Beer Diet: What We Learned

The “Beer Diet” – I’m the doctor that supervised Evo Terra as he spent every October for the last three years drinking beer and eating sausages – and while doing this lost weight, lowered his cholesterol, lowered his body fat, and lowered his C-reactive protein and blood homocysteine levels (measures of the body’s inflammatory response).

Here are the Five big lessons we have learned from this experiment:
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Bacteria, Heart Disease, and Red Meat and eggs?????

Bad News for Red Meat: Well, read the fine print
There are more bacteria in your colon than people on planet earth. Without bacteria people couldn’t survive or thrive. Bacteria are responsible for us being able to get vitamins, they break down fiber into chemicals that protect us against colon cancer. Now, in a study recently published in Nature, proposing that red meat leads to heart disease through bacteria.

The mechanism is a byproduct of the metabolism of some bacteria called TMAO (trimethylamine N-oxide) which, in some studies, is correlated with an increased risk of heart disease.

is red meat healthy

In the experiments conducted they took meat eaters and vegans and fed them steaks. Why I wasn’t invited to participate is clearly an oversight – after all, steaks…. They discovered when red meat eaters ate steak their level of TMAO went up, but not if vegetarians ate it. They even discovered it wasn’t the meat, but rather the carnitine in the meat that did this (a common supplement in protein drinks for those who want to look like Arnold Schwartzeneger on steroids).

Takes a bit of presumption doesn’t it. But lets work backwards from this hypothesis and start with a favorite saying:

Correlation does not equal Causation
The evidence that red meat causes an increase in coronary artery disease is mixed, at best. The latest study showed there was no evidence that this was an independent risk factor. Smaller studies such as the Nurses Health Study and Health Professional Follow-up study showed an association with a relative risk factor of much less than 2. I blogged a summary of those studies.

Your Gut and Bugs
The bacteria in your gut are important. They protect you- by simply occupying space, they prevent bacteria that are harmful to you from finding a home, as well as  parasites, yeast, and perhaps some viruses.  It has been estimated we have over four pounds of bacteria in our gut. Just a few other numbers that are fun: it is estimated there are over 100 trillion bacteria in our gut (the human  being is made up of about 10 trillion cells, so there are more of them than there are of us – or, a philosopher might ask – who are we really).  We have grown only about 70% of the bugs found in our gut, or so we guess. The byproducts of these bacteria include chemicals that prevent fungus from taking hold,  prevent other bacteria from getting close, and they alter the pH of the gut to keep it comfortable for us and our friendly bacteria, but not so much for the bad bacteria.

These friendly bacteria help produce vitamin K, and biotin. In addition to helping ferment other substances that our body cannot break down, and by breaking down those substances make them available for us to get nutrients from them. While humans cannot digest fiber, some of the bacteria in the gut can digest fiber, and the byproduct of that digested fiber is an agent that decreases the risk of colon cancer (our poop has stuff that bacteria eat and bacteria poop keep us from getting cancer). Is it possible that the bacteria in our gut could create something that makes it more likely for us to have heart disease, or cancer? Yes, it is quite possible.  What you eat does alter your gut bacteria. Who you kiss alters your gut bacteria. Who your parents are alter your gut bacteria. When you get an antibiotic, your gut bacteria change.

With some antibiotics and a combination of stomach acid reducing agents (Prevacid, Nexium, etc) a bacteria that overgrows the colon called Clostridium difficile  (C diff).  This bacteria so overgrows the colon and as a result people can develop ulcers, bleeding, toxic mega-colon, and perforation as well as death. This is a concern for surgeons, something we encounter far too often.

Some people can get overgrowth of bacteria in their small bowel that can lead to malabsorption of nutrients including bloating, nausea, diarrhea, constipation, and long term problems like  anemia from iron malabsorption, and has been linked with some auto immune diseases.

Think of your gut like an eco-system. If it is in perfect harmony, you benefit from it. If not, an overgrowth of one or another bacteria can lead to problems. 

Diet certainly affects which bacteria inhabit your gut. The big question remains, is there a diet, or set of foods, that will encourage the gut to have more “friendly” bacteria and less “bad” bacteria. Here is the realm of speculation – other than a diet rich in fiber being healthy, we don’t have a great answer.  This doesn’t stop people from speculating about one diet or another being better.  In this case, the speculation would be that vegans and vegetarians eat a diet that keeps the bacteria that produce TMAO to a minimum.

And the colon- remember, people have been telling you for years about how bad the colon is- from Kellog and his enemas (he died in his 60′s from heart disease, was a perfect vegetarian and loved colonics) to modern day colon cleansers.  No doubt there will be on Walgreen’s supplement shelves a pro-biotic that will get rid of the bugs that make TMAO.

Gut bugs and Diet
There are three types of gut flora that have been described based on the diet that people have. The “enterotypes” are descried as Prevotella, Bacteroides, and Ruminococcus.  Each one associated with a specific type of diet. Prevotella comes from diets with lots of simple sugars, or high-glycemic index carbohydrates. Bacteroides is associated with animal proteins, or the typical western diet. It is those people who have the Prevotella species that had a higher TMAO blood level. Oddly 3 our of 4 of the subjects that had the Prevotella species were omnivores.

