Joseph Arcita, Before and After

This post is a meta-guide!

(That means it’s a guide to a guide).

This is Joseph Arcita: on the left is a “before” picture and on the right is “after”.  Click the pictures to read Joseph’s story.

Part of his story is his use of the ketogenic diet (KD) as his nutritional plan.  KD is something that interests me greatly: I am a frequent contributor to Mark Maunder’s Basic Ketogenic Diet blog and to two Facebook groups: The Ketogenic Diet Group (it’s a closed group, but you can ask to join), and Ketogenic Dieters, an open group with close to 500 members.

And I have blogged about this stuff before: On Ketogenic Diets back in December 2012, particularly looking at the reports of the effects of ketosis on cancer, and I also summarised and commented on some (203!) of the comments on Mark’s blog “203 Comments on Mark Maunder’s “Basic Ketogenic Diet” in February 2013.

On the FB groups people are often asking how to get started, and there is food advice there.  But today someone pointed me to Joseph Arcita’s “A Guide to Ketosis“.  It has to be one of the most comprehensive guides I’ve seen.  I hope he turns it into a book.

It is so comprehensive that you might like to know what’s in it: here’s the Table of Contents (copied and pasted from his site, so all of these links are clickable).  I have one or two minor points of contention (like there is no “good” and “bad” cholesterol; it’s all good, and you need it … but what he probably means is small-particle Low-Density-Lipoprotein) and I’ll discuss those at the end of this post.  But if you never get that far, don’t worry: the man is a hero!  Joseph says:

Here is the guide to ketosis. The contents of this article can be located here. If you’re currently wondering what on earth ketosis even is, then you’re in luck for I plan not only to befuddle but also to enlighten. All you have to do is read on.

I’ve personally had fantastic results on keto, and I really believe in the validity of this diet – not only in terms of fat-loss, but also in terms of health-gain. There is a lot of understandable skepticism and tons of misconceptions about keto; I want to let newcomers know, however surprising it may be, that keto (or at least a diet low in grains/sugars and high in fats) is a very healthy diet with numerous benefits.

This guide is very long so I’ve partitioned this post into subsections. The links contained within the contents are ‘clickable’ and will transport you directly to that section. You can also right click and select “copy link address” of a particular section/section title, and you can either bookmark it so that you can return to a specific section easily or you can give the link to a friend if you want them to read a particular section. If you want to return to the contents of the page simply click on the ‘upwards’ arrows that are next to each of the section titles within the main article.

I. Why You Should Care About Ketosis: The Benefits of a Ketogenic Diet
1A. Ketosis Increases Neuronal Stabilization and Mental Focus
1B. Ketosis Promotes the Loss of Body-Fat and LDL Cholesterol
1C. Ketosis Eliminates Various Ailments such as Type 2 Diabetes and Hypertension
1D. Ketosis Treats Several Diseases such as Alzheimer’s and Various Cancers
1E. Ketosis Promotes Cardiovascular Health
1F. Ketosis Preserves Lean-Body Mass
1G. One Will Lose Body-fat More Quickly on Keto Than Not
1H. Ketosis Blunts Appetite and Increases Meal Satiety

NOTE:  Unless you are of a VERY scientific frame of mind, SKIP SECTION TWO!!!

Summary: Metabolism is how your body gets energy.
Human bodies can do it a number of ways
You can “burn” glucose, or you can “burn” fat.
How this happens is pretty complicated: show it to you doctor; there’s probably an evens chance that he/she won’t understand it, either!
Quoting Joseph:

In other words, under a ketogenic metabolism, the body uses dietary and bodily fats as its primary energy source.

It is possible to induce the initiation of this metabolism thru a careful diet; this diet must contain limited amounts of carbohydrates, sugars, and proteins, and should be comprised primarily of fats.

II. Understanding Ketosis; An Overview of Metabolism 
2A. Metabolism Defined
2B. The Krebs Cycle
2C. Glycolysis
2D. Fat Lipolysis and Fatty Acid Beta-Oxidation
2E. Citrate Synthase Inhibition and Beta-ketothiolase Activation
2F. Ketogenesis and Ketosis

He refers to LBM=Lean Body Mass — what would be left if you lost all of your fat.  You never do want to lose all of your fat, but most of us could do with less fat and more lean.

He also refers to “energy deficit”.  In a nutshell: if you are big you won’t need to count calories at first, because a keto diet leaves you feeling full and you won’t eat so much.  But weight loss always does require consuming less calories than you use, so as you get close to your goal weight, or close to your goal for lean body mass, you may need to count calories.

III. The Basics of the Ketogenic Diet 
3A. Entering Ketosis: A Macro Ratio for Keto

PUFAs: summary: you will lose weight faster:

 if a majority of your fat percentage comes from things like seeds, nuts, oils, and fatty fish

It also says that there is NO science that says that butter is bad for you (you’ll see why if you get the science; otherwise skip to section 3C.)

3B. Saturated vs. Polyunsaturated Fatty Acids
3C. Sample Ketogenic Meal Plan
3D. The Wonders of Fiber
3E. How to Enter Ketosis Quickly, Easily, and Reliably
3F. How to Know You’re Under Ketosis
3G. The Gloom of Induction
3H. Losing Body-Fat
3I. Building Muscle-Mass

Summary: Don’t do intensive exercise once you’re in ketosis.  My own recommendation is Nordic Walking: http://www.WalkingForHappiness.co.uk

3J. Aerobic Exercise
3K. Glycogen Refeeding
3L. Reentering Glycolysis Correctly
3M. A list of Ketogenic Foods
3N. Step by Step Guide to the SKD, TKD, and CKD

IV. Keto Testimonials 
4A. ladysixstring
4B. Dominaterisk
4C. sepatown
4D. vgisverbose

V. Useful Resources and Websites for the Keto-Minded 
5A. The Cook’s Thesaurus
5B. Restaurant Nutrition Facts
5C. Keto Macro-Nutrient Calculator
5D. Keto Goods Online
5E. Keto Recipes Galore
5F. Further Information

VI. Keto FAQ 
6A. What is the ketogenic diet in simple terms?
6B. Is ketosis unhealthy?
6C. Is ketosis unnatural?
6D. How can you lose fat if you eat fat?
6E. Is it best to bulk on keto or on a normal diet?
6F. Are ketostix reliable?
6G. Please leave any questions in the comments.

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From Junk Food Science

In the low-carb, paleo, keto world, we’re always banging on about the advantages of eating bacon, but some people have concerns.

One set is about eating saturated fat.  Worry not: the “science” that says that saturated fat is bad for your arteries is wrong, but I’ll deal with that elsewhere.  Another concern is is with nitrates and nitrites: don’t they cause cancer?

Well, there seems to be some conflicting evidence, but here are some references that suggest not.  To summarise: bacon is preserved pork: nitrates are naturally occurring substances that have been used for centuries to turn belly pork into bacon.  Nitrates occur in the soil, and in many vegetables; in fact bacon that is advertised as “no added nitrates” is not really telling the truth: they use celery (sounds healthy) which is a good source of nitrates.

One of the posts below opens with this eye-catching question:

Which of these sources will give you the most ingested nitrites:

467 servings of hotdogs

1 serving arugula

2 servings butterhead lettuce

4 servings celery or beets

your spit

The answer is obvious … or is it?

You’ll have to do the reading to find the answer, but I think you’ll be surprised!

It’s a longer story than that, of course, and if you want chapter and verse (some people need to track down the research, and that is important), here are some starting points.

Facts About Sodium Nitrate and Sodium Nitrite
Good or Bad? Nitrates and Nitrites in Food
The content of nitrates and nitrites in fruits, vegetables and other foodstuffs
Nitrates In Vegetables Protect Against Gastric Ulcers, Study Shows
Does banning hotdogs and bacon make sense?
The “No Nitrites Added” Hoax
Toxicity of Sodium Nitrite (Wikipedia)
The Nitrate and Nitrite Myth: Another Reason not to Fear Bacon
“The fear of nitrates from bacon has no basis in reality”
NTP Technical report on the toxicology and carcinogenesis studies of Sodium Nitrite (11MB PDF)

(This list originally compiled by Roger D Enochs)

Roger posted a quote from the PDF:

Under the conditions of this 2-year drinking water study, there was no evidence of carcinogenic activity of sodium nitrite in male or female F344/N rats exposed to 750, 1,500, or 3,000 ppm. There was no evidence of carcinogenic activity of sodium nitrite in male B6C3F1 mice exposed to 750, 1,500, or 3,000 ppm. There was equivocal evidence of carcinogenic activity of sodium nitrite in female B6C3F1 mice based on the positive trend in the incidences of squamous cell papilloma or carcinoma (combined) of the forestomach.
Exposure to sodium nitrite in drinking water resulted in increased incidences of epithelial hyperplasia in the forestomach of male and female rats and in the glan- dular stomach of male mice.
Decreased incidences of mononuclear cell leukemia occurred in male and female rats.
Further, the USDA standard for for nitrate and nitrite levels in food[2] limits it to 200 ppm for nitrate and nitrite combined. We get much more dietary nitrate from vegetables than from cured meat, unless you eat a diet of primarily cured meat.
As established by the U.S. Department of Agriculture (USDA) in the Meat Inspection Regulations cited above, the use of nitrites, nitrates, or combinations of them cannot result in more than 200 parts per million (ppm), calculated as sodium nitrite, in the finished product.
It has been estimated that 10 percent of the human exposure to nitrite in the digestive tract comes from cured meats and 90 percent comes from vegetables and other sources. Nitrates can be reduced to nitrites by certain microorganisms present in foods and in the gastrointestinal tract. This has resulted in nitrite toxicity in infants fed vegetables with a high nitrate level. No evidence currently exists implicating nitrite itself as a carcinogen.
The 200 ppm level is well below the levels used in the above tests (750-5000 ppm), and even those high levels found no links to cancer (at least in rodents). Perhaps there are other health issues, but cancer is the one I always hear about, and the evidence does not appear to be there. A quick search didn’t turn up any research regarding nitrates and the liver.”

