Week 14: Against the Grain?

It is so hipster to say, "I don't eat wheat, the gluten you know." This makes the whole gluten-free movement suspect, it seems too trendy. However, just because something is trendy does not mean it is false. I thought I would begin with the area in this new movement that actually hurts the health of those that follow this trend.

Don't eat the fake food that the agribusiness food conglomerates pass off as health food. We have all seen it: chocolate covered gluten-free pretzels, gluten-free frozen waffles, highly-processed gluten-free crackers, and gluten-free chicken nuggets. You should not eat these in their gluten forms, let alone their non-gluten forms. I must  admit I like chocolate covered pretzels, but I don't eat them. In addition, for most people who do not seem to have a problem with gluten, that switch from coarse whole grain bread to white-as-the-driven snow rice bread is probably hurting their health.

The video I posted last week suggested that 25% of our daily calories come from "healthy" whole grains. To me that is just crazy talk. (I will often suggest videos that I disagree with.) Even for those that do not have a problem with gluten this is just too much. If this percentage includes starchy vegetables like potato, then this seems about right for the "average" person.

But there is a danger to the idea of an average person. Let me quote someone with whom I usually agree, myself: 

The average person should get a Pap smear every year. There is no controversy about this. This is because the "average" person is a woman. But if you are among the 49% of the population that is male this advice makes no sense. You are either male or female, there is no average. 

This same point applies across a wide variety of health issues. 

You either have a gall bladder or you don't. Since the gall bladder helps in fat digestion, someone without one needs to take particular care with fats in their diet. Someone who is diabetic needs to eat differently than someone who is not diabetic. If you have insulin resistance, your diet needs to be different than if your insulin functions well.

This same point appllies to wheat consumption.

Why are grains and starches such a large percentage of the average diet? They are cheap. This is often why poor people are obese, they just can't afford to avoid carbs. Let me give you an example from my local store. A loaf of cheap bread is $2.49, so for 17 slices the cost is 15 cents for 65 calories. Frozen brussels sprouts was $2.29 for 2.5 servings of 60 calories is 91 cents per serving. Ultimately we need enough calories to live, and carbohydrates are relatively cheap.

What is gluten? Wikipedia tells us.

Gluten (from Latin gluten, "glue") is a mixture of proteins found in wheat and related grains, including barley and rye. Gluten gives elasticity to dough, helping it rise and keep its shape and often gives the final product a chewy texture.

Gluten is the composite of two storage proteins, gliadin and a glutenin, and is conjoined with starch in the endosperm of various grass-related grains. Worldwide, gluten is a source of protein, both in foods prepared directly from sources containing it, and as an additive to foods otherwise low in protein. It is appreciated for its visco-elastic properties.

Gluten contains hundreds of proteins, which have low biological and nutritional value and high contents of prolamins (glutamines and prolines), as opposed to the grains of pseudocereals (gluten free), which are rich in proteins with high biological value (albumins and globulins).

Gluten for the most part goes right through you when you eat it. It provides no nutrients and no calories. This is not all bad, but it does result in problems for a subset of the population. Wiki continues:

Gluten-related disorders is the umbrella term for all diseases triggered by gluten, which include coeliac disease (CD), non-celiac gluten sensitivity (NCGS), wheat allergy, gluten ataxia and dermatitis herpetiformis (DH). Currently, their incidence is increasing in most geographic areas of the world. It can be explained possibly by the growing westernization of diet, increasing use of wheat-based foods included in the Mediterranean diet, the progressive replacement of rice by wheat in many countries in Asia, the Middle East, and North Africa, the development in recent years of new types of wheat with a higher amount of cytotoxic gluten peptides, and the higher content of gluten in bread and bakery products, due to the reduction of dough fermentation time.

What is the percentage that are effected by this? No one knows. The general estimate is that 1 to 2% of the population have a particularly nasty form of gluten reaction called celiac disease.

Coeliac disease (American English: celiac) (CD) is a chronic, immune-mediated mainly intestinal process, caused by the ingestion of wheat, barley, rye and derivatives, that appears in genetically predisposed people of all ages. CD is not only a gastrointestinal disease, because it may involve several organs and cause an extensive variety of non-gastrointestinal symptoms, and most importantly, it may often be completely asymptomatic. Added difficulties for diagnosis are the fact that serological markers (anti-tissue transglutaminase [TG2]) are not always present and many patients may have minor mucosal lesions, without atrophy of the intestinal villi.

But that is not the only problem with wheat. Many have digestive problems with wheat. For others the gluten ends up in the bloodstream and this causes antibodies to be formed.Wiki tells us: 

Non-celiac gluten sensitivity (NCGS) is described as a condition of multiple symptoms that improves when switching to a gluten-free diet, after celiac disease and wheat allergy are excluded. Recognized since 2010, it is included among gluten-related disorders, but its pathogenesis is unknown. NCGS is the most common syndrome of gluten intolerance, with a prevalence estimated to be 6–10 times higher than that of celiac disease.

If this 6 to 10 times is correct then somewhere between 6 and 20% of the population has this problem. The video I will post next week for your homework suggests the figure of 10%.

