Stop Protesting and Start Cooking

Yes- someone is protesting Kraft because they use “artificial” colors in their Mac and Cheese. They then made up an entire post about how Kraft uses genetically modified wheat in their product.  While they generated a lot of buzz for this lets start with the obvious:

You’re feeding your kid processed food and protesting Kraft?  

Instead of protesting a food maker, why don’t you use that time to cook them a real meal?

In ten minutes you can have a spaghetti squash cooked in a microwave and ready to serve. We showed that in a video here. That has ten times the fiber of the pasta and one tenth the calories – and it tastes great.  Instead of their “cheese” you can grate some real Parmesan cheese on top, or you can heat up some other sauce you get from the store (there are some great healthy sauces out there). Now, in less time than making Kraft’s dinner you have made your own – it has a vegetable serving in it (something you don’t get with Kraft) – it tastes better, it is fresher, and it will cost you less.

Plus here is another advantage: you are showing your child that the kitchen you are in can be used for making real meals.  You are setting an example for them. JJ in the Kitchen

Over 200,000 signatures were gathered for this.  And Kraft met with them! Ok, the power of social media and all that. What an ego boost for their blogs (no, I won’t link to them because they are silly blogs that are quite anti-science). Here is their comment though, “We wanted to educate the American consumer and let them know what is in their food. We just picked an iconic food product to really get that message across.”

So protest away to Kraft, or anyone you wish- but if you would instead take the time to make real food for your kids you can save some of that energy and not have to worry about “chemicals.”

So here is my recommendation for all of you food bloggers out there protesting big industry because of how they process foods — get off your blog and show your kids how to cook – and not from a box.

And if you spent time worrying about what is in the box of Mac & Cheese – don’t. Just get in the kitchen and learn to cook. Your kids will love it, you will love it, and you will eat better – healthier, and live a much better life.

Get an apron, learn how to cook, it is the most empowering thing you can do for yourself.

In fact – one of my favorite chef’s said it best in an interview – well – here is the video of the interview:

Here is a video about how to do Spaghetti Squash

Meat and Mortality: Does Eating Meat Decrease Your Lifespan?

Is Meat Unhealthy?

Ribs on BBQDoes eating red meat decrease your lifespan? This is a discussion that has been going on for years, with vegetarians and vegans stating that meat is not only bad because of the cruelty to animals, but it will decrease your life. There have been a number of studies looking at this, and the results vary, but this week a new study showed -

 After correction for measurement error, red meat intake was no longer associated with mortality, and there was no association with the consumption of poultry.


While this is good news to the lovers of red meat – those who love bacon had different news:

The results of our analyses suggest that men and women with a high consumption of processed meat are at increased risk of early death, in particular due to cardiovascular diseases but also to cancer. In this population, reduction of processed meat consumption to less than 20 g/day would prevent more than 3% of all deaths.

You have to wonder about a publication with editors that would let that statement slip. Imagine if we could prevent any death – but I suspect all members of that study will die. Besides the grammar, the real issue of the processed meat portion is the variable of smoking.

We cannot exclude residual confounding, in particular due to incomplete adjustment for active and passive smoking. The sub-group analysis for processed meat showed heterogeneity according to smoking, with significant associations only in former and current smokers and no significant associations in never smokers, which is compatible with residual confounding by smoking. 

This is explained further in the article with these statistics:

There was also a statistically significant interaction between smoking and processed meat consumption (P-interaction 0.01), with mortality being significantly increased among former (HR = 1.68, 95% CI 1.29 to 2.18) and current smokers (HR = 1.47, 95% CI 1.18 to 1.83), but there was no association among never smokers (HR = 1.24, 95% CI 0.89 to 1.72). 

Since the relative risk of smoking is 20, and the relative risk of this was 1.14 one must assume that smoking is bad for your health. So it may be the person’s smoked lungs rather than the smoked pork.  Although clearly smoking was bad for the pig.

Increasing vegetables and fruits in the diet was almost a protective factor:

Those with a lower fruit and vegetable intake (below median intake) had a higher overall mortality in the highest consumption category of processed meat (160+ g/day) as compared to subjects with a fruit and vegetable intake above the median intake (P-interaction 0.001).

But the study was in contrast to the US study:

However, in contrast to the US cohorts , there was no statistically significant association of red meat consumption with risk of cancer or cardiovascular mortality. (see ref 7 and 8 below)

The problem with the US studies has more to do with the basis of their data gathering than anything else. We blogged about the topic of red meat related to mortality last year. The basis of those studies is this: a bunch of people are given a questionnaire about what they eat. They fill it out. Depending on the study, their health is followed for a number of years, and using statistical analysis determination is made about what factors influence their health.

Human beings are not hardwired to remember what they ate a year ago, even a week ago. The flaws in this type of study are the data gathering, expecting people to remember what they ate over the last year.

The European study avoided this by having clinics that did more measuring and in depth analysis, and their data has less flaws than the US Data, but still, the basis is sketchy.

All Meat is not the Same
The other missing piece is this: meat is processed differently by different places, and the meat is handled differently. Animals that are raised on grass have higher levels of Omega-3 fatty acids, where animals raised on grains have higher levels of Omega-6 fatty acids.  If you process your meats in Italy, there is a different production than in Northern Germany, which is different than in Iowa – some being more prone to harsh chemicals that may (or may not) linger.

Vegetarians v Vegans
One study that looked at all groups- it turns out that Vegans and meat eaters live to be about the same age, those that have the best survival advantage were fish eaters.  In fact, occasional meat eaters have a longer lifespan than vegans.