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There are those in the diet world who stick firmly to the “Calories In, Calories Out” (CICO) model, citing the “Law of Thermodynamics”.  This is a bit of a problem, and can be easily knocked over as an argument.  Firstly, there is no one “Law of Thermodynamics”.  If someone quotes that at you, ask them if they mean the zero-th, first, second or third law.  That will probably shut them up!  The thing is that we have been advised to eat less and exercise more to lose weight for the last 50-60 years and during that time obesity rates have soared around the world.  Clearly something is wrong.

There has been much work over the last decade to show that, in human nutrition terms, a calorie is not just a calorie, and I put myself firmly in that camp.  CICO leads to weight-loss advice that says either eat less, exercise more, or both.  This is over-simplistic, and if you want chapter and verse on how to demolish this argument, read Gary Taubes’ books.  ”Why We Get Fat” is the easy book: Good Calories, Bad Calories” (Known as “The Diet Delusion” in the UK) is the “big book” (if exercise is all you need, you could lose weight simply by carrying GCBC around with you!)

But while I am a total fan of Gary, and feel that his books have changed my life, the good old calorie can still tell us a few things:  it can show you just how easy it can be to become malnourished when you’re on a diet.

For instance, the “average” person needs around 2000 calories a day to maintain normal life.  This, of course, varies a lot.  According to the math I would need 3050 calories a day to maintain my current size, and my wife would need 1755 (she’s younger, much smaller, and more active than me).  You can see that it’s quite a range.

We know that body fat is a highly-effective energy storage medium: one pound (.45kg) of fat contains 3500 calories.  So if we just go with the basic idea of “eat less”, if we want to lose 1lb a week we need to consume 3500 calories less per week, or 3500/7=500 calories less per day.  For Susan that would mean reducing her daily calorie intake by 28%, for me I’d need to reduce by 16%.

That’s all very well, but our food is not just an energy supply.  In addition we need micro-nutrients and, although as their names implies we don’t need much of them, when we don’t have enough the results can be horrendous.  For instance, a severe deficiency of vitamin C causes a disease called scurvy, where your teeth fall out, you get suppurating sores and you get severely depressed (well, you would, wouldn’t you?)

Beri Beri victim

Pellagra sufferer

Beri beri, a disease caused by a lack of thiamin (vitamin B1) caused extreme lethargy and even death.  And pellagra, caused by a deficiency of vitamin B3 (niacin) affected more than three million people in the American south, killing 100,000 of them in the early part of the 20th century.

I got quite a shock, researching this.

I am from the UK but my wife is American and her father was a southerner.  When she grew up she was accustomed to eating grits (from the same stem as English “groats”) and still enjoys grits when we go out to breakfast if we are in the Southern states.  I have always laughed: to me grits looks like wallpaper paste, tastes not much better, and I imagined it to be completely devoid of nutrition, because grits is made from corn kernels, dried and soaked in lime (that’s the chemical, not the juice of the fruit!)  But apparently, the key nutrient in corn (maize), niacin, is biologically unavailable (it’s locked up).  However, if you treat the maize with lime it makes the niacin nutritionally available.  Traditionally, new world cultivators of maize knew this (how?!) since 1500BC and didn’t suffer from pellagra, but when maize started being shipped around the world, people who adopted it without knowing about this process of  nixtamalization developed diseases of malnutrition.

Now you may think that these were all diseases of the past, and that we no longer need to worry, but here’s the interesting (and worrying) thing … these are diseases of extreme malnutrition, but malnutrition happens on a sliding scale.  If you are bit short of micro-nutrients you might not suffer from anything as bad as pellagra, beri beri or scurvy, but your health will be negatively affected.

Various governments publish “Recommended Daily Allowances” (known by various names depending on the government and the day of the week) for various nutrients.  But these amounts are the amount that, if everyone in the population had that much, around 50% of them wouldn’t get ill.  How much you need, not just to avoid malnutrition, but to be in optimum health, is probably much more than the RDA, or whatever your country calls it.

So, if you are aiming to lose one pound a week on your diet, and you do it by reducing what you eat by between 15% and 30%, you’re reducing your micro-nutrients by that amount, too.

Scary, isn’t it?

Before dieting you were probably malnourished to some degree; now you’re dieting it’s got worse.  We have all heard of pregnant women getting cravings–that’s because the baby is using up the mother’s micro-nutrients.  The craving is the body’s drive to get the mother to correct the deficiency.

Irradiated food symbol

But, if we’re eating a “normal” diet, are we getting all the nutrition we need?  No.  In the Standard American Diet (SAD), which (obviously, by definition) most Americans, and large numbers of people in the rest of the world eat, our food is deficient in these micro nutrients, for a variety of reasons:

• The soil is worn out: we keep cropping, but don’t replace what we take out
• The time from field to fork gets longer: vitamins start to decay once a plant is picked.  In America the average distance travelled from field to fork is around 1500 miles.  And if you think it’s better in Europe, just remember that most of your “fresh” vegetables and salad stuff comes from southern Spain.  A tomato grown in a greenhouse in Malaga will have done over 1500 miles by the time it gets to a supermarket in Birmingham.
• Vegetables, nowadays, are picked before they are ripe, so that they will last longer on supermarket shelves.
• Food is irradiated, destroying its DNA.
• A lot of food is so processed that it has few, if any, micro-nutrients: what we call “junk food”.

So, we are already eating a diet that is low on nutrition, and then we eat 15-30% less of it.  Less of a bad diet is a worse diet, not better.  No wonder we have cravings and get hungry.

What are we to do?

Well, I already knew a lot of this information about nutrition, but it wasn’t at the top of my consciousness until I read Naked Calories and Rich Food, Poor Food by Jason and Mira Calton. Time for a declaration of interest.  Currently I have no commercial relationship with the Caltons at all.  But I am so impressed with the books, and with their supplement, that I am hopeful that I may be able to import it into the UK.  I’ll alter this sentence if and when that happens!

By now you will understand the title of this post.  If most of the food we eat is just “naked calories”, how can we make sure that our calories are well-dressed?  The art and science of making sure that you have enough micro-nutrients is complex (one of the things I like about the Calton’s supplements is that they have made it very easy), but there are some things that we can do straight away.

Looking at the list of problems above, you can see that eating your five a day will help, especially if they come from a local, organic farm.  When we live in Florida we buy as much as we can from Lake Meadow Naturals (about 10 miles from where we live) and in the UK we use Sunnyfields Farm and Beechcroft Farm, both, I was surprised to find, exactly 9 miles away from where we live, but in opposite directions!

Next, don’t keep stuff too long.  Buying it fresh, organic and local is all very well, but if it sits in the veg drawer in the fridge until it’s floppy and unpleasant, you might have done better to buy canned or frozen!

Lastly, for now, aim for the most nutrient-dense foods that you can find.  I will be helping with that by posting about various foods.  For now, check out my recent blog post “Which Avocados are best for Paleo/Primal?”

And educate yourself.  For starters, read the Calton’s books, and click the various links on this page.  And watch out for the next posts in this series.

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Haas or Fuerte Avocado

REALLY dark Haas

This is the first of a series of post that I will be doing which are more about micro-nutrients than continuing to push the macro-nutrient wars (HFLC vs LFHC).

There doesn’t seem to be much warring going on in the area of micro-nutrients, and I think it’s vital that all of us who care about our health to understand the importance of nutrition, as opposed to just where do the calories come from. Anyway, much more of that in the future, but for now I am hunting down foods that are nutrient dense and which fit right in with eating well (whether you’re eating paleo or trying to stick to the “official” food pyramid).

And my food of choice today is the avocado, which is healthy in more ways than several!  In particular, you should be eating avocado with your salads and veggies! Why?  Because a lot vitamins and antioxidants in your veg are fat-soluble.  That means, if there’s no fat in your diet those vital nutrients go in your mouth and straight out the other end, without touching the sides!  But if you have some slices of avocado in the same meal, you not only get all the incredible nutrients in the avocado, but the heart-healthy fats in the avocado (similar to those in olive oil) will carry the nutrients from the salad or veggies into your system, where they can be used.

