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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Obesity and Patients

Obesity and Patients
This is probably one of the best videos that I have seen recently about the causes of obesity and how we treat our patients. It is something that we physicians must remind ourselves of constantly: to treat patients with compassion and empathy.

But the second message is also important: we don’t know what causes obesity – and the old thoughts about eating too much are no longer valid. We do know this, it isn’t what you eat, it is how your body processes the food. Too much processed grains, sugars, carbohydrates – are not good – and moving away from a diet of those will be important to the lifestyle change any who wish to lose weight and keep it off will have.

If you wish to lose weight, we know that you must change what you eat. The one thing all experts agree upon now is this: avoiding processed grains and free sugars. Both plant strong diets, and paleo diets preach this. It isn’t just calories.

So the first step for many of my patients is this: learn to cook – and for me- this is the mission for all of my patients. And we like it when they start young.

JJ and the kitchen

Starting kids early – learning to cook, appreciating good food- is one of the best starts you can do for your family

Identifying Yourself with Your Diet

Raw Food, Vegans, Paleo, and Your Identity

T Rex

Did T Rex become extinct because they were not vegan, or because their arms were too short to floss?

Did you ever meet a vegan who, in the first 20 minutes of conversation, doesn’t let you know they are a vegan?  How about someone who only eats raw food? Or someone who eats “paleo?” People self-identify with the food they eat – believing that somehow, by only eating  in one manner they are (a) eating healthier (b) protecting the world from itself and (c) superior to others because of their chosen diet.

People who change their diet are often changing from a typical American diet to something better. Like the person who finds religion, or the smoker who quits, they become a food evangelist.  For the first time in their life they are paying attention to what they are eating – or as they like to say what they are “putting into their body.”  Their bias is that ” they feel better ” and they don’t hesitate to tell the world how their diet is working for them. Then they start reading more and more about how their diet is better – and there will be thousands of articles one can find about it.  They will spend countless hours researching and confirming their bias about a particular diet. Then they will flood social media with citations. Never did they convert from a “balanced” diet to “veganism” or “paleo” –  they always went from typical American junk to a diet where they paid attention to what they ate.  Never considering that simply eating better and avoiding junk was the reason for their improved “health.”

Cartoon from APEY

Then there are those who seek to put everything into a shake, or a bar, or a pill. Mix this protein powder with this supplement powder, and while you are at it toss in a supplement or two. Ok, it may not taste great but don’t you feel better (healthier) and superior to those who are eating that burger? The extreme of this is what we physicians can do intravenously – feeding a person by IV. Physicians do that, we can put every micro and macronutrient into an iv bag and feed a person. It saves lives when we do this to patients in the intensive care unit, or people who have lost their guts and people can live on this, but they cannot thrive on that. So before you buy into that latest shake or bar, or pill, think that real food, not highly processed is far better and healthier for you.

Five myths about eating and diets that might surprise you:

(1) Raw vegetables are better for you and contain more nutrients than cooked

False: People cannot break down the methylcellulose that is the cell wall of plants.  Hence, when you study people who eat raw food, versus the same vegetables cooked- and then test their blood to see who has more micronutrients (vitamins, minerals, and other good stuff) – the cooked vegetables and fruits provide more nutrition than the raw.

The reason raw food people lose weight is because they don’t get as much nutrition from raw foods as cooked. The ability to cook allowed more nutrients to be available, and some evolutionary biologist state this is why early man was able to leave sub-Saharan Africa and go throughout the world. Today people will starve themselves eating raw food, but feel they are eating better, lose weight – without any concern with a balanced diet.

(2) Vegans live longer 

This is false. When you look at broad categories, the longest living group in study after study are those who primarily eat fish for their protein, not vegans. Next come vegetarians, then vegans – who have about the same lifespan as meat eaters. Some will tell you about The China Study but that had a number of flaws.

 

(3) Red meat is bad for you

Red Salmon

People who primarily eat fish live longer than vegans or vegetarians

Too much of anything is bad – be it red meat, carrots, or celery. But red meat is easily broken down by the body, provides enough nutrients and in the latest study out of Europe, with over half a million people (the largest study ever) there was no association with red meat and cancer.

(4) Cavemen ate without certain foods like wheat and they lived well so we should because we have not had enough time to evolve to eat things like gluten.

False again.  First a genetic mutation happens in one generation, not thousands of years. Second, in spite of the paleo-folk thinking that it takes 10,000 years to make a genetic change (see above) we have been grinding plants into a flour since at least 30,000 years ago. There are clearly people who should not eat gluten, just as some people should not eat peanuts, but that is not the majority of people.