Since I have run into this personally, let me tell you three stories.

My mother had a long history of digestive issues. But she ate what she was supposed to including "healthy" whole grains. Her muffins were to die for. Yet her stomach issues continued all her life. Oddly enough, there was a period where she made her own oat bread, and during that period she was better, but it never occurred to anyone that there might be a connection. Was there? I have no idea, but looking at her symptoms and the list you see of those with gluten issues, the correlation is quite strong. I wish she had known to try taking gluten out of her diet.

My wife also has had a long history of stomach issues. She even had a biopsy to see if she had celiac disease, although oddly enough this was not mentioned to us as a possibility. For some reason no test was ever done, even by the expert we consulted, to test for H. Pylori.  Our GP tested her and she had it. After two treatments she  was much improved. But yet she still had problems so the doctor, again the GP not a specialist in that field, tested her for gluten sensitivity. She was sensitive, but only slightly. But regardless of the ambiguous test results she removed wheat from her diet and improved the rest of the way back to close to where she was before the stomach issues began. She will occasionally eat bread, especially when she goes home to Russia--Russian bread has never given her any problems. Many others have also reported that non-US bread  does not cause these symptoms.

(For those who might also live In Idyllwild, my doctor is Kenneth Browning at Fern Creek Medical Center.)

I often said to myself, "At least I do not have to worry about this!" But our doctor, having seen so much problems with gluten in the diet started given the antibody test to all his patients. Guess what? It seems that I had about twice the reaction to gluten that my wife had, yet I had no symptoms. Apparently this is relatively common. A later test showed no gluten issues, but this was after I quit eating gluten and that will result in a lower antibody count. Do I have gluten sensitivity? I have no idea. While a physician will use the tools they are given, I am not sure how good a tool testing for antibodies actually is for gluten sensitivity. 

Before I give us our action plan for this week I think a little homework is in order as my action plan for this week is very difficult and I think that you will want more information before you decide to start it.

Here is the case against removing bread:

Here is a short video that favors removing gluten:

I decided not to include a video from Dr Davis, the most popular advocate of removing gluten. While I enjoyed his book,

I am not convinced that gluten causes all health issues in American today. The critique of Dr Davis from the Canadian news program embedded above seemed fair in that regard. When you have someone claim that an issue causes everything, I think you are entering the world of pseudo-religion and have left the world of science. However the video, by focusing in on the most extreme view, ignores the fact that wheat is a problem for a substantial number of people, and this is often undetected and without symptoms. For example there are 2-3 million undiagnosed sufferers of celiac disease in America today. This says nothing about those with gluten sensitivity.

So since the test is not as helpful as one would like what is the solution? It is called an elimination diet. Web MD describes it this way:

1. Stop eating suspicious foods.

During this time, you will need to:

Carefully read food labels and ask how foods are prepared at restaurants so you can be sure to avoid possible triggers.

Keep a food diary to record the foods you are eating.

If you remove a certain food and the allergy symptoms go away while following this diet, your doctor can usually confirm that that food may be the cause of your problems.

Many of these diets suggest eliminating huge swaths of the traditional American diet. As you may have noticed, I do not think drastic change is beneficial. If you want to do more research on this diet, you might consider J.J. Virgin's book:  

I have not read her book as I disagree with her premises of radical dietary changes, but I have found her helpful and entertaining on her multiple guest appearances on podcasts. The problem with this radical change is that it is not sustainable, and it also gives false information. If you give up a substantial portion of your current diet you will also be giving up the bad versions of these foods. It may be that the foods themselves are fine, but the version of that food you are eating is bad.

So for this next week do some research. Consider buying a book on elimination diets. This next week eat up any wheat products that you may have on hand, remember that pasta is usually made from wheat. Do not buy any wheat products this week. This will involve actually reading labels as the food industry puts wheat in a large number of products. Then next week we can discuss what you will eat instead of wheat

Week 13: How Much of This Are you Doing?

While I do not agree with all of this video that I embed below, I think it is a good starting place to begin again my blog series on health after my vacation. (If you are curious, I already am back to my pre-vacation weight.)

My disagreements focus on two areas.

First, I am more open to supplementation, especially in the short term as one experiments on oneself to decide what works best for you. I do agree that it is important to actually measure vitamin D levels in your blood if you are going to supplement. How else would you know if it is needed or if it is working? In addition I would recommend that one also take magnesium and K-2 if you are taking vitamin D... well, even if you are not. Our modern foods are very low on these items, and they work together with vitamin D. I do not recommend calcium for men. I discussed this in week 5.

Second, the mania for increased grain consumption is not good for a substantial subset of the population. Actually, the difference between whole grain and processed grain is not large in one important area. Both are converted to sugar by the body rather rapidly. We talked about the Glycemic Index in week 9.  Some people think they have had their vegetables if they had French fries for lunch and rice for dinner. No, no you have not. Ketchup is not a vegetable either! I suggest you limit all starches to a large degree. If you are going to eat them, and I do, include them in the grain category. I will be talking about starches and grains next week.

Since the video is a general video I thought it might be time to review what we have talked about. In week 1 I encouraged you to write down everything you eat. With modern iDevices this is actually not as difficult as one would think. It is extremely helpful to actually know, not just think you know, what you eat. 