Florida Avocado

But there are two main types of avocado (well, actually there are loads … for a complete rundown check out this post from Food Republic: “Know Your Avocado Varieties And When They’re In Season“).  The two main types that people know about are the larger, smooth-skinned “Florida” (picture courtesy of The Witchy Kitchen) and the smaller, dark and bumpy-skinned Haas or “California” avocado (what we buy looks more like the picture up right).

But which is better?

Well, each has their fans, Floridians saying that the California is oily, Californians saying that the Florida is watery.  As I live part of every year in Florida I set out hopefully to show that the Florida avocado is more nutritious, but I’m afraid I bombed on my mission.  Using the USDA Nutritional database, the Haas scores higher on just about every nutrient:

You can see from the numbers that  those who describe Florida avocados as watery are right (their water content is higher) and those who describe Haas as “oily” are also right: their fat content is 50% higher!

So, if all you care about is low fat and low calorie, you will choose the Florida avocado (but, be aware these figures are “per 100 grams”.  A Florida avocado is much bigger than a Haas, so you will probably end up with more calories anyway).  And notice that the Florida might be lower in calories, but it is much higher in sugars, so if carbs are your concern, rather than calories, you will choose the Haas every time.

And if you want those good, heart-healthy fats to help carry all the vitamins and minerals to where they can be used, Haas scores again, as well as the significantly higher amounts of vitamins and minerals.  So, sorry Florida!  I wish I could be promoting my home state.  Maybe some Florida farmers can start producing Haas; here’s someone whose granny has grown a Haas tree in Florida.

Personally, I turn most of my avocados into guacamole, add some of my special high-fat home-made mayo, and often add some other nutrient dense favourites.  My current batch of guac is a slightly strange colour because I added turmeric!  Tastes OK though, and turmeric is a master spice.  More on that later.

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I recently published a post called “How Do We Know What We Know“?  I think it’s important that we think about how we come by the knowledge that we use to manage our lives.

Some people believe what they are told; “I read it in the newspapers”, “I saw it on TV”, “It must be true”.

Some people believe what they are told by authorities: their doctor, religious leader, etc.  Some people work off of a gut feeling, and some trust scientists.

But what is science?

What it isn’t is a bunch of (mostly) men in white coats with clip boards peering into microscopes and test tubes.

Science is a process of coming to know: of justifying a belief.

Beside me as I write I have what Brits call a torch and Americans call a flashlight. It doesn’t work and I want to know why.  My guess is that the battery is flat, so I take out the old battery, shove in a new one from my drawer, and the torch lights up.  That, in a nutshell, is the whole scientific process.

In science we start with a problem (torch doesn’t work); we form an hypothesis as to what the cause of the problem is (formally, according to Wikipedia, an hypothesis is a “proposed explanation for a phenomenon”.  Or a guess as to what is causing the problem).  We then design an experiment to test the hypothesis (hypothesis is that the battery is flat; experiment is to replace old battery with a new one.  If the torch then works we will declare that our hypothesis was the correct one).

There are a few problems with this experiment.  What if the problem wasn’t a flat battery, but a loose connection, and that taking one battery out and putting another back (or even the same one back) restored the connection?  Then we would have a “false positive”.  And we’d probably chuck away a perfectly good battery (and the torch would probably fail again next time it was shaken, and we might decide it was going through batteries too fast and chuck the torch out as well as the batteries.)

So to make the scientific process a bit more likely to produce good and useful knowledge, we come up with a whole set of hypotheses, and try to design experiments to test all of them.  For instance, hypotheses for our non-functioning torch might be:

1. Flat battery
2. Dead bulb
3. Loose connection
4. Alien invaders have stopped electricity working on earth.
5. etc.

If we have an electric meter or tester we can use it to measure a brand new battery, straight out of its packet.  If that works then we know that the tester is working, and we can also rule out hypothesis number 4.  We can then use the tester on the battery.  We may need to test the battery and the bulb, and the connections, because the problem might be 1, 2, or 3, or any combination of the three variables (or four variables if we haven’t yet ruled out the alien invasion).

I’m sure that I am labouring the point, and that you get it by now.  But you may also be getting a sense that, to an outsider, science looks glamorous while actually it involves a lot of care and pains-taking step-by-step rigour.

In the science of nutrition, as in all other science, when we do experiments we need to “control” for all the variables.  If we think that eating chocolate is what is making someone fat we could take two groups of people, feed one group chocolate and the other not, and measure them.  But to be absolutely sure the problem is the chocolate, the two groups must eat exactly the same apart from the chocolate.  And exercise the same, and sleep the same, and drink the same, and live at the same altitude (I’ve just got back from a week in the rocky mountains: you’d be amazed at the difference it can have on you; even how often you need to wee!)

So, anyway, that’s what science is: it’s just a way of thinking about solving problems, of producing knowledge.

But here’s an interesting thing: it’s the science of finding things that will make people well.  On the face of it, if you developed a pill that stopped people getting smelly feet you might think you’d get a large group of people who have smelly feet, divide them into two groups, give one group the pill, the other group no pill, and see how smelly the feet were of the two groups.

But that’s not what pill researchers do.

They make a second pill that looks exactly the same as the first pill, but which does absolutely nothing.  It’s probably just made of chalk.  And no one knows which pill is which (except the people designing the research).  In particular, neither the folks taking the pills know which is which, nor do the folks handing out the pills.  This is called a “double-blind” trial and it is to prevent the outcome being influenced by the placebo effect and researcher bias.  The placebo effect is when people who are given the “sham” pill, but who believe it to be real, get better anyway.

Very many scientists tend to dismiss all sorts of things that are outside their paradigm as “just the placebo effect”.  But hang on … are you telling us that just because people believe they are getting treated, they actually get better?

Yup.

There’s even placebo surgery.  People with a knee problem were anesthetized, the surgeon made an incision, then just sewed it up without doing anything, and people got better!

So what do they mean by “just” the placebo effect?  This is amazing!  While many scientists sniff at the placebo effect, they clearly recognise that it exists, or they wouldn’t have designed the blind trial.

But just a minute here.  That’s why they designed the blind trial.  But what about the double blind trial?

Well, that’s because they also recognise that what the experimenter believes can also effect the outcome of the trial.  Hmm.  Weirder and weirder, don’t you think?  Obviously, of course, you can’t have double-blind knee surgery, but still …

So, we have our sweet-feet pill, and we design a double blind trial.  You’d think, if the pill worked, one group would have sweet feet and the other group smelly feet.  No: doesn’t work like that.  What we are looking for is for a “statistically significant” number of the sweet-feet group to see some improvement.  You never, ever get 100% cured with the real pill and 100% not cured with the placebo.

Never.

Here’s a fun one; some researchers wanted to test out the claims of some herbalists that the herb ginkgo biloba can help with sexual problems.  They found that it didn’t.  But they didn’t find that no-one got better, they found that equal numbers of people got better in both groups!

The aim of this study was to examine the effect of Ginkgo biloba on antidepressant-induced sexual dysfunction. The Ginkgo biloba (n=19) and the placebo groups (n=18) were divided; each to be administered with Ginkgo biloba and placebo respectively for 2 months by means of a randomized placebo-controlled, double-blind study. The results of this 2 month trial were: (1) there was no statistical significant difference from the placebo at weeks 2, 4 and 8 after medication; (2) in comparison with baseline, both the Ginkgo biloba group and the placebo group showed improvement in some part of the sexual function, which is suggestive of the importance of the placebo effect in assessing sexual function.

A placebo-controlled, double-blind trial of Ginkgo biloba for antidepressant-induced sexual dysfunction

Last point before I get to why I am telling you all of this.

Some people suddenly realised that, because all drug trials are done using double-blind trials with placebos, there was an awful lot of clinical trial data about placebos.  If you analyse it, you see that some people are “placebo responders”: pretty much they will get better whatever you give them, whether it’s the drug or a chalk pill.  And then there are the placebo non-responders.  They won’t get well whatever you give them.  I bet you are already thinking of a few grumpy people that you know for whom nothing ever works.  And a few Pollyanna types for whom everything is always wonderful.  If you’re a placebo-non-responder you probably spend your life wanting to slap some sense into the Pollyannas of this world.

If you find this stuff fascinating and want to know, this may be the place to start: What Is the Placebo Effect? By Kendra Cherry, About.com Guide.

Diets

Well, it’s taken me long enough to get to the point, but here it is.  I would be willing to bet that, for every diet, nutrition plan, weight-loss pill that’s ever been invented, however crazy, there is at least one person for whom it was a miracle cure and changed their life.

And for every serious, perfectly researched, based-on-pure-science-and-nutrition, life-style change that’s ever been invented, there are a whole host of people who got fat and sick and died a horrible death using it (well no, probably not that bad, but you get my point).

All of this is because, in my next post, I am going to try to create a map of the dieting, weight-loss, lifestyle territory, and I want you to understand that, while I may sneer at some things, and exalt others, I just know that there are people for whom the silver-bullet capsules filled with floor sweepings worked like a dream, and I’m sure that there are people who have eaten a Big Mac, fries and a full-fat Coke with extra sugar every day of their lives and went on to win Olympic Gold in the Ultra-Marathon.