1. Meat consumption and mortality – results from the European Prospective Investigation into Cancer and Nutrition. Rohormann S, et. al.  BMC Medicine 2013, 11:63

2.Food-Based Validation of a Dietary Questionnaire: The Effects of Week-to-Week Variation in Food Consumption. Salvini S, HunterDJ, Sampson L, et al:. International Journal of Epidemiology 18:858-867, 1989
3. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaireHu FB, Rimm E, Smith-Warner SA, et al:. The American journal of clinical nutrition 69:243-249, 1999

4.  Lack of efficacy of a food-frequency questionnaire in assessing dietary macronutrient intakes in subjects consuming diets of known composition.Schaefer EJ, Augustin JL, Schaefer MM, et al: The American journal of clinical nutrition 71:746-751, 2000

5. Bias in dietary-report instruments and its implications for nutritional epidemiology.Kipnis V, Midthune D, Freedman L, et al: Public Health Nutrition 5:915-923, 2002

6.Red meat consumption and mortality: results from 2 prospective cohort studies. Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Stampfer MJ, Willett WC, Hu FB: Arch Intern Med 2012

7.Meat intake and mortality: a prospective study of over half a million people.Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin AArch Intern Med 2009, 169:562-571.

8.  Is It Time to Abandon the Food Frequency Questionnaire? Kristal AR, Peters U, Potter JD: Cancer Epidemiology Biomarkers & Prevention 14:2826-2828, 2005

9.Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Key, T., et. al. Am J. Clin. Nutr March 2013, 97 (3)

Mediterranean Diet: Heart Health – Not Just Yet

Mediterranean Diet Good For Your Heart?

Healthy Mediterranean Diet

This week most news outlets are touting the recent article in The New England Journal of Medicine about the Mediterranean Diet, and how it cut cardiovascular disease. But here is the rest of that story:

There was no significant reduction in heart attacks, there was no reduction in death from heart disease, but there was a small reduction in death from stroke. When you combine the strokes into a category of cardiovascular disease you have the difference the article noted.  To be clear, the study did not say a reduction in stroke, or a reduction in disability from stroke but just death from stroke.

There is a call for studies of diets to see how it affects heart disease, or cancer, or other diseases. But here is one that really didn’t show anything, and yet some are saying- hey, we need more.

What was not properly accounted for in the study was smoking, people who were taking statins, people who were taking blood pressure medicine,  and there was more obesity in the control group. There was no weight loss in the Mediterranean diet group.

Even the New York Times didn’t get this, their article said, “About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study has found.”

In another part of the NYT article they said, ” Disease experts said the study was a triumph because it showed that a diet was powerful in reducing heart disease risk, and it did so using the most rigorous methods. “ 

The study did not show that the diet was “powerful” in reducing heart disease risk, and the most rigorous method used was statistical jockeying to add stroke deaths to heart issues to put it all under one statistical umbrella.

Plus, one group were required to drink a liter of olive oil a week (thats a lot of oil).

What was also missing from the study was any laboratory data, nothing showing a change in blood lipid chemistry (which may not matter). There was nothing in the data that showed changes in plaque formation. There was nothing in the data that showed inflammatory markers were lower.

Bottom line: you have a study that makes a lot of reaches, conclusions, and promises, but the facts are simply not there to support it. It also shows that the era of science journalism is gone.

Eating Healthier is better than not – in fact: Just Cook! :

Olive oil- buy local (US olive oils).

There are plenty of ways a person can eat healthy. And once someone begins to pay attention, and eat healthier they tend to think that their diet is the best of any. Diets become a religion for some people- proselytizing with the evangelical fervor of a Revival preacher.

What the report in the New England Medical Journal showed was this: eating healthier is a bit better than not.

A lot to love in this diet – what I like most, is it gets people into the kitchen, and cooking. There is nothing wrong with a diet that is rich in fruits, vegetables, whole grains, fish (and shellfish) with less emphasis on cattle raised on corn (grass fed is ok), and decreased portions, is probably best. Oh- and don’t forget the red wine.

 One of the New York Times columnists got it partially right. Mark Bittman, whose contributions to the food section of the NY Times are known for advocating cooking, healthy foods, and less red meat.  His column pointed out the flaws, as Bittman called physicians who were critical of the article. Bittman’s colum about this can be found by clicking here.  Bittman does credit Ornish with a diet showing a reversal of heart disease – which, sadly is simply not true (our review of Dr. Ornish here). Essentially, Ornish’s cardiac imaging was flawed – and his studies have not been reproduced.

What is the Mediterranean Diet – a Diet Plan

Breakfast: Greek yogurt. Fruit, fresh and whole. Granola made from fresh nuts, whole grains, and sweetened with blueberries. Fresh, whole wheat toast, or sourdough pancakes. Cucumbers with onions dipped in balsamic vinegar with some olive oil.  Tea or coffee

Mid-Morning snack: fresh fruits, nuts, or – dried fruits (that you have made).

Lunch: Fresh fish grilled or fried in olive oil. A hearty lentil soup. Fresh fish with pita bread.

Mid-afternoon snack: 1 banana or 1 apple, or some fresh fruit. A handful of nuts

Dinner: Chicken – baked or roasted, in a warm hummus salad. Fresh pita bread. Green beans blanched, then dressed with olive oil and mustard. Or pasta with a true Marinara sauce. One the island of Sardinia, I ordered pasta with Marinara sauce – besides tomatoes, in the sauce were fresh mussels, lobster, mackerel, and tuna — and it hit me – this is what marinara means- from the sea.

2 glasses of red wine.

Dessert: Poached pear with yogurt, or baked apple with nuts, fresh fruit salad

 Mediterranean Diet: What it consists of 

Vegetables and Fruits: the base of the Mediterranean pyramid. The bulk of food in this comes from these ingredients. Fruits form the basis of most deserts. This means fruits or vegetables with every meal- and for every snack, up to ten servings a day. These are not processed juices, these are something you can identify out of the garden. If you have dried fruits, that is acceptable, and prefer that you do them.

Grains: Whole grains, not processed wheats: quinoa, wheat berry, and sesame seeds. Perhaps my favorite of this is hummus, a great snack, all vegetable, that provides all the essential amino acids. It was this snack that allowed migration across the world.

Dairy: Greek yogurt, cottage cheese, are all used in this diet.

Fats: Primary source is olive oil in this diet, also grape seed oil

Pasta: A basis of high-carbohydrate, high fuel for people from the Mediterranean to China.




Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. Estruch R,et. al. N Engl J Med. 2013 Feb 25.PMID: 23432189


The NYT article can be found here.

Food Can’t Cure You: It Can Kill You

Diet Does Not Cure Cancer

fresh produce healthy eating food mythsLet’s set the record straight on a silly, popular, and pervasive idea: Food cannot cure you—unless you have a specific deficiency: food cannot cure you of cancer, heart disease, or Alzheimer’s. But a proper diet, may delay some disease, or the effects of some disease.  It really frosts me when someone states this diet will keep you from getting some disease – at best such is misleading, at worst it can be catastrophic.

Food can kill you, and I see that everyday in my practice – people have an auto-destruct button- it is their mouths. And don’t think you can eat poorly and make up for it with taking supplements. If you eat a balanced diet you do not need to buy supplements, like vitamins, fish oil, calcium, or others.  Diets that are rich in these micronutrients may make a difference, the supplements themselves have never been shown to improve health, with the single exception of pregnancy.

Antioxidants are a prime example of false food claims. Every few months someone promotes supplements that contain antioxidants as beneficial to avoiding cancer, heart disease, Alzheimer’s, or macular degeneration of the eye. Scientists have tested to see if antioxidant  supplements prevented or improved heart disease or cancer. The use of antioxidants, in study after study,  made no difference. In fact, people who took antioxidants, like beta-carotene and vitamin E, didn’t live as long!. But that doesn’t stop some people from promotingsupplements. The sale of antioxidants continues to be pushed by physicians who spend more time in front of the camera than reading medical journals (I’ll call them TV doctors or TV MDs).

Micronutrients: A group of ingredients needed by humans that must come from food. Examples include calcium, iodine, antioxidants, iron, zinc, and vitamins.

Macronutrients: The major ingredients humans consume, including protein, fat, carbohydrate, amino acids, sugars, essential fatty acids, and alcohols.

The latest trend among cookbook authors is to list the macro- and micronutrients in their recipes with vague reference to how this is healthy. For example, you might hear “great for your prostate” or “promotes heart health,” even though science shows the nutrient just doesn’t work that way. While the recipes of those celebrity chefs are tasty, the list of micronutrients they put at the end is little more than word salad.

Even worse is the notion of eating certain foods instead of taking prescribed medicines. If your doctor prescribes a medication to lower your cholesterol, just eating more foods like salmon is NOT the same.

You may enjoy your glass of red wine—but don’t think it will save you from heart disease. To get enough resveratrol, the highly touted antioxidant in red wine, to reap any heart benefit, you would have to drink 2,000 bottles of wine in a day.

There is a long history of pitchmen (charlatans), from Graham (of the cracker) to Kellogg (of the cereal), who sought the fountain of youth through foods, supplements, and colonics. The trend in food promotion today is to highly tout and write about a chemical of the month—from antioxidants to the notion of “superfoods”—which often doesn’t hold up when tested by science.

Did you know:
Corn Flakes and Grape Nuts were once promoted a health food? Kellogg and Post were two competitors in Battle Creek Michigan who invented the cereals and marketed them as health foods.

To illustrate about  balanced diets, consider that in the 1500-1700’s many sailors died of scurvy, a disease that caused old wounds to open up, teeth to fall out, and a horrible death. Those sailors who had a balanced diet never got scurvy. It was discovered that scurvy was preventable by eating limes, which is why British sailors are called “limeys”. The ingredient in limes that prevents scurvy is vitamin C. The simple discovery—that a vitamin deficiency causes disease, began the idea that if we could isolate the vitamins and micronutrients we could prevent many other diseases.

But that does not mean a massive amount of vitamin C is better. Linus Pauling, the two-time Nobel Prize winner, believed that high doses of vitamin C would cure the common cold and prevent cancer. When I met Pauling, he was suffering from a cold; a few years later he died of prostate cancer. The more important lesson of vitamin C is this: Sailors who were fed a balanced diet did not suffer from scurvy.  

21st Century FOODS:
There are a lot of ways you can get food today. You can get foods from a restaurant that are made for you, you can get convenience food that you just heat in a microwave. There are also foods that have been processed and fortified so the manufacturer can claim you’ll get all your nutrition in a bar or a shake. You can even get your nutrition through an intravenous line (iv). Then there is the old fashioned way of whole foods that you put together and cook. We hope to show you that eating whole foods is simply better than eating fortified or convenience foods.

The disadvantage of whole foods is they have a short shelf life. Think of a ripe peach, it’s shelf life is only a few days.  Whole foods are quickly spoiled, can easily get bugs in them, mold, or become rancid. Many foods are processed so they have a longer shelf life. But when humans first started to process foods the processing removed some essential micronutrients, like vitamins- and people who ate a diet rich in process foods developed vitamin deficiencies. Vitamins are now put back into the processed foods– this is called “fortifying” foods. We do this with breads, cereals, juices, and infant formula.

The ability to chemically produce vitamins, and other micronutrients, had an impact in medicine. Putting nutrients into an IV has saved hundreds of thousands of lives. While people can survive on IV nutrition they cannot thrive on IV nutrition. Surgeons learned that it is better for  people to eat food, than to get nutrition from an IV. Think of IV nutrition as the ultimate convenience food.

Pikes Place MarketYou’ll see how it is better to be eating those foods that naturally contain nutrients, than to eat food that has been processed and requires fortification with micronutrients. This is the current state of affairs, and probably has to do with our limited knowledge of how certain micronutrients work together, how they absorb in humans, and perhaps there are more micronutrients to discover.

While we advocate the use fresh and local foods this is not always possible or reasonable. While Seattle has one of the oldest and best markets at Pike Street, a few miles away in the grocery stores you cannot get the same fresh ingredients. Many inner city folks only have processed foods to deal with. You have a unique advantage by getting and using them- and the advantage is taste and maybe better health (maybe). But if you miss the chance to get those foods, if you miss the chance to go to your local farmer’s market – you are missing out on some amazing local and tasty food.