Speaking of cavemen – noodles have been found in ancient China, and it was noodles that allowed trade between China and Rome (the Silk Road).  A pot of noodles from 4000 BCE has been found (I wonder if it should be cooked with pork or chicken?).

(5) The human is meant to eat (or not eat) ( fill in this blank).

 

What should we eat, Dr. Simpson?

There are a lot of people out there who will try to convince you that the body is only meant to eat meat, or vegetables, or not eat something else. They have diagrams of teeth, comparing to other teeth of other animals but here are a few clues (a) we evolved from them (b) the primates that ate primarily vegetables have not survived well and (c) we have societies from pure meat eaters to almost pure vegetarians who have all lived well and prospered. The human body is quite flexible.

In the last year we have had one person eat sausage and beer for a month – lost over 15 pounds, and liver enzymes were fine, but the cholesterol lowered as did lipids. Then eat nothing but eggs and beer for a month with similar results. We also had someone do nothing but shakes and smoothies for a month with similar results.  What did they prove? That if we limit our intake of food, which all of those did, and keep things in a bit of a balance, you can do just fine.

Mummies & Eskimos with Heart Disease: it isn’t Modern Diets that are the Problem: The People of St. Paul

The recent study that came out showing that ancient people had heart disease, including a group of Alaska Natives whose mummified remains revealed that the perfect paleolithic diet did not protect from heart disease. Funny thing, Alaska Natives have known this for years. While some may want to say our diet is the ultimate, we have known it is just our way to survive – to live.   St. Paul is a small community of several hundred in the Pribilloff Islands. A remnant of the ancient people of Alaska, with only minimal changes from our paleolithic era.

Most people would never know about these islands were it not for the TV series, Most Dangerous Catch.  It is these islands that the crab fisherman come to process some of their crab. Viewers of the show will recognize the name of the place.

St George Island from St. Paul

In the distance is St. George, the smaller of the two islands. St. Paul is 7 miles wide, 14 miles long. Formed from volcanic activity.

Lonely islands, in the middle of the Bering Sea – but home to some of the most ancient people on earth. St Paul is a three hour flight from Anchorage. Sometimes the weather is so fierce that people have been unable to leave the island for several days.

Like their ancestors, these Alaska natives get their food from fishing. Halibut, crab, salmon, char, and the occasional seal. The only thing that has been introduced into their diet has been the reindeer herd on the island – that would provide a bit of our dinner that night. While there is a single grocery store, products from the lower-48 are expensive and not often used.

The recent Lancet article stated:

 

The presence of atherosclerosis in  pre-modern human beings suggests that the disease is an inherent component of human ageing and not  characteristic of any specific diet or lifestyle.

alaska Aleut

The Aleuts, or Unangan, peoples inhabit the western most part of Alaska – purple. The two little spots above the t in Alutiiq is where St. Paul Island is-

In the article they had studied   mummified remains of Alaska Natives, my ancestors. The Aleuts  live on the  islands in the western part of Alaska.   These islands, formed from mostly volcanic formation, to this day are rich in marine life, with abundant fish, seal, whales, and occasional berries.

I was last there when invited to a celebration in St. Paul because of their new clinic. A beautiful facility, staffed by physicians out of Anchorage. But this facility is vital to the community.

St Paul Seals

The island is a natural breeding ground for seals, who migrate here yearly. The Russians forced Aleuts to inhabit the island to harvest the seals

The island was originally uninhabited until the Russians arrived. Used primarily as a hunting area for natives, then the Russians discovered the great seal population they forcibly moved hundreds of Aleuts here to harvest the fur.  Those families still remain.

Why, you might ask, should you think about Aleuts?  Why do food scientists think about them? These were/are one of the great hunter-gathering societies, eating a diet of fish, meat – even getting their vitamin C, not from citrus, but from marine life. Those relatives, my ancestors, had a diet rich in omega-3 fatty acids, did not eat processed grains – in fact, they rarely had any food but what would be the ideal paleo-rich, non-processed, occasional berry (in season – fresh and local) diet.

For the study in Lancet, it was made possible to see what my ancestors ate because  the climate in these parts allows mother nature to mummify the body, making the bodies available to study.