But I’m also willing to bet that neither of those people are you!

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This is a bit of a long post, but it’s important!  It’s part of a series where I hope to help you to find out how to make decisions about life!  Big aim!  In this post we will discuss knowledge, epistemology, paradigms, statistics, and how journalists, marketeers and others try to pull the wool over our eyes.  Here we go …

When I began this post it was a chapter for my book; the chapter was called “Back to School”.  But I was worried about the chapter title: I hated school and if I saw a chapter called “Back to School” in a book it might have put me off. I suppose if you’re still reading then it hasn’t put you off!

I hope not, because this information is important (and I’ll do my best to make it unlike my experience of school). But here’s the problem: there is an awful lot of information out there about diet and nutrition. Some of it is useful, some of it is downright wrong. Some is misleading. Some is relevant to some of the people, some of the time and not relevant to others. How on earth are you going to be able to make up your mind what to do? How are we going to find out the knowledge we need, and differentiate it from knowledge that’s unhelpful?

To make matters worse I believe that there are a lot of people that we might think we can trust to have the knowledge we need: dietitians  doctors and the like. It turns out that many of them don’t really know either! My evidence for that is simply that if you start reading you will find that there are doctors out there who violently disagree with one another. They can’t all be right, so some of them must be wrong! But each believes that they know what they are talking about. In order to be able to begin to unravel this mess, we need to spend a little time thinking about how we know what we know (and, hence, how other people, like the doctors and nutritionists, know what they know).

What I am aiming to do in this post is to give you the knowledge that you need to be able to make up your own mind about what seems right for you and how you might judge who to believe and who not to believe.

This subject (how do you “know what you know”) is called epistemology (eh-piss-tem-ology) and is a key part of philosophy.  It may all seem terribly esoteric and too complicated to worry about.  But have you ever been in the position of being absolutely convinced that you were right about something, and then discovering that you were wrong?

The philosophers talk about knowledge being “justified belief”, and it is this question of “justification” that is the key.  You thought that you were justified in believing something, but it turned out that you weren’t.  If I were to tell you that I am a “young earth creationist” and I believe in the absolute truth of every word in the Bible, then, depending on your beliefs, you’ll either believe everything I say, or write me off as a nutter and disbelieve everything I say.  On the other hand, if I tell you that I have a PhD in applied physics and that I am a convinced atheist, then a different set of people will believe me or reject what I have to say.

This is because different people have different ways of justifying their beliefs; of having faith in what they know.  What I want to do here is to show some of the tricks of the trade, so that you are better able to work out whether the knowledge that people offer you is a justifiable belief, or not.

Just so you know, I am not an atheist, nor even an agnostic.  I have both philosophical and scientific training.  I am not a “young earth creationist”, and I believe that you can find nutters with unjustifiable beliefs in just about every school of thought out there!  I try to avoid calling them out in public: it won’t change their minds and it just makes enemies.

While we’re on the subject of jargon, I want to introduce another word that may be new, “paradigm” (para-dime).  The word has been around for centuries but was used in the last century by Thomas Kuhn to talk about what he called “scientific revolutions”.  A paradigm is a whole set of beliefs that all seem to support one another, until you get a “prevailing world view” that seems, to almost everyone” to be “true”.  One example was the paradigm about the earth as the center of the universe, with the sun going round it.  When Galileo called that idea into question it almost got him killed.

It is in the nature of “scientific paradigms” that we have a whole set of beliefs that all seem to hang together, except, maybe, for one or two minor, irritating bits of data that don’t fit.  Most people say that the observations that produced those irritating bits of data were just wrong.  But eventually more and more bits of irritating data turn up, until someone has a sudden insight, and a whole new idea (or paradigm) is born.  If you had a scientific education that included a bit of science history, you may have come across the “phlogiston” theory, or the theory of the “ether“.  One with which we struggle now, that is relevant to our concerns, is the theory that dietary fat is bad for you and that we should all be eating “healthy carbs”.  To many people this isn’t a “belief”, or a theory or a paradigm, it is the TRUTH!

The irritating bit of data is that, despite pushing this advice for 50 years, we are all getting more and more obese, there is an increase in diseases of inflammation, and auto-immune disease are also increasing at an alarming rate.

Liz Lipski, PhD, CCN, CHN

This “inconvenient data” is dismissed in various ways by those committed to the old paradigm, as are the “unscientific people” who are looking for alternative theories that embrace and acknowledge these facts.  I think I may be revealing my personal biases here.  And although no-one has been burned at the stake for saying that dietary fat isn’t bad for you, there have been incredibly intelligent, knowledgeable and high-qualified people who have been pilloried by the establishment for being heretics.  One example is Liz Lipski, PhD, CCN, CHN, a highly-qualified nutritionist in North Carolina, USA, who has been denied the right to practice, despite having 30 year’s experience in the field.  Passions are raised!  Check out her story on the web page set up to try to defend her.  By the way, back in primitive times people could be killed for their beliefs, or, slightly less extreme, they could be exiled.  Of course, that wouldn’t happen today, would it?  Well, Liz Lipski used to live and work on North Carolina.  Now she’s based in Maryland.  I wonder if the reactionaries will follow her there?

Arthur Fry, inventor of the Post-it note, with one on his forehead with a picture of a light bulb. Wikipedia Collective Commons

Over 30 years ago I learned something called “co-counselling” (it’s what’s behind “Together We Can”). I can still remember the first Saturday morning that I sat in a co-counselling seminar in someone’s living room in a house in Esher, Surrey. One of the seminar leaders said, “In co-counselling it’s the client who is in charge”: I had one of those bolts of insight: a “road to Damascus experience” (or a “light-bulb” moment, or an epiphany). I suddenly realized that, up to then, if I had gone to see a doctor, or a counsellor, or any other person whose profession it was to help me in some way, my attitude was slightly aggressive and along the lines of “well, you’re the professional; fix me”. You see it in medical dramas on the TV. The poor long-suffering doctor, being very polite, says to the patient, “what seems to be the problem?” and the pugnacious patient responds, “well, you’re the doctor; aren’t you supposed to know that?” and we, the TV audience, wonder how the doctor manages not to slap the patient round the head. I realised that, in the past, I had been lucky not to have been slapped by my doctor!

Ever since my light-bulb moment in that seminar I have changed. Now, when I go to the doctor my attitude is: you’re the doctor and you have studied illness and health and you know a lot, but maybe not everything. I’m a reasonably intelligent person, and I know a lot about me. Here are my symptoms or worries; I’d appreciate hearing your opinion. And having heard that opinion I may, or may not, decide to take the offered advice or the offered medication.

From time to time I get gout. My favourite ever doctor, Dr Halfpenny, counselled me to take allopurinol, the most popular drug for gout. My uncle was one of the first people ever to be put on allopurinol and he swore by it. But it’s something you take every day, and I didn’t want that.  I discovered I had gout many years ago when I slipped in the foot bath at a public swimming pool and stubbed my toe very painfully. The hospital thought I’d fractured it and put me in plaster (from the ball of my foot to my knee, when the pain was in my big toe!) By the following week my whole leg was inflamed and I went back to the hospital. A doctor looked at it and said, “I know what that is: it’s gout!” and I said thank you and left the hospital before anything else could be said.

When I got home I spent ages reading books and articles on the internet and found that there were a number of recommendations for eating cherries to cure gout. It seemed weird, but worth a try. All I can say is that it works (for me, and for many others). That was maybe 20 years ago: since then there has been a lot more recognition that cherries work for gout, and Montmorency (tart) cherries best of all. You can even get cherry capsules from health stores. If you ever get gout, try it. For me it works like a miracle. My worst ever attack was in January 2010. It was so bad I was contemplating asking for a wheelchair (we were in Fort Lauderdale, about to board a cruise liner). Susan hiked off into the local shopping mall and came back with cherry juice, fresh cherries, and cherry powder capsules. Two days later I was Nordic Walking up the highest hill on Sint Maarten with not a twinge of pain.

I said that, in this chapter, I want to give you the information you need to make up your own mind about the diet you will follow. That’s not just information about “this food does this and that food does that”. The most important information that I can pass on is about how to judge information that you are offered (including mine!) You will find diet and nutritional information everywhere. How can you judge which may have something important to say, and which not is the question here.

For an example of the “who do you believe” stuff on the internet, here’s an example of a hyper-intelligent person saying that the “cherries cure gout” thing is just gullible fools being taken in by snake-oil salesmen.

The blog post is called “Thinking is Dangerous“.  His thesis is that there has been little serious scientific research done on the effect of eating cherries on helping with gout.  True.  However, there are countless people out there who have tried it and who swear by it.  They, of course, being “unthinking non-scientists” don’t count.  But for most people, eating a bowl of cherries isn’t going to do any harm, and if it relieves the pain of gout (which is really bad) then it has to be worth a try. He sums up:

You can see for yourself that the evidence is weak to non-existent. Of course, that doesn’t mean the evidence won’t be there in the future, the point is they don’t need it. They have people willing to be duped in to believing it works (placebo-effect alone), with the press as their willing conduits – it seems churlish not to put yet another fawning, uncritical Daily Mail link in time-honoured fashion, so here it is, from Sept 2008.