Processed Foods: Any food that is modified in some way to be eaten
Fortified foods: Foods that have had vitamins and other micronutrients added
Convenience foods: Foods that have been processed and fortified for longer shelf life and pre-cooked or made easy to heat up to serve.

The nutritional information included on many recipes is little more than a wild guess. The cooking process changes the properties and concentrations of the nutrients in the foods, making any type of accurate analysis nearly impossible.

There is less fat and, thus, fewer calories in meat after you cook it.  Nutrients also change depending on how you cook the food: frying will be different than baking, which will be different than cooking sous vide.

Just adding up calories of the ingredients of a recipe won’t add up to the calories your body receives. If you cook with olive oil or butter, you won’t get 100 percent of the calories of that oil, only about 10 percent.

Cooking also changes how your body is able to process nutrients. Your body is able to get at more of the nutrients of cooked vegetables, even though the total nutrient count goes down. Cooking meat allows more proteins to be available for your body and also inactivates the animal’s hormones and other bioactive proteins.

Your genetic makeup determines how your body will process the food. One diet will not fit all.  Eskimo people can eat large quantities of fat and meat, but Eskimos cannot process simple sugars and carbohydrates the same way as a person of European descent.  On such a high fat diet Eskimos have low heart disease, until they have a western diet.  Scandinavian people easily process dairy products, but Mediterranean people do not process dairy effectively; dairy products for most Mediterraneans result in flatulence and weight gain. Science is just beginning to understand that our genetics plays a part in how we process certain foods. One diet will not fit all humans; one lifestyle will not fit all humans.


(1) Multiple studies showing that dietary supplements don’t reduce cancer risks, and may even increase it.  One has to feel sorry for people who take supplements thinking that they are doing something good for their health and yet the evidence is clear, and overwhelming- those who do not take supplements live longer. My concern always is that people eat unbalanced diets and seek to compensate by taking supplements.

J.Nati’l Cancer Instit Pub Med ID 22534785

(2) No association between dietary intake of vitamins, minerals, or fatty acids with colon cancer. Meaning- you can take all of those things and you still will get colon cancer at the same rate as if you didn’t take them. Even in the largest study looking at older men taking a multi-vitamin, while there was some decrease in some cancers – there was no decrease in mortality, death from cancer, or colon-rectal cancer.

Int J Cancer 2012 Pub Med ID 22139959

JAMA 2012

(3) Perhaps one of the most frustrating parts of anti-oxidants is that they work, in some level, in the laboratory with cells. But in clinical trials with people, they do not seem to work. Taking something that works in the lab, even with well worked out mechanisms in vivo, does not mean it works well in people. However, diets that are rich in anti-oxidants do benefit people, but not the supplements containing “anti-oxidants,” or the multi-level marketing programs selling anti-oxidants.

Molecules 2012 Pub Med ID 22418926

(4) Not only is there no evidence that antioxidant supplements prevent disease or ameliorate disease – there is evidence that some supplements increase mortality, especially Beta-carotene and vitamin E.

Cocharane Database Syst Rev 2012 Pub Med ID 22419320

(5)The agent in red wine is called resveratrol, which has been shown some benefit even with cancer. However, it does require higher doses than just a glass of wine. There are two ways of looking at this data – the use of resveratrol in a laboratory clearly has an effect, but to take 2000 bottles of wine to get that effect, makes one wonder if the effect on humans might be lost. Yet there is clearly a positive effect of those who have modest amounts of wine. 2000 bottles- I say, the journey of 2000 bottles of wine starts with a single glass – cheers.

J Diet Suppl 2012 Pub Med ID 22432802

(6)The intake of resveratrol in a dietary supplement doesn’t have any impact on DNA-stability  – which is how the higher dose works. It would take about 2000 bottles of wine to get the dose that has an effect.

Mutat Res 2012 Pub Med ID 2298176

(7) Scurvy is a miserable disease that is caused from a deficiency of vitamin C. Clinically sailors would get apathetic, bruise easily, old wounds and scars would open, and swollen legs.  In 1740 on one trip around the world the British Navy lost 1400 of the 1900 sailors, most to scurvy. James Lind was a navy surgeon who did experiments in 1747 and found that citrus fruits not only prevented but cured scurvy. Lind’s data was ignored by many, who felt scurvy was caused by the conditions of the life of a sailor. In addition, Lind suggested boiling down the lemons into juice. But when the juice was boiled it destroyed the vitamin C.  In 1794 when a 23 week trip to India, lemon juice was used daily and had no outbreak of scurvy made news throughout the British Navy. Among the British sailors in the West Indian colonies, found limes easier, and on that basis American sailors referred to the British Navy as “limeys.” Captain James Cook, on his journey to the Hawaian Islands, found that by providing sourkraut none of his sailors developed scurvy, and for that   It wasn’t until 1800, however, that lemons were used routinely in the British Navy.

Nutr Rev 2009 Pub Med ID 19519673

(8) The key of balanced diet discovered after years of unbalanced diets in the 16th and 17th century. Did you ever wonder about Eskimos and scurvy? Very little citrus fruit found in the far north, and yet there is no scurvy among Eskimos. It turns out that they get enough vitamin C through the meats that they eat – especially in the raw meats such as walrus (more about Eskimos and walrus tartar later).  To prove that you could avoid scurvy through a balanced diet, even before Vitamin C was synthesized in a laboratory, in 1928 anthropologists lived with the Eskimos and did not contract signs of scurvy.  Scurvy was not universal among sailors either – those who had a bit of a balanced diet, didn’t have this disease. While humans do not make vitamin C, and must get this micronutrient from diet, many animals do synthesize their own –and the highest concentrations in the liver of animals, lowest in muscles (typically we eat muscle as our source of protein). So while the Eskimo diet may not appear balanced to many, these people have been able to occupy this biologic niche on a diet primarily on foods that seem high fat.  The westernization of the Eskimo diet, has increased obesity and heart disease – those Eskimos moving to the city have higher levels of heart disease, cancers, and obesity.  When the traditional foods were examined, they also contained high levels of the micronutrients of Omega-3 Fatty acids, iron, phosphorus, zinc, copper, selenium, niacin, pantothenic acid, riboflavin, and vitamin B12. This has led some to claim that the diet of our ancestors, during the Paleolithic diet, is an ideal diet. In this case, the traditional diet of Eskimos would be high in fats, raw sea food products such as walrus, fish such as Arctic char, and seal oil. Not a diet that would be easy to follow for most in the United States. But remember, besides not having the lifestyle of the average Eskimo, we also do not have their genetic make-up, which makes them unique (see reference 15).