St Paul

Main Street in St. Paul. They have one bar, one post office, one grocery store, and one church

This group was use to physical activity, without animals to transport them they relied on the kayak for whaling, fishing, and transportation to visit one another on other islands.  With Russians reporting that some of these peoples would go hundreds of miles in Kayaks.

kayak

Restoring an ancient Kayaks. Much larger than the individual ones used for modern sport

Kayak

A better view of how large these ocean going vehicles were

It has been postulated that the Eskimo (the Aleut are the same group as the Eskimo) would have the lowest incidence of coronary artery disease because of their diet. The hunter-gathering society had a “reported” low incidence – although as with many population studies have shown, you often find it when you look for it. For a more in depth discussion about population studies and how we have missed them see here. The Pima Indians, of Arizona, are called “the most studied group” in the world. It was once assumed they had no heart disease, and thus began an intensive study as to why they didn’t have heart disease- but as more studies were performed, turns out the Pimas, like many societies, have heart disease. In fact more of it than western societies. It is the same with the Eskimo health, whether from Greenland or other areas, when critically examined, this society has the same rate of heart disease as others.

Modern Man:

Some have speculated that the incidence of coronary artery disease among Eskimos is because of their interaction with modern man. The introduction of grains into their diets, tobacco, and machinery with less exercise. Not only did the study in Lancet article show that cardiac disease was present in those paleo-people, it is in line with laboratory studies of Aleuts showing they have the same markers for cardiac disease as the rest of us.

Smoking:

Aleut home Alaska Native Center

This is a modern representation of homes of the Aleuts. This from The Alaska Native Heritage Center in Anchorage, Alaska. A worthwhile place

While they did not have tobacco, all ancient peoples used fire. The Native Alaskas of the Aleutians  had homes built partially underground, and used community fires with smoke going out of a hole in the roof, or used fires to heat water that would heat the homes. This might have lead to increased exposure that would accelerate heart disease, but the dispersion of smoke from this would be hundreds of times less than exposure from those who inhale tobacco.

Seal oil was used for lamps. Which, like olive oil, burns quite brightly.

Today they use electricity.  So the second-hand smoke from fires and lamps is no longer a factor. They still eat a diet primarily of fish.  Still, as we found from this little clinic for a town of 400 people, there is  heart disease. Several times a year a person is evacuated out of this town to the city of Anchorage for advanced cardiac care.

One of the  mummified remains of an Aleut lady showed severe artery disease to the extent that if we saw this today she would undergo vascular surgery. This in a woman who was in her late 40′s to early 50′s. She may very well have died of a stroke.

 

St. Paul island birds

The people still get eggs, but they prefer the fresh ones from the cliff. Higher in omega-3 fatty acids than the ones from the chicken farms. These islands have some of the most unique birds in the world.

In fact, in the recent study published on-line by Lancet, they discovered atherosclerosis was prevalent in all areas of the world, over a 4000 year time span, and several continents, with peoples having ancient diets from rich in saturated fat, to near vegetarian, to pure paleo.

Exercise:

Exercise you say? Turns out that in ancient cultures, without the benefit of cars, bikes, or probably even animals- physical activity was normal- and lean and mean were simply natural. Like a six-pack, probably every ancient Alaska Native  person had one– but in their coronary arteries were plaques, that would make any modern, beer belly, sedentary modern human proud.

Diet:

These ancient ones didn’t have trans-fats, they didn’t have soda, they didn’t have wheat, they didn’t have dairy, they didn’t have cheese, but they did have heart disease. And today, they stil do.

Heart Disease:

The study showed that heart disease was found throughout ancient civilization. It wasn’t the diet that prevented it. In fact, probably was genetic like most of us thought all along. Like their ancestors before, the Aleuts of St. Paul have the same disease, virtually the same diet. Their lifestyle is better now, with indoor heat, better insulation. They still live a physical life. But one thing they need- much like many – is some statin drug like Lipitor  which works much better than their ancient diet, or any diet you can think of .

Ask an Alaska Native if their diet protected them from disease: they will tell you, it didn’t. Food wasn’t meant for medicine, food was meant to nourish the body. A lesson the ancient people knew – one that many doctors are still learning.

REFERENCES:

Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations.Randall C Thompson, Adel H Allam, Guido P Lombardi, et.al. www.thelancet.com   Published online March 10, 2013

High prevalence of markers of coronary heart disease among Greenland Inuit. Jørgensen ME, Bjerregaard P, Kjaergaard JJ, Borch-Johnsen K.Atherosclerosis. 2008 Feb;196(2):772-8 PMID: 17306273