Oh, by the way, this blogger publishes neither his name nor his picture.

All we know about him is that he says that he’s from the UK and works in manufacturing.  He believes that who he is, is irrelevant to whether the knowledge (or opinions) he shares are relevant.  That’s up to you to judge.

So. I maintain that eating cherries is good for curing gout on the basis that it has worked for me over many years and I have heard the same from many other people.  Is that serious scientific research?  No.  So if your only basis for a justified belief is serious scientific research, you won’t accept that from me.  On the other hand, you might decide to check out this assertion by looking it up on the Internet. If you Google “cherries gout arthritis” you will find that the US Food and Drug Administration (FDA) are threatening manufacturers and cherry growers with legal action unless they stop “making unsubstantiated claims that cherries and other fruits can help with arthritis”. On the other hand, the US Department of Agriculture (USDA) has run research that shows that sweet Bing cherries can help arthritis and gout (gout is a form of arthritis) . I am delighted by the USDA research because it confirms my experience (you could say that it confirms my prejudices) when I was very irritated by the FDA.  At the bottom of that USDA internet article it does say:

The grower-sponsored California Cherry Advisory Board helped fund the research.

My reaction is “well, good for them; helping to find simple solutions for people suffering from painful conditions”. On the other hand, if the Tobacco Growers Association sponsored research that showed that smoking 10 cigarettes a day lowered the risk of getting gout I would be spitting fire and pouring scorn on the research. So now you know even more of my biases!

But I digress. How can you find advice about diet that works for you? Firstly I want to teach you about some tricks that advertisers and newspapers do … and even people who want to push their particular diet plan. I came across it this morning when I took the top off a tub of miso soup paste and inside there was a circle of paper that says, “Miso Soup Consumption linked with up to 50% Reduced Risk of Breast Cancer*”. In very small print round the bottom of the circle of paper it says, “*As reported in the journal of the National Cancer Institute, Vol. 95, Issue 12”.

The first thing you need to notice here is the word “linked”. This is a “warning word” and it warns you that this was an “epidemiological study”. Sorry about the long word: “epi-deemy-o-logical” is how you pronounce it and it means (from the Greek) “outside the skin”. In other words this research didn’t look at what was going on inside the women who did (or didn’t) consume miso soup. It was merely (note my use of an emotive word there, “merely”) a statistical exercise. They counted women who drank miso soup (and those who didn’t) and they counted the women who got breast cancer and those that didn’t, and they did statistics on the numbers to see if they could find a connection. They didn’t look at the chemistry of miso soup or the biochemistry of breast cancer; it was all numbers “outside the body”.

Let me give you an example. Let’s suppose that we find two women. One of them absolutely loves miso soup, believes it’s good for her, and drinks a bowl almost every day. The other woman hates it, neither knows nor cares whether it has any health-giving properties and wouldn’t touch the stuff if you paid her. We follow these women through their lives and eventually the woman who hates miso soup gets breast cancer and, sadly, dies. The other woman lives to be 103 and on her 103rd birthday when all the journalists are interviewing her and asking her how she got to be so old she says that she puts it all down to drinking miso soup. The miso soup manufacturers are over the moon with excitement and put her picture on all their packets and sales of miso soup soar.

What isn’t mentioned in this story is that the woman who died has a family history of breast cancer: her mother and sister both died of it and she worked in a nuclear power station handling nuclear fuel rods. The woman who lived to be 103 lives on a remote island in the Pacific where the air is clean, the water pure and most people live to be 120 without drinking miso soup. Now we see that drinking or not drinking miso soup may have nothing whatever to do with the one woman dying young and the other living to be a grand old age.

Now, let me go look up that study. You can see the summary for yourself . Basically the study looked at nearly 22,000 Japanese women aged 40-59. They got them to fill out “self-administered” questionnaires (that means the women took the piece of paper home and filled it out themselves: not the most reliable way of getting data) and the researchers looked for a statistical relationship between women who said they drank miso soup and women who got breast cancer and the researchers found an “inverse relationship” (meaning the soup drinkers were less likely to get breast cancer). So far so good. Anyone for a bowl of soup?

Next we need to look at that “50%”. Looks impressive, doesn’t it? But what was the risk of getting breast cancer anyway? If, as a Japanese woman between the ages of 40-59, there is a 90% risk of getting cancer and you can cut that down to 45% by drinking miso soup, then it looks like a no-brainer, doesn’t it? Swig it down! But what if the risk of getting breast cancer was only 1%? Reducing your risk from 1% to half a per cent doesn’t sound like much, does it? And when you read the paper further it says that the effect is greater in post-menopausal women. Now you have to judge where you are (I guess you’ll know whether you are post-menopausal or not!) The paper does say that they corrected for various things:

Results: Consumption of miso soup and isoflavones, but not of soyfoods, was inversely associated with the risk of breast cancer. The associations did not change substantially after adjustment for potential confounders, including reproductive history, family history, smoking, and other dietary factors.

(Oh, by the way, of the 21,852 women that they studied between 1990 and 1999, 179 got breast cancer, which works out at about 0.8%. So maybe that label should say “drinking miso soup could reduce your absolute risk of getting breast cancer from 0.8% to 0.4% if you’re a Japanese, post-menopausal woman between the ages of 40-59”. But that’s not so snappy, is it?)  Please note: I am not decrying miso soup.  I am not saying that the manufacturers are lying.  But when you delve into the research a little, you discover that it isn’t quite as exciting as you may have imagined.  And if breast cancer is a concern, there may be other, more effective things you can do to mitigate your risk.

There are a few other bits and pieces I want to mention here. Firstly, the word “confounders”. An epidemiological study looks for “correlations” but it does not indicate causality. Just because the women drinking the soup didn’t get so much cancer doesn’t mean that it was the soup that saved them.  For instance, let’s say that it is widely believed in Japan that miso soup is good for you (I don’t know whether that’s true, but stay with me here). Then we might guess that the women who drink miso soup are the sort of women who take good care of themselves and are careful about what they eat. That might be the real reason for the reduction in cancer risk. Maybe (again, I don’t know) miso soup is very expensive. Maybe only rich people who generally eat better-quality food are the ones who drink miso soup. Maybe miso soup is much easier to get hold of in quiet, rural communities. All these possibilities that I am raising are what are called “confounders”. Because the very nature of this sort of research is that the researchers are looking for correlations such as “people who drink miso soup get less cancer”. But we must not get fooled that we have found causation: we haven’t discovered that people get less cancer because they eat miso soup.

But this is what the advertisers and newspapers do. They bamboozle us into thinking that correlation is causation. It isn’t. The researchers above say that they have adjusted their results to take into consideration such confounders as “reproductive history, family history, smoking, and other dietary factors”. Good. But what about just plain coincidence? After all, a reduction from 0.8% to 0.4% isn’t exactly massive, is it?

So, what would I do if I was a woman and concerned for my health? On the basis of what I have learned here I think I might drink the odd bowl of miso soup. How many I might drink I don’t know—the research doesn’t mention that!  It would probably depend on how much I enjoyed it.  (Actually, the nutritional guidelines I currently follow are a bit anti-soy, so I would probably go and do some more research f my own.)

Stanley Young: Assistant Director for Bioinformatics, NISS

If this stuff fascinates you, I have found a wonderful (but pretty difficult unless you’re a university-level statistician) presentation that compares the paradigms of epidemiologists (who use a lots of statistics) and of statisticians (who also use a lot of statistics, but don’t always approve of the way non-statisticians use them).  It is called “Everything is Dangerous: A Controversy” and says:

The basic thesis is quite simple. Epidemiologists have as their statistical analysis/scientific method paradigm not to correct for any multiple testing. Also, as part of their scientific paradigm they ask multiple, often hundreds to thousands, of questions of the same data set. Their position is that it is better to miss nothing real than to control the number of false claims they make. The Statisticians’ paradigm is to control the probability of making a false claim. We have a clash of paradigms.

This paper is by S Stanley Young of the National Institute of Statistical Sciences.  He is the Assistant Director of Bioinformatics.  You can read everything (relevant) about him on his webpage.  No hiding for Dr Young: go read his CV; certainly impresses the heck out of me!

We have looked at one sort of research: epidemiological research. What other sorts are there? Epidemiological research is “outside the body”. If you go and read that article about cherries, those researchers were looking inside. They took blood samples. They knew the sort of chemicals in the blood stream that cause, or are indicators of, gout. They then fed the women in the study cherries and took more blood samples. Here we are seeing more directly that the cherries appear to be reducing the chemicals in the blood that cause gout. However, here’s a big difference between an epidemiological study and a study of this kind. The miso soup researchers monitored nearly 22,000 women for 10 years. The cherry researchers worked with 10 women for a week.

Nutrition research on human beings is really difficult. Just to go back to the miso soup research: the researchers got their data by asking the women to fill out self-administered questionnaires. We have no idea how accurate the women were, or whether they lied. There is a tendency for people to report what they think you want to hear.