Clin Nutr 1992 Pub Med ID 16840004

Int J Circumpolar Health 2012 Pub Med ID 22818718

(9) Micronutrients were what chemists in the first half of the 20th century were trying to isolate to supplement processed foods.  The advantage of the processed foods is portability and stability. The processing of foods allowed humans to travel (bread for the west, and noodles for the Silk Road). But diets rich in some processed foods led to multiple micronutrient deficiencies, so chemists worked to isolate the micronutrients needed and return those nutrients to the processed foods to avoid deficiency. Beriberi is deficiency of vitamin B1 that was discovered when people ate diets high in white rice, but not brown rice.

In 1897, Dr. Christiaan Eijkman, a Dutch physician , demonstrated that beriberi is caused by poor diet, and that feeding unprocessed rice (instead of the white polished variety) to chickens helped to prevent beriberi. The following year, Sir Frederick Hopkins postulated that some foods contained “accessory factors”— necessary for the functions of the human body – we now call these vitamins. In 1901, Christiaan Eijkman in the Netherlands correctly interpreted beriberi  as a deficiency syndrome. Eijkman coined the term “vitamin.”

In 1929, Eijkman and Hopkins were awarded the Nobel Prize for Physiology or Medicine for this discovery. Hopkins later showed that margarine was inferior to butter because it didn’t contain vitamin A and D (ultimately margarine was supplemented with A and D, but it continues to be inferior).

These discoveries brought in the golden age of biochemistry with idea that we could isolate all the essential micronutrients, then put them back in processed foods, and led to finding the vitamins that were responsible for xerophthalmia, rickets, pellagra, scurvy, in addition to beriberi. By fortifying foods with these micronutrients led to reduction of widespread micronutrient disease in developing countries.

This worked with breads, cereals, juices, and infant formula. As much as we can get by with the processed foods with replacement of the micronutrients, there is a benefit to eating diets that are naturally rich in the essential ingredients. This may indicates that there are more micronutrients left to discover, as well as how these various ingredients are presented to our body makes a large difference in long-term health (see the next reference).

J Nutr 2012 Pub Med ID 22157539

Langenbecks Arch Surg 2007 Pub Med ID 17221268

(10) Cooking has an impact on what people can absorb and process from foods. The term we use is bioavailability- which is the amount of an ingested nutrient that is absorbed and available for use by the body. Another term we use is bioaccessibility, the amount of a nutrient that you eat that is available for absorption – and that has two components – how much can be released by the food matrix, and digestion. We use to determine the nutrients in a food from a chemists lab. The chemist would break down the food and determine the amount of micronutrients in that food. It turns out that people don’t absorb everything in food, and how you cook it changes how you absorb it. For example, if you take a carrot that is raw, a chemist can tell you how much vitamin A is in it. But that does not mean you will absorb all of that vitamin A. But if you feed the carrot to a person and measure how much vitamin A is in their blood and compare carrots that are cooked with raw carrots, it turns out that you get higher levels of vitamin A in the cooked carrots than in the raw carrots. This is how we know that people get more vitamins out of some cooked vegetables than raw, or how you get more when you cook some in certain oils than with others.

Another example is fructose in fruit. You can measure how much fructose is in banana – about 7 grams. But when you eat the banana only you might absorb less than half of that amount, the rest of the fructose is bound to fiber and isn’t available to be absorbed. In contrast with refined fructose, like a 20  ounce soda, would be the equivalent of eating 10 bananas (over half the fructose in a banana is not absorbed

Front Physiol 2012 Pub Med ID 22934067

Heat and cooking change the texture of beef and nutritional components. You have had the steak that is overcooked and dry, or the moist juicy steak. But heat not only changes the texture of the food – it also changes the macronutrients and micronutrients of the food.

J Agric Food Chem 2006 Pub Med ID 22062402

Throughout these references you will see a common theme: the supplement is not as good as the food. Omega-3 fatty acids are important, but taking fish oil capsules is not the same as eating fish. Think of the same thing with fortified food – it is like taking a supplement with a meal. You can sustain with these foods, but still there is something about whole foods we don’t YET understand.

(11) The Eskimo population has very low levels of an enzyme that is responsible for converting fat into usable energy (carnitine palmitoyltransferase). This is problematic with infants who are fasting because of illness, and the discovery of this has been an important therapeutic note for physicians who deal with Eskimo children. For if Eskimo children fast too long their blood sugar goes dangerously low and they can die. Sadly for the children, this is not an evolutionary advantage, but remember, in the remote arctic, infant mortality from disease is high anyway, having this enzyme does not change that. But this enzyme which accelerates the death from disease, is not a disadvantage, and may in fact me an advantage (decreasing the time of the disease, decreasing its ability to spread from one family to another). The evolutionary advantage of this enzyme is that it allows the Eskimo to store energy easily, and makes it difficult to take energy out of fat. In the western world, this means that Eskimos would store processed carbohydrates all too quickly, leading to obesity. But it also affects them into adulthood. This genetic anomaly, once thought to be rare, is common among aboriginal arctic people. But this points out how one cannot take one “diet” and assume it will work with all people. The genetics of diet are just starting to take be learned. For the adults, the ability to quickly store, and to make it difficult to utilize fat is evolutionary advantageous in this society – it allows them to survive famines particularly well. J Lipid Research 2012 Pub Med ID 22045927

24 Hour Flu Does Not Exist: Its Food Poisoning


Food Poisoning: Don’t Get Mis-Diagnosed

dr terry simpson arizona lap band

In the kitchen and in the Operating Room

You wake up feeling like you are hung-over, muscles hurt, then you realize you need to run to the bathroom. You call in sick to work, and spend the day in bed – quietly hoping your intestines will calm down and while you don’t feel like eating – you just want to keep down some water for a bit. The next day you wake up feeling fine- maybe a touch weak, but ok.  It isn’t the flu, you were poisoned.

