithic diet (no grains or dairy but plenty of lean meat, fish, fruits, vegetables, root vegetables, eggs, and nuts) and those who undertook the Paleolithic diet were satisfied with less food. There was also a decrease in leptin in the Paleolithic group by 31% and by 18% in the Mediterranean group.

There have been other studies that show that people who go with this diet have improved laboratory values – less triglycerides, lower blood pressure, some weight loss, that the diet has a better glycemic index (the food doesn’t increase blood glucose levels as much). This diet compared to a standard diabetic diet did better. Those studies are short term, with small numbers of individuals, and hints of laboratory values.

So before one assumes I am putting this diet plan into the trash bit along with Ornish- there is clearly some data here that shows good nutritional sense in the food.

While highly processed carbohydrates transiently increases blood glucose levels more than whole grains – it does not mean that bread is bad for a person. At least we don’t know enough about this to state that today. Clearly, people who eat a lot of flour based products can get fat quickly, and getting off the bread and bakery products will help reduce weight, decrease hemoglobin A1C levels, decrease triglycerides, and overall be healthy.  Some people need to be told to never eat them again – as some alcoholics must never drink again- and some people are able to moderate them so they do minimal damage to the body.

Only a few studies have examined the effects of the Paleolithic diet on laboratory values that we associate as increased risk for disease – but again, those were laboratory values, not a long-term follow up for disease.

The premise for the Paleo diet may be flawed, but here are the parts of the Paleo diet that most would agree with:

(a) Highly processed grains – white flour, rolled oats- do cause a rapid increase in blood glucose levels and the body responds to that by increasing triglycerides and ultimately fat.
(b) Fish – as long as it is not contaminated with mercury, is a protein source that is high in Omega 3 fatty acids, which have been shown to be beneficial. If you have some great fish three or four meals a week it works out well.
(c) Vegetables and fruits are the basis for most diets- thus a vegetarian could participate in a Paleo diet easily. Too many people do not eat enough fruits or vegetables or look to them as snacks.
(d) The trend away from cattle feedlots and desire to have grass fed rather than grain fed beef. Grain fed beef is fatter and more prone to being infected with Salmonella or E.Coli than grass fed beef.  There is a wider variety of taste with grass fed beef, and most who find grass fed beef end up preferring its flavor. Grass fed beef is best cooked with Sous Vide cooking.
(e) If you eat more calories than you burn you will gain weight. But it is more than just calories – it is also the types of calories. Eating high glycemic index foods mean you will spike glucose pushing it into cells, where it will be quickly transformed and stored as fat. Low glycemic index foods will be slowly burned  - thus, calorie for calorie with the Paleo diet plan you will tend to burn the fuel from the food as opposed to store it.
(f) If you eat a majority of your food with highly processed grains instead of whole grains you will have a faster rise in blood sugar. Some attribute this rise to increased obesity and an increased load on the pancreas.

Overall- this is not a bad diet program. Nothing in it would appear to cause nutrient deficiencies and there is some preliminary evidence that this diet keeps a person more satisfied with less food. It is a low-carbohydrate diet, and those diets, in comparison to other diets, tend to produce faster and longer weigh loss.

Here are a few scientific references- I’m sure we will add more as time goes on

Low incidence of fatal coronary heart disease in Pima Indians despite high prevalence of non-insulin-dependent diabetes. RG Nelson, ML Sievers, WC Knowler, BA Swinburn, DJ Pettitt, MF Saad, IM Liebow, BV Howard, and PH Bennett
Circulation. 1990;81:987-995

Food for Thought: Dietary change was a driving force in human evolution. Wm R Leonard. Scientific American. December 2002: 107-114.

A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in inviduals with ischemic heart disease. Jonsson, et. Al. Nutrition & Metabolism 2010, 7:85

Thirty thousand-year-old evidence of plant food processing. A Revedin, et al Proc. Nat. Acad. Sci, November 2010: 107:18815-18819