A major problem in self reported dietary studies is people who under-report their true habitual food intake, or change their diet, during the period of the survey.
The problem of accuracy in dietary surveys. Analysis of the over 65 UK National Diet and Nutrition Survey, Adrian Cook, Jane Pryer, Prakash Shetty, J Epidemiol Community Health 2000;54:611-616 doi:10.1136/jech.54.8.611

Maybe the women over-reported. Maybe they just lied. Who knows? And the research was done over 10 years. Maybe some of the women had been drinking miso soup all their lives and others took it up once they were in the study. Maybe they’d never thought about it before, but the study may have made them think about it. Maybe the long-term drinkers drank a bowl a week, but the newcomers decided to drink a bowl a day to catch up. And what about cultural differences? Are Japanese women more or less likely to follow instructions than, say, American men (I’m sure that we all have opinions about this: but has anyone done the scientific research?!)

To do really hard scientific research on nutrition you need a population that you can really control and where you can measure just about everything. You probably need them in cages where can you measure to the nearest gram exactly what they eat and where you can operate on them to see what’s going on under the skin. And in any even remotely decent society that isn’t going to be possible with humans. Which leaves us wondering how relevant it is that rats fed on this or that diet, contracting, or not, this or that disease, has any relevance to us.

There is some famous research, about which really violent arguments rage on the internet, where rats were infected with a toxin often found in food that is “off”: aflatoxin. These rats were then divided into two groups and one was fed a diet that had 20% of an animal-derived protein called casein and the other group was fed a 5% casein diet. The 20% group got more cancer than the 5% group. The researchers are dedicated vegetarians and they say, “Look, a diet with higher levels of animal protein causes cancer”. The meat-eating researchers looked deeper into the results and said, “yes, the 20% rats got more cancer. That’s because the 5% rats died of a protein deficiency before they had the chance to get cancer”.  (If you like watching fights, you’ll love this: it’s an almost religious war!)

And then there’s bias. This may come as a shock, but scientists are human beings. They have axes to grind, they have masters to please. In order to do research a scientist needs money: he has to pay his own and his family’s food bills, pay the rent, put fuel in the car. Someone needs to pay for the research. If Bill and Melinda Gates, determined to do good in the world, put up the money from their foundation to pay for the miso soup research that’s one thing. But, be honest, if it turns out that the miso soup research was paid for by a consortium made up of soy producers and food manufacturers, do you think you would trust it quite as much? Probably not. Consider the cherry research paid for by the cherry growers: does that change your faith in the results?  I’m probably not making you feel good now, am I? Who are we to trust?

All is not lost: there are ways around this, and that is to do your own research, using a study group of one (or more, if you cook for the family or friends!) In its extreme form this is called bio-hacking. Extreme bio-hackers do their own DNA sequencing at home and wire themselves up to all sorts of machinery. At my end of the scale it’s called “suck it and see” and involves choosing the advice that seems reasonable to me and trying it out, taking what measurements I can (like weighing yourself, taking your own blood pressure and, if you’re diabetic or pre-diabetic, monitoring your own blood glucose levels. With all these things it’s probably an excellent idea to discuss them with your doctor before you start.)

But how do we find some advice that we want to “suck and see”–some knowledge that we want to test?

It used to be that I never read books on nutrition because they were so confusing. Everyone seemed to contradict everyone else and with many of them I couldn’t see where the advice was coming from.

For instance, many years ago someone recommended the food-combining diet to me. I thought that it should have been called the food separating diet because, it seemed to me, it was mostly about not eating this sort of food with that sort of food. Mostly it was about not eating carbohydrates in the same meal as proteins. That meant you could have a fried egg for breakfast, but you couldn’t have toast at the same time. And that would mean the yolk would run all over the plate.  I needed the toast as a “raft” to convey the egg from plate to mouth (took me some time to switch to eating scrambled eggs!) And what about beans such as baked beans or lima beans? They are both protein and carbohydrate at the same time. Should I have beans as a carbohydrate meal or a protein meal? The books seemed to say I could decide for myself, which to me was tantamount to saying that this diet was whatever I wanted it to be. Despite the fact that it was recommended by people I liked and trusted, it didn’t make sense to me; I couldn’t understand what it was based on.

Then one day I was having dinner with a group of people I hadn’t met before and made this point about the beans. One of them said, “Aha!” Beans proved the point of the food-combining diet, for we all know that beans are pretty indigestible. They give us gas and make us worried in polite company. That, said my new friend, is precisely because they are both carbohydrate and protein. Hmm. That made sense to me. Not enough sense, I have to admit, to make me switch to a food-combining diet, but it made me think.

Mind you, on that basis egg on toast should make you fart, and I’m not aware that it does!

So here’s what I recommend that you do. Well, no: here’s what I do!

Someone recommended that I read a book: “Why We Get Fat and What To Do About It” by Gary Taubes.  Long ago I stopped accepting recommendations to read this or that diet book, simply because they were all so contradictory, and I had no basis for deciding between them. For some reason this one caught my attention. It was available on Kindle, it was cheap, and, on a whim I bought it and actually read it!

Reading it was another “road to Damascus” experience and completely changed my life and my thinking (I blogged about it elsewhere). Gary Taubes isn’t a doctor and he isn’t a nutritionist. He’s an investigative journalist especially interested in (bad) science. Having written a book about the infamous “cold fusion” physics research, someone suggested to him that if he was interested in bad science he should look at the science of nutrition.  (By the way, if you want an example of “paradigm wars” click that Amazon link for the cold fusion book, and read the customer reviews, comparing the 5-star reviews and the 1-star reviews.  There are some folks there with a near-religious attachment to the idea of cold fusion, and they are seriously angry with Gary.  But, you will notice, his book doesn’t persuade them.  Probably nothing will.)

Gary spent a long time looking at the research and wrote a huge tome called “Good Calories, Bad Calories” (in the UK it is called “The Diet Delusion”). It is 500 pages long and has 75 pages of references. Its Amazon.com ranking is truly amazing for a heavy-duty text book (as of March 22, 2013: it will have changed by the time you look at it):

Amazon Best Sellers Rank: #1,664 in Books (See Top 100 in Books)
#1 in Books > Medical Books > Medicine > Internal Medicine > Occupational
#7 in Books > Cookbooks, Food & Wine > Special Diet > Low Fat
#11 in Books > Health, Fitness & Dieting > Diets & Weight Loss > Low Carb

Having written that magnum opus a lot of people asked for an easier version that they could hand to their partner, doctor, patients, et cetera and Gary wrote “Why We Get Fat: And What to Do About It”. It ranks even higher:

Amazon Best Sellers Rank: #636 in Books (See Top 100 in Books)
#2 in Books > Health, Fitness & Dieting > Diets & Weight Loss > Food Counters
#3 in Books > Health, Fitness & Dieting > Diets & Weight Loss > Low Carb
#5 in Books > Cookbooks, Food & Wine > Special Diet > Low Carbohydrate

Clearly he is connecting with a lot of people. “Why We Get Fat” is available on the Kindle for $6.86 or £4.27. (And if you don’t have a Kindle you can download “Kindle for the PC” or “Kindle for the Mac” for free and read Kindle stuff on your computer). It won’t break the bank!

Now here’s what I got from Gary’s book: it made sense to me and it showed where a lot of the “received wisdom” in the diet world doesn’t make sense. For instance, for most overweight people if you go to the doctor and say, “doc, I’m worried about my weight, what should I do?” most doctors (and nutritionists and “health experts” and diet gurus and general know-it-alls) will say “eat less, exercise more”.

This has been the advice for the last 60-70 years.

Look around you. This advice isn’t working.

If you ask the “eat less, exercise more” crowd why the advice isn’t working they will say that it’s because all of us fatties are lazy and greedy and we don’t do as we’re told. As if that would explain how come babies are being born obese nowadays: born lazy and greedy!  (Note the inconvenient data that doesn’t fit the current paradigm about the causes of obesity.)

And if you were to go to a health expert and say, “I’ve been invited out to dinner by a very important business client. They are excellent cooks and will serve up a big dinner. I don’t want to look rude; what can I do to make sure I have a good appetite that day?” They will tell you to skip breakfast and lunch and go for a long walk. In other words “eat less, exercise more” is the recipe for getting a good appetite. And that’s what they recommend to “people of size” who want to lose weight. Hmm.

Now think for a moment about teenage boys. They lay around in bed for most of the day and when they do manage to haul themselves upright they come down stairs and empty the fridge. And they grow; almost overnight it seems. But we don’t say “my son has grown six inches taller in the last year because he is greedy and lazy”. He grows because his hormones are telling his body to grow. It takes a lot of energy to grow, which means he needs to take on a lot of energy and he frequently doesn’t have much to spare for doing chores (although amazingly he does have energy for chasing girls: obviously it’s a different sort of energy).