No virus, influenza or otherwise, lasts for only 24 hours.  When flu season comes, that miserable virus will last 2 to 3 weeks. What does last for that period of time is food born illness. So  before we go into that– be sure to get vaccinated against the flu!


Kitchen Safety and Avoiding Food Poisoning

Food poisoning (technically we doctors call it foodborne illness) happens when we eat or drink something that is contaminated with bacteria, parasites, or viruses, or with some chemical that causes illness.

FACT: Every year 48 million people in the United States become ill from food, 128,00 are hospitalized, and 3,000 people die from foodborne illnesses. 

With chicken we worry about salmonella.However, if you are cooking above 130°F, the salmonella bacteria are unable to grow, as are all other common bugs. Still, food safety is important. Wash hands after handling raw meat, and wash all surfaces and utensils after they come in contact with raw meat. It is more likely that the raw meat will contaminate those surfaces and that those surfaces will pass the bugs onto other foods than you becoming sick from the meat directly.

For beef, the FDA states that it is safe when kept at a temperature of 130°F for 112 minutes or 140°F for 12 minutes. The temperature of a rare steak is between 130°F and 139°F in the center. By cooking the steak for 45 minutes at 136°F in a sous vide water oven, you will keep well within the recommended limits. Some cook the steak longer—two to four hours—but I find that 45 minutes for a 1-inch-thick steak works well. The fast grilling of a steak or standard cooking will also kill those bacteria.


avoid food poisoning

Proper handling of poultry – includes washing all surfaces and utensils

The biggest issue with bacteria and food safety is cross-contamination. This means the bugs from one food are passively transferred to another food, where they grow. For example, if you wash some raw chicken in the sink where there is a cutting knife, you can contaminate that knife with bacteria. If you clean the knife insufficiently to rid it of the bacteria and then use it to cut some cooked eggs, these eggs can become the perfect place for bacteria to grow like crazy (especially if the eggs sit at room temperature). If you eat the eggs, you can get sick from the chicken (so the chicken came first). The lesson here is that if you wash raw poultry in the sink, be sure to have that sink cleaned out well to avoid cross-contaminating other utensils or serving dishes. Anytime you handle any raw meat or eggs, treat everything they touch as if it just came out of the toilet.

Do not use the same cutting board for raw and cooked meats. If you own only one cutting board, be sure to wipe it down with a bleach solution after cutting raw meat on it.

If you use a knife or fork or any instrument on raw meat, wash that utensil carefully. Essentially, consider raw meat to be contaminated, along with anything it touches: you, your clothes, your cooking utensils, your cutting boards, and your knives. Remember, when people get sick from the bacteria from raw meat, it is typically because of cross-contamination from other foods, from food workers improper techniques.

Refrigerate all foods promptly. If food is at room temperature for more than two hours, it may not be safe to eat. The bacteria that cause food poisoning typically do not produce an odor or change the texture of the food. Think about this the next time someone invites you to a buffet.

Make certain that your refrigerator is kept at 40°F or cooler, and that there is plenty of room for air to circulate in the refrigerator. Keep the freezer at or below 0°F.

Wash your hands carefully. I use a special soap made primarily from alcohol, the same type of soap surgeons use before scrubbing in the operating room. You can purchase this from most stores; one brand is Purell. Always wash after handling raw meat, poultry, fish, shellfish, produce, or raw eggs. Scrub and lather for at least for 20 seconds after handling any raw meat. An easy way to do that is to sing “Happy Birthday” to yourself twice while scrubbing your hands.

Wash all fruits and vegetables under running water before eating or cooking them. Use a vegetable brush to scrub melons and cucumbers, and then dry with a paper towel. Consider the vegetable brush contaminated, so sanitize it frequently.

It is better to throw out food than to be sick. Don’t be afraid to toss out any food that makes you suspicious.

How do “they” decide how much and how long to cook? Microbiologists have determined how much heat and time is needed to kill 90 percent of the bugs To kill 99 percent of the bugs you have to cook the food for twice as long (or increase the heat).

MYTH: You want to kill all those bugs!

Using a digital thermometer means never guessing

No, let’s not. First, it is probably impossible to do that. Second, the longer you cook something or the higher temperature you cook it, the more the heat will affect the flavor of the food. There are no guarantees that overcooking food will make it safe, or that under cooking food puts you in danger.

Because it is an average, the standards are much higher than commonly needed. Even if you were to kill 99.9999 % and someone’s thermometer was off, or the oven was not heating properly, then overcooking provides some safety but at the expense of flavor.

The entity responsible for this in the U.S. Department of Agriculture (USDA) is the Food Safety and Inspection Service (FSIS). As with most government bodies, it has a scientific advisory panel that makes recommendations. The advisory panel found that the FSIS figures for poultry were way too high. The FSIS recommends temperature and time enough to kill 99.99999 percent of the bacteria) but the panel recommended enough to kill 99.995 percent of the bacteria. At 122°F there are no bugs that are known to survive – on this planet.

“But on Chopped they reject under cooked food!”
I’m a huge fan of the Food Network. On the show Chopped you will see the judges reject food that they consider “under cooked” or “raw.” Are they crazy? Well, they might be (most chefs, like surgeons, get a bit nutty). But they sometimes are overdoing it when it comes to chicken or worrying about cross-contamination in a 20- to 30-minute contest. The funny thing is they will eat something that a chef has double-dipped. (The mouth has a far higher bacteria content, but if they would kiss it, they eat it!) The bottom line: over cooking foods ruins the flavor and texture. Pork can be pink, and chicken should not be cooked to an internal temperature of over 145 – and use a thermometer (guessing is never precise).