In another study showed that these broad enterotypes were associated with long-term diets. When people were fed a controlled diet the enterotypes remained the same during the ten day study. While some bugs changed quickly, it appears your gut ecology takes a while to change – which, if you think about it, is not surprising.

You are probably thinking- 100 trillion bacteria, and the population of some types more than others?  Think of the United States with its population and other countries with their population. In Norwegian countries there are more Scandinavians, in Italy there are more Latins – now think of your gut. In Vegans, there are going to be more bacteria that do well with their host who eats vegetables – and in omnivores, the bacteria that populate it will likely be more of those that like chewing on remnants of meat.  The hypothesis here is that those bacteria produce more TMAO, and thus meat eaters, when given meat, make that harmful substance that leads to more cardiac deaths (forget that this is a poor correlation in any study looked at, just go with it for a bit). Now- bacteria don’t just eat meat and poop out TMAO – there are enzymes involved in the conversion to this “deadly” substance – and one of them is Vitamin B2, which is typically LOW in vegetarians.

What about TMAO and the Nature Article?
One arm of the human study was with six people.  Five of them were meat eaters and there was one vegan. This is little more than an observation, and hardly  enough of an observation to make headlines.  That one vegan didn’t make TMAO means nothing. It could be that the vegan had antibiotics recently, it could be that they are an exception, it could be a lot of things. The one vegan was a male, and the non-vegans were females – and when the statistics were examined carefully – well, not a difference. But significant, even as an observation – nope.

Of course of the 23 vegans/vegetarians and 30 omnivores they looked at the bacteria in their stool (reminds me of the movie The Madness of King George – when they were obsessed with his stool) – and found the different types of bacteria attempting to correlate those bacteria with meat eaters or vegetarians. The problem was, some of the individuals with the “good bacteria” were omnivores.

The Nature article also looked at a mouse study. Mice are not humans, but with mice they didn’t feed them steaks. Instead they used carnitine. Carnitine is an amino acid, often used in supplements, but your body makes this amino acid naturally. To date there have not been studies that show that carnitine rich foods increase TMAO, in fact the one food that elevates TMAO is some seafood. Seafood, by the way, is associated with decreased risk of heart attack.

In the mouse study they fed them enough carnitine to the equivalent of a human eating about a thousand steaks a day. And I would submit if you eat that many steaks a day you might have some problems. The other issue is this: the gut bacteria of the mouse are not the same as the gut bacteria of the human. Are you a man or a mouse can apparently be answered by checking your fecal bacteria.

AND NOW EGGS?

It is the same argument and discussion for eggs. Turns out that the correlation with eggs and heart disease is zip. In fact, one of our patients finished a month of eating nothing but eggs and saw his cholesterol drop! Again, this is just a bad article with a lot of bad press.

A House of Cards
This study and news report is a part of a house of cards. Conclusions built upon conclusions, with a benign observation from one vegan, and a study in mice. In their conclusion the Nature paper stated that this went along with evidence of risk reduction for non red meat eaters and they cited the Mediterranean diet study in NEJM.  What they fail to grasp is that diet didn’t show a decrease in heart attacks, or heart related events, only a decrease in risk of dying from a stroke – and no absolute decreased risk of dying.

This study again falls into the “red meat is bad,” and shows two things: studies that make headlines in newspapers show that in the slow death spiral of print media they fired their science reporters first  and second, if you want your study to get headlines, find something that shows what the popular press thinks is true.

Saturated fat and cholesterol in beef don’t cause heart problems, and your body makes more carnitine than you get from your diet by a factor of six (unless you are a mouse that is force fed).  TMAO is a huge byproduct of fish, and fish eaters seem to have longer lives and less heart disease.

So- this study make sense to you? Is there maybe a message here? One thing is certain: vegetables are not bad things for you. While some of the omnivores in this group had “good gut bacteria” it could be because they ate a lot of vegetables. So- if I were you, I’d make sure I had plenty of that good old fashioned fiber in my diet.  Who knows, maybe that helps the good bacteria from having heart attacks.

steak and beans

REFERENCES:

The red meat article, published originally on Nature.com

Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013 Apr 7  Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, Britt EB, Fu X, Wu Y, Li L, Smith JD, Didonato JA, Chen J, Li H, Wu GD, Lewis JD, Warrier M, Brown JM, Krauss RM, Tang WH, Bushman FD, Lusis AJ, Hazen SL. PMID: 23563705

Here is the article showing that fish and other sea products give rise to increases in TMAO more than meats.

Dietary precursors of trimethylamine in man: a pilot study. Food Chem Toxicol. 1999 May;37(5):515-20.  Zhang AQ, Mitchell SC, Smith RL. PMID: 10456680

Here is an outstanding article by Chris Masterjohn that gives a far more in depth analysis than I did.

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.

 

 

 

REFERENCE:
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.

Definitions:
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.

REFERENCES:

(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