So, maybe, just maybe, there is a different explanation (different paradigm) as to why we obese people get to be this way. Taubes says that our hormones (a different set of hormones than the teenager’s hormones that tell him to grow up) are telling us to grow out. We aren’t fat because we eat too much; we eat too much because we are fat.  That blew my mind. I had to go back and read it several times. I won’t reproduce Gary’s arguments here: if you want to check them out, go buy the book on your Kindle or on your PC and read it: it’s a pretty easy read. Or really splash out and buy a real copy that you can carry around with you.

The biggest effect that this book had on me was to show that there are nutritional principles in common use that were just plain wrong. There is some inconvenient data.  Maybe our paradigm is wrong.

And that there are also some nutritional principles that are based on ideas that just seem to make sense to me. I get to choose which to believe and which to use to base my own personal research on.

For instance, the whole “fat is bad for you, eat low fat stuff” is based on some really bad epidemiological studies. The idea was introduced into American national consciousness because the authorities were worried about an increase in death from heart disease. Well, it’s controversial to say the least whether or not there was an increase in deaths from heart disease at the time, but there certainly has been a massive increase since we’ve been following the “low fat” ideas. Not to mention obesity, diabetes, Alzheimer’s syndrome and a whole host of other nasty and expensive things.

The powers that be are convinced that it’s because we’re all fat, lazy and greedy (and stupid, I suppose) and won’t do as we’re told. Grrr! Taubes provides a (for me) believable and viable alternative, and he provides the facts and figures to back it up.

Gary’s book opened up some new doors for me and on the other side I saw the whole nutrition field in a different light. I was able to see some large groupings of ideas and within those I could see some that made sense (to me); some that didn’t. Some that were clearly just commercial, some that came from people who believed something with huge passion, which I can respect, but I didn’t have the same beliefs as I do. So that saved me a lot of time. I could see that the vegans were principled people with their hearts in the right place; I wasn’t going to damn them, or even try and convert them. However, I didn’t believe that veganism was for me. And I was vegetarian for about 10 years or so, but that hadn’t worked for me, and when I finally gave it up several illnesses cleared up within days. But again, I’m not about to try and convert any vegetarians (my own daughter is vegetarian: I wouldn’t dare!) I’m sure that there are plenty of vegetarians who can tell you stories of things that cleared up for them when the stopped eating meat.

There are fierce arguments between vegetarians and meat eaters and both can point to anecdotal evidence to support their arguments (that means “I can tell you an anecdote about a friend of mine who did _______ and ______ happened”).  All true scientists dismiss anecdotal evidence out of hand.  And if there is just one anecdote, that’s reasonable.  But when thousands of people try something over and over and you have tens of thousands of anecdotes, then there is something that, maybe, needs further investigation.  And if 10,000 people report that cherries cured their gout, and you can’t construct a research study that confirms that, then I would tend to believe that it’s more likely that there’s something wrong with your research design than that 10,000 people are deluded.  (And I have no basis what-so-ever for knowing how many people believe in the cherry-gout thing.)

One of the biggest confounders that both of these armies often miss is this.  Although there are millions of people concerned with nutrition and the diet industry is huge, the vast majority of people pay almost no attention to their diet: they eat what they see on TV or on the shelves of the supermarket. In America, amongst people who know about this stuff, it’s called the Standard American Diet or SAD (how appropriate!). Those people are eating artificial food that is packed with sugar and high-fructose corn syrup. It is processed to the point where it isn’t food: people talk about “food-like substances”.  This TED-talk video shows how one person (Robyn O’Brien) switched their paradigm from “there can’t be anything wrong with food in the supermarket”, to being concerned and doing her own research:

http://www.youtube.com/watch?v=rixyrCNVVGA

Now there are no meat-eaters who would say that you shouldn’t eat fresh vegetables and salads (well, there may be one or two, but they are off the scale!).

So when you find a vegetarian who can point to people who got better from various illnesses when they switched to a vegetarian diet, or you find someone who recommends the cave-man diet who can point to similar success stories, it’s probably because those successful people switched from the SAD diet and started to think about what they were eating.

Whether you go Atkins or South Beach, or Paleo or Vegetarian or Vegan, or 100% meat eater, or ketogenic … all those arguments pale into insignificance when compared with whether you are eating artificial “food-like substances”, or food: food that your great-grandmother would have recognised as food. Some people (and I will be one of those … just give me a while to get around to it) will argue that it might be a good idea to eat food that your great-great-grandmother 200 times over would have recognised as food, but let’s start with just one grandmother at a time!

So here’s something that may be different between you and me and our grandparents. In our modern western society we don’t have to know much about food if we don’t want to. We don’t need to know how to catch it, find it, prepare it, cook it, or keep it. We can just go to the supermarket, buy something in a box, sling it in the microwave, eat it out of the packet; not even have to wash up. Job done. My mother-in-law went into hospital in February 2012 and we flew out to help her move home in April. In the fridge was half a loaf of bread: it had been there for three months. As far as we could see there was nothing wrong with it. I can’t quite get my head round what a manufacturer must have done to that bread to keep it from going stale or mouldy for three months. And this is in Florida: in Florida you only have to stand still for 10 minutes before you start growing mould! It’s a state-wide obsession.

We may live to be 100, in full health, on such a supermarket regime. But it’s not likely.  My dad made it to age 91 having been a moderately heavy smoker all his adult life.  And he didn’t die of cancer or lung disease.  But that doesn’t mean smoking is good for you.

If you are choosing your food this way, you are doing the same as I was before I learned co-counselling, when I went to see the doctor. You’re saying to a food manufacturer, “you’re the expert; feed me” and assuming that that food manufacturer has your good health as his primary motivator, when you don’t.  There is vanishingly little evidence to support that belief and almost overwhelming evidence to the contrary, as I will list elsewhere.

Remember what my co-counselling teacher told me?

The client is in charge.

It’s sort of like that old Latin saying, caveat emptor, “Let the buyer beware”. It’s a principle of law that says it’s up to you to make sure that what you’re buying does what you want. Around the world laws are changing to give “the consumer” greater rights and protection, but the manufacturers are always one step ahead, except when they are two steps.  Around the world there is a principle that says you can’t introduce new things into the food chain until they are proved safe.  In America it’s the other way round: you can’t prevent new foodstuffs until they are proved dangerous.  So people have been going to court and asking for a judicial injunction on planting GMO crops in their neighbourhood until proved safe.  The US Congress has just passed a law that says judges can’t issue such injunctions.  Many would argue it’s unconstitutional.  I would argue that if you want to stay healthy you need to learn about this stuff!   When it comes right down to it, doesn’t it make sense to get educated, to learn about your own health and your own nutrition, and to make your own decisions?

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My life has been turned upside down the last couple of days.  Normally each day brings doom and gloom as we learn of yet another indication of global warming, yet another GMO crop, yet another US state passing a law that says someone can fiddle with our food without telling us.

And then I came across a TED-talk that I think is the most inspiring and exciting thing I ever heard.

http://www.youtube.com/watch?v=vpTHi7O66pI

This man has developed a management method which he calls Holistic Management:

Holistic management describes a systems thinking approach to managing resources that builds biodiversity, improves production, generates financial strength, enhances sustainability, and improves the quality of life for those who use it.

Wikipedia

At the same time it saves failing farms financially, it reverses “desertification”, it improves the soil, increases bio-diversity, improves rivers and streams, and sequesters (stores) carbon from the atmosphere into the ground!

On this next video at 1’55″ an Australian farmer describes how her farm was around $750,000 in debt.  She says:

Since we started holistic management we have increased our profitability by 20-30% per year.

They are now out of debt.

http://www.youtube.com/watch?v=zavLvBU9iwI

If we still have your attention, take 45 minutes to watch this next video: it gives a whole series of case studies:

http://www.youtube.com/watch?v=mtQBoMoqc9U

If you’re like me you’ll want to know more.  Have a look at two relevant websites:

• Savory Institute: www.savoryinstitute.com
• Holistic Management International: holisticmanagement.org

There is a whole bunch of free material that you can download from HMI’s downloads page.

And if you really get excited, you can order the two books from Amazon!

My mind is spinning with ways to get involved: to help.  There are thousands of people concerned with ancestral / primal / paleo / low-carb nutrition.  Here’s a man saying that the way to save the world from global warming is to produce grass-fed beef.  What’s not to like?

You comments, please, below.

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I have created a list of 280 Paleo/Primal/Low-Carb/Weight Loss/Fitness Facebook Pages that I have “LIKE”d. It is a series of links: click the link: provided you are logged on to Facebook, it will take you to the page. If you like the look of it, click the “Like” button. You will then get posts from that person when they update their page. It’s a good way of getting educated and staying on top of what’s new.

It was a bit of a technical feat getting this list out of my FB account and into a useful format. If you discover pages here that are really nothing to do with paleo, primal, weight loss, low carb, getting fit and/or overcoming obesity, please let me know.

And if you find pages that really ought to be listed here (like yours, maybe?!) please message me on the first page listed here (which is mine!)

Some of them (like Lorraine Pascale and Jamie Oliver) you could (correctly) argue are nothing to do with Paleo/Primal etc.  I agree.  But I want to include one or two that just begin to get people who are hooked on the SAD diet just starting to think about different ways of being. Having been through them all, there really are some that shouldn’t be here. Let me know which ones you think should be deleted.