My favorite quote is from Chef Gordon Ramsay, who on his show “Hell’s Kitchen” will scream at the contestants when they under cook food (they usually under cook scallops or halibut on the stove top). He yells: “It’s raaaaaw!!!” Then tosses the food on the floor or in the trash.



(1) The loss from food borne illness in the United States is about 77 billion dollars a year.

J Food Prot 2012 Pub Med ID 22221364

(2) The time and temperature combinations for beef can be found from the Food Safety and Inspection Service guidelines. The part of their Chart is here: Min Internal Temp F 6.5 log lethality 7.0 log lethality 130 F 112 min 121 min 135 F 36 min 37 min 140 F 12 min 12 min 145 F 4 min 4 min 150 F 67 seconds 72 seconds The 6.5 log lethality means you are killing 99.99997 percent of the bugs (also called 6.5D) . A 7D lethality means you are killing 99.9999999 per cent of the bugs. If you have highly contaminated poultry (37,500 bacteria per gram of raw meat) then 3.5 ounces of meat would have 5.4 million Salmonella. To drop 7D means you would reduce 10 million pathogens to one bug. It takes about 105 Salmonella per gram of food to cause illness, less Salmonella than that cause no clinical symptoms. Thus, with worst case scenario you could kill just 99.999 per cent of the bacteria and not have symptoms (a 5D reduction).

Min Internal Temp F 6.5 log lethality 7.0 log lethality
130 F 112 min 121 min
135 F 36 min 37 min
140 F 12 min 12 min
145 F 4 min 4 min
150 F 67 seconds 72 seconds

The bacteria E. coli strain 0157 can cause illness with as little as 10 bacteria per gram of food. Thus a 6.5 D would not be adequate but a 7D would. As you increase the temperature, it decreases the time – it is a logarithm scale, which is why the drop in time with an increase in temperature. In low temperature cooking (Sous Vide), medium rare beef is typically cooked at 136 degrees for 45 minutes to an hour. That, combined with the searing of the surface at 400 degrees (most bacteria would reside on the surface of the meat) in addition to seasoning the surface of the meat with salt,which also kills bacteria, provides a large margin of safety. Most bacteria do not live above 120 degrees, and as you increase the temperature you kill more of them. At 102 degrees most bacteria can no longer reproduce- which is the protective nature of human fevers.

Sous Vide – its quite safe

(3) There are many ways of becoming contaminated by food workers. Most food illness comes from food workers, not from cooking. Another reason to cook and eat at home.

J Food Prot 2009 Pub Med ID 19205488

(4) Hand washing guidelines can be found at the CDC website. The keys are to not wear rings, jewelry, watches when handling raw food. Soap and water are fine- keeping the water running or turning on the water with a paper towel works. After any food preparation, and as often as needed, to remove contaminated residue. Remember, before handling food to wash also- consider your hands unclean.

I like to hand wash by singing “Happy Birthday” twice – then I know I am done!

Parts of this post come from our new book coming out soon — (we hope) – called JUST EAT.



MSG: Does Chinese Restaurant Syndrome Exist?

Mono-sodium-glutamate (MSG) – the cause of “Chinese Restaurant Syndrome.”  It turns out  this syndrome is a myth.

The syndrome was first reported in a letter to The New England Journal of Medicine in April of 1968. A physician wrote that he developed a syndrome which he thought might be associated with salt or MSG, and asked the medical community to respond to this syndrome. He described the symptoms as “ numbness at the back of the neck, gradually radiating to both arms and the back, general weakness and palpitation.” He said several of his friends had it also. He speculated that it might be the cooking wine, or the soy sauce- although the restaurant he went to used the same brand of soy sauce he used. He also noted his friends suggested it might be the seasoning of MSG used by the restaurant. (1)  The next month ten letters responded – one didn’t think it was MSG, one noted it didn’t happen in all Chinese restaurants – and might be placebo, and another reported a patient developing a stroke after eating the food. The media picked up the new disease “Chinese Restaurant Syndrome” and it became a food-type allergy. Ten months later the journal Science reported that Monosodium L-glutamate “is the cause of the Chinese restaurant syndrome and can precipitate headaches.” (2)  The report in Science, was written by one of the people who wrote the letter back to NEJM that May, Dr. Schaumburg. In fact, a later one of his letters was initially done in great humor, “ With the enthusiastic co-operation of the Shanghai Cafe one of us ate Chinese food for breakfast, lunch and dinner until the search had been narrowed to either hot and sour soup or wonton soup, both of which produced the reaction. A rough filtrate of wonton soup also produced the reaction. Upon sampling of the individual ingredients, the dagger of suspicion pointed at monosodium glutamate. Further experiments confirmed this suspicion. The experiments were performed with the use of approved blind and double-blind technics on three volunteers. If the suspicion that irresponsible human experimentation was done has crossed your mind, be at ease. The days of Walter Reed are not past.” (3)


My mother had this in her kitchen. Pure MSG – it made food taste a lot better

The MSG Follow Up Research
Forty years after that original letter, and in spite of years of trials, and clinical trials, it was finally put to rest that “so-called ‘Chinese restaurant syndrome’ and in eliciting asthmatic bronchospasm, urticaria, angio-oedema, and rhinitis. Despite concerns raised by early reports, decades of research have failed to demonstrate a clear and consistent relationship between MSG ingestion and the development of these conditions.” (4)

In spite of good clinical data putting this myth to rest, there will be plenty of people whose confirmation bias tells them they cannot eat in Chinese Restaurants, and will blame MSG, all the while not realizing that without MSG their bodies would cease to function, and that there is more MSG in the Italian food they prefer, than the Chinese food they shun. In test after test, MSG was not any worse than the placebo given in random studies.