I haven’t got in to CrossFit yet: waiting for the class to start.  So I’m especially interested in CrossFit pages.

Click this link to go to the page.

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We are not suggesting that as our ancestors ran across the plains of Africa they were nibbling on chunks of chocolate!

While the basic ingredients in good chocolate are real food, and really good for you, it is difficult to find commercial chocolate that doesn’t contain stuff that paleo people wouldn’t want to eat, like high-fructose corn syrup, sugar, various preservatives, etc.

So here’s a recipe that you can use to make your own, “real food” chocolate.  This is another “n=1″ piece of research (or n=x, where x is the number of people in your family!) in that the taste is very much down to personal preference.  It’s a case of “suck it and see” (sorry!)

It is also ketogenic chocolate (see the section on nutritional information at the bottom of the page).

In the equipment list and the ingredients lists below, if you click any of the pictures it will take you to Amazon where you can buy these things if you don’t have them.  We are making this chocolate while we are in Florida; availability of equipment and ingredients may vary in other countries.  When Susan talks in volumetric measurements, she’s talking American cups, spoons, etc.

You can download a printable version of Susan Courtneys Healthy Dark Chocolate here (right click and choose Save As).

In the video Susan mentions her Sweetener equivalents chart.  Right click the link and choose Save As to download.

There are six videos taking you through making paleo chocolate.  Here’s the first (the others are spaced down the page).

http://www.youtube.com/watch?v=umbDYDjY6V0

Equipment

Double boiler.

There are dozens on Amazon; this is one of the cheapest but has good customer reviews. You can spend up to $300 on a beautiful, traditional copper “bain marie”, but that isn’t necessary!

You can also pop a basin on top of a saucepan of hot water!

Pouring Funnel

If you are going to put your chocolate into forms or moulds (molds) then this is essential.

If you are making “bark” by just tipping the chocolate into a baking try lined with parchment (greaseproof) paper, then it’s not necessary (but you get big, hard lumps of chocolate: I broke a tooth on a piece!)

Scales

There is no need to get this sophisticated: however it is a good idea to have some scales in your kitchen to measure ingredients.  Americans: this may be radical for you, as you are used to working in “cups and spoons”.  The rest of the world is used to working in weight: I’ll translate from ounces (oz) to grams as we go.

However, these are brilliant: they will analyse and weigh all your ingredients so that you can have the equivalent of a professional “nutrition label” for your chocolate.

Moulds or Forms

… or “molds” if you’re in America!  There are lots of different ones on Amazon.

We used to make “bark”: Susan would line a baking tray with grease-proof (parchment) paper and just tip the molten chocolate in it, and put it in the freezer.  When it was solid we’d break it into lumps and put it in zip-lock bags, back in the freezer.  You do tend to get BIG lumps that way!

In addition to the above you will need some sort of mixer or beater, some measuring cups and spoons and a spatula.

And quite a lot of dish-washing liquid and cloths: it does have a tendency to get everywhere!

http://www.youtube.com/watch?v=-fiLq6-P0fw

Ingredients

Organic Cocoa Butter

Whether or not you use organic or inorganic is, of course, up to you.

But you are making high-quality chocolate here, so why not go for the best ingredients?!  The brand shown here is Kakosi, which is what you see Susan using in the video.

Coconut Oil

We use Nutiva coconut oil.  It seems to be a reasonable price for the quality: again, we are looking for organic.

On Amazon there are all sorts of brands and all sorts of “qualities”: Certified Organic, Extra Virgin. etc., and they all seem to have pretty good customer ratings and comments.

Another “suck it and see” area, I think.

Organic Baking Cocoa

Equal Exchange seems to come with a version that says “vegan” in the title, and cost a lot more.  But ours says “vegan” on the tin, so I don’t understand the difference.  This is also fair-traded, so your chocolate is not only healthy, but also ethical!

Susan used to use a mixture of cocoa powder and carob powder, and it’s certainly true that the chocolate that had carob in it felt slightly gritty in the mouth.  Now we just use cocoa powder, and it tastes fine.

Sunflower Lecithin

The brand that Susan is using in the video is currently (March 3 2013) out of stock at Amazon, so I searched for “Sunflower Lecithin Organic” and it came up with soy lecithin granules, not organic, so beware!

The brand here is liquid, is sunflower, has no GMOs, and no soy, so I think that Susan would approve.

Sweeteners and Flavourings

Susan uses a mixture of stevia powder (which she gets at our local whole food store, Hoovers Market) and Luo Han Guo (Chinese Monk Fruit!).  If we were back in the UK, we would probably use liquid stevia from our medical herbalist, Alan Hopking.  If you haven’t come across stevia before, check out what Alan says about it, here.

In the video Susan mentions her Sweetener equivalents chart.  Right click the link and choose Save As to download.

When looking for stevia, you can get the powdered leaves, and that powder is green.  I know that Alan would tell you that it’s one of the purest forms, and I’m sure that as a medication it’s the best.  But I tried it, and to me it tastes of grass (not “grass”, but that green stuff on your lawn!) and I don’t want my chocolate to taste like it’s just been mowed!

Once upon a time stevia was hard to come by, because it hadn’t been approved by the FDA as a food stuff.  Now it has, and everyone is in on the game, and it’s harder to get good stevia.  We know that the major soda drinks manufacturers are starting to use stevia, and the suspicion is that, at least in the USA, they are producing GMO stevia, so we avoid Truvia and PureVia.  Vanessa Romero has a good article about it here.  The picture on that page, of  NuNaturals stevia is what I use in my coffee: but it’s not as sweet as the pure stevia that Susan is using in the video (it has bulking agents so that the contents of the little packet are about the same sweetness as in any other packeted sweetener).

http://www.youtube.com/watch?v=Ng0t1nKTtR4

Process

1. Melt 4oz (115 g) of cocoa butter and 4-5 ozs (115g – 140g) of coconut oil and 1 tsp (5ml) lecithin in the double boiler.  Stir until it is all melted.
2. Add a cup (250ml) of cocoa powder and mix with your mixer until it is all mixed in.
3. Add a quarter teaspoon (1.25ml) of stevia powder and a couple of teaspoons (10ml) of luo han guo powder.
4. Stir, taste, and add more cocoa powder, stevia and luo han guo to taste.  This really is an experiment.  You won’t produce anything inedible, but it may take several goes to get the feel for what is your favourite.
5. If adding orange flavouring (or vanilla, or any other) add that last, just a little at a time.
6. Pour the mixture into your pouring funnel and fill the molds.
7. MAKE SURE YOU ALREADY HAVE A FLAT AREA, BIG ENOUGH, IN YOUR FREEZER!  (I can’t tell you how long it takes to clean once runny, now frozen solid chocolate off of the inside of your fridge or freezer.  We went off chocolate for quite a while after that incident!)
8. Put it in the freezer for a couple of hours, until it’s hard.
9. Remove from the molds, pop into zip-lock bags, and continue to store in the freezer.

Are you old enough to remember “melts in your mouth, not in your hands”?  This melts in your mouth, your hands, on the plate you serve it on, on the rug, your mother’s pure white carpet, the sofa, your clothes … (’nuff said?)

You can download a printable version of Susan Courtneys Healthy Dark Chocolate here (right click and choose Save As).

http://www.youtube.com/watch?v=chXbcGj7xBM

Alzheimer’s Syndrome

We don’t know that this chocolate will cure, prevent or slow down Alzheimer’s, but that’s what got us looking, as Susan says on the video. She was inspired by Dr Mary Newport and her website, www.coconutketones.com. Check out Dr Newport’s book and website: in particular, watch the latest video from CBN news.

Susan also talks about MCT oil (medium-chain triglycerides).

We use it a lot, but haven’t tried it in the chocolate: it would probably make it even meltier at room temperature!

http://www.youtube.com/watch?v=n8-9XoQA4cw

Nutritional Information

I was so keen to get the videos made that we didn’t stop to use our fancy scales properly, so I will have to do these calculations by hand (well, spreadsheet!)  I am only going to consider the fats and the cocoa powder; everything else is present only in vanishingly small quantities.

Main Ingredients

Cocoa Butter	Coconut Oil	Cocoa Powder
Fat 108g, Carbs 0g, Protein 0g	Fat 140g, Carbs 0g, Protein 0g	Fat 255g, Carbs 32g, Protein 16g

These figures are for all of the ingredients.  Note that the carbs in the cocoa powder are all dietary fibre, so most people would ignore them.

However, given that we got 45 chocolates out of this mixture, it shows that each chocolate is almost 6g of fat, 0.7 gm of carbs (of which 100% is dietary fibre), and 0.35 gm of protein.

I therefore declare that these chocolates are ketogenic chocolates!  If you restrict yourself to 20gm of carbs a day, and include fibre in that (which is being very strict), you could still eat 28 chocolates a day and stay within your limit.  That assumes you eat no other carbs, but I reckon if you eat 28 of these a day you wouldn’t want to eat anything else!

http://www.youtube.com/watch?v=hPqDXe0cvco

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