In 2011 the Food and Drug Administration’s committee on GRAS (Generally Recognized as Safe) substances stated this: “  There is no evidence in the available information on L-glutamic acid, L-glutamic acid hydrochloride, monosodium L-glutamate, monoammonium L-glutamate, and monopotassium L-glutamate that demonstrates, or suggests reasonable grounds to suspects, a hazard to the public when they are used at levels that are now current and in the manner now practices. However, it is not possible to determine, without additional data, whether a significant increase in consumption would constitute a dietary hazard.”  Much like salt, too much isn’t a good thing. (5)

Why MSG is so Important to you
Proteins are made up of molecules of amino acids – some of those amino acids our body can manufacture (they are called non-essential because we do not need to get them from our diet) and some amino acids we must obtain from our diet (called essential amino acids). Glutamic acid, and its form MSG, is a non-essential amino acid – meaning, our body produces glutamate and uses it to build the proteins we need. Without MSG you would be unable to build proteins, run the metabolism your body needs– without this amino acid you would not exist.While glutamic acid  is present in every food that contains protein, umami can only be tasted when it is separated from the protein – and functions as an individual amino acid.

MSG – It is one of the tastes you perceive
Before MSG was known for “Chinese Restaurant syndrome” it was used for the flavor it produced, to enhance food.  MSG  produces a  distinct savory flavor that is called Umami. MSG is a common additive in China- while visiting you would see it used almost as we would use salt here. In the United States MSG was sold under the name “Accent.”

China Lamb

In every market in China, such as here in Xi’an, one of the common flavors added to foods is MSG

We have discovered that humans have taste buds for  Glutamic acid  (MSG).  That flavor, umami, or savory (meat-like)  stimulates specific receptors located in taste buds, and is now recognized as one of the five basic tastes in addition to sweet, salty, sour, and bitter.  MSG is found in many foods, especially in parmesan cheese, tomatoes, soy sauce.  One would think if MSG was a real problem there would be an “Italian Restaurant Syndrome.”

There is no one region of the tongue that tastes sour, salt, bitter, sweet, or umami.  You may have seen “tongue” maps that show this, it turns out that the taste buds are distributed throughout the tongue. The entire tongue, has taste buds throughout – as well as the intestine (but that is for another blog).

Balance of flavor
If you ever eat something that is too salty, you want to balance it with sweetness – why we love dessert. But umami, that savory taste is why we love the balance in Italian cooking. We add Romano cheese to noodles to enhance the “flavor” – romano is filled with umami. America is in love with ketchup, and tomatoes provide that unique umami flavor. In Japan, instead of adding Romano or Parmesan to their noodles, they are judged by dashi – a broth that is made with seaweed (kombu) that has lots of MSG (and where some of the original MSG was derived from).

While in China, our favorite places to eat were on the streets – and beside almost every wok was a bowl of MSG – used to liberally season the foods, much like we use salt here. Street food in China is among the best food you can get. Some have even suggested that the balance of flavor that umami provides is one reason the Chinese are not subject to obesity (more about that later).

In Australia and the United Kingdom Vegemite and Marmite are all MSG or glutamate based – and all an essential part of that culture.

We are born to appreciate that flavor- human breast milk has almost 3o times higher glutamate than cow’s milk.

In my home state of Alaska, we prefer oysters, clams, and crabs when harvested in February through March – and it turns out they have their highest level of glutamates then. One would think that the Bering Sea would be better to harvest in the tranquil months of summer, but in August the lowest levels of glutamate are then, and Natives will tell you there just isn’t the flavor of the crab that you would like.

Whale Tale

August is great in Alaska to see whales, but not great for getting oysters, clams, or crab – the MSG levels are too low and they have less flavor

If you have an imbalance in flavor, then you compensate. Umami, it has been suggested, would provide a better balance if used more in foods. In other words, the emphasis on fat, sweet, and salty has led to some of the obesity, had there been more emphasis on umami, less food would be consumed, because there would be more of a balance. (6)

MSG and Obesity:

Apparently this “non essential” amino acid is now being blamed for obesity and short stature.  As you can see by reference (6) MSG can be used to help regulate appetite. Then came a paper in 2011 (7) claiming to show a correlation between MSG and obesity.  Sadly- this was one of the most poorly written papers, and was taken apart for multiple flaws in (7). To quote them: ”

Finally, even though observational studies often provide useful information for hypothesis formulation, given the significant questions and concerns raised in this study, it is premature to even generate a plausible hypothesis on MSG intake and obesity.

The current epidemic of obesity is worldwide, including in Asia. Because MSG has been extensively used as a flavoring agent in Asia, it could also potentially play an important role of enhancing palatability and acceptability of calorie-reduced diets. Until further confirmatory information becomes available, extreme caution needs to be exercised not to raise undue public safety concerns regarding MSG consumption.”


(1) Chinese-Restaurant Syndrome. Kwok, RHM. N Engl J Med 1968; 278:796April 4, 1968 (Letter to the editor)

(2) Monosodium L-glutamate: its pharmacology and role in the Chinese restaurant syndrome. Schaumburg HH, Byck R, Gerstl R, Mashman JH. Science. 1969 Feb 21;163(3869):826-8.PMID: 5764480

(3) Sin Cib Syn: Accent on Glutamate. Schaumburg HH, Byck R, N Engl J Med 1968; 279:105-106July 11, 1968 (Letter to the editor)

(4) Monosodium glutamate ‘allergy’: menace or myth?Williams AN, Woessner KM.Clin Exp Allergy. 2009 May;39(5):640-6. PMID: 19389112

(5) From the US Food and Drug Administration GRAS database.

(6) Umami flavour as a means of regulating food intake and improving nutrition and health. Mouritsen OG.  Health. 2012 Jan;21(1):56-75. PMID: 22544776

(7)↵ He K, Du S, Xun P, Sharma S, Wang H, Zhai F, Popkin B. Consumption of monosodium glutamate in relation to incidence of overweight in Chinese adults: China Health and Nutrition Survey (CHNS). Am J Clin Nutr 2011;93:1328–36.

(8)A lack of epidemiologic evidence to link consumption of monosodium L-glutamate and obesity in China.vBursey RG, Watson L, Smriga M.Am J Clin Nutr. 2011 Sep;94(3):958-60; author reply 960-1. doi: 10.3945/ajcn.111.020727.