While I do occasionally drink a diet soda when I am traveling, I have mostly eliminated them from my diet. It is helpful for everyone to do so. Fat people drink diet drinks. 

In week six I point out that one must reduce calories. This is not good news, but it is obviously true. 

Yes, moving your body is necessary. I gave some fun ways to do exactly that in week 7.

Are you eating your vegetables? In week 8 I suggest a very modest 1 cup of cooked vegetables, and an occasional salad, one that you make yourself to control what is in the salad dressing. Not at all difficult, yet many of us don't do it.  

In week 10 we talked about sugar and the dangers it gives to those that eat it. I am not talking about an occasional slice of birthday cake. I am talking about those daily donuts on the way to work. We are just sabotaging our health when we eat too much sugar, especially fructose. 

If we are cnstantly bombarded by food ads, it makes it difficult to avoid eating these foods, usually without even thinking about it. in week 11 we explored advertising and ways to avoid it. 

Restuarants, as much as you can, should be avoided. In week 12 I offer some suggests about how to reduce your eating out.  

We are overweight for a multitude of reasons. I will continue to explore these reasons and suggest ways for gradual improvement.

But in any event this presentation is quite good and helpful and is your "homework" for this week.

Week 12: How Dependent Are You?

From Time Enough for Love by Robert Heinlein:

A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.

So how much of this can you do?

I read recently that "Millennials" spend more for eating out than all the rest of their grocery budget. Since eating out is expensive, I can see that this is true. Let me remind you that the purpose of a restaurant is to separate you from your money. Of course the best way to do that is to provide good service and good food. But anything "good" will be expensive. Another way to make money in a restaurant is not good but quick and cheap. Do you want to bet me about which option most people take? If you drive through any commercial area, you know the answer.

So my action plan for this week is to reduce your eating out, and when you do eat out, eat at better restaurants. Ethnic restaurants can be good choices. But since it is difficult to beat something with nothing let me offer you a way that with an investment of one hour a week you can prepare your lunches in advance. I have used this technique for decades, although currently due to freezer space shortage I am not. I am also assuming that you have access to a microwave at work.

The basic idea is that you make a hearty soup/stew once a week and freeze it into individual servings for lunch. Then, so you don't get tired of one thing, you label these frozen meals with a day of the week. So after your first batch you have lunch for one day for the next 6 weeks. Then you do the same the next week and repeat. After 6 weeks you have a lunch meal for 6 days a week. So you can't complain about a lack of time, who doesn't have one hour a week? This will "kill two birds with one stone." It will be a much healthier alternative and it will be a lot cheaper than eating at a restaurant for lunch.

Here is a recipe for chili that works well for this.

2 lbs meat

One onion

3 cans of beans

I can of peppers in adobo sauce.

1 can of Ro-Tel (hot pepper flavored) tomatoes

2 cans regular tomatoes

2-4 tablespoons chili powder

I fill the large pot I will be making the chili in with regular tomatoes, the Ro-Tel tomatoes, and 1/2 can of the adobo peppers. (I freeze the rest for the next batch.) I also add half the chili powder at this time. I put it on high and stir constantly until it is boiling. My goal is to caramelize the tomatoes, but be careful not to burn them. I reduce the heat to medium. Continue to stir as the boiling stops and then stir from time to time.

Next I prepare the meat in a separate pan. I left the type of meat vague because there are many options. Most would use ground beef. I often use stew meat—but my favorite is lamb. Depending on the meat you may need to use some oil for cooking. I add the rest of the chili powder to the meat. After cooking, remove the grease from the meat but keep it for later. Add the meat to the other pot with the tomatoes.

Add enough of the reserve grease to cook the onion in the same pan that you cooked the meat. I prefer bigger chucks of onion personally. Add the onions to the pot. I personally throw out the leftover grease. If I use good meat, there is usually none left.

While there is considerable debate about beans in the diet, I use them in moderation. For this dish I use one can each of kidney, navy, and black beans. Although the beans are already cooked, I want the flavor to meld so I cook for 30 minutes more.

This makes about 8 servings.

So with a one hour time investment each week you can have your lunches completed in advance You will probably wait longer than that at a restaurant for 6 lunches.

Action Plan: reduce your eating out. Preparing food in advance and freezing is one technique to accomplish this.

Week 11: Charlie Chan and the Mystery of Obesity

I have been watching old Charlie Chan movies. While I would not call them the greatest movies ever made, they are not bad. Charlie Chan sometimes makes jokes about his weight. To my eyes he does not look that fat, but to the eyes of the people at that time he was. Today he would be considered average. I can only recall one other actor that was fat, a police officer in Panama. Everyone else was attractive and thin, even the older actors. (It does look odd to see their pants worn so high on the waist. There is a reason that baggy pants are so popular, even our youth has a belly.) Of course this is not entirely a fair comparison to make as modern movies also have thin people as actors. But there is no doubt that people now are much heavier than they were back then.

Starting around 1970 people started eating an extra 400 more calories a day on average. Why? The theories abound: increased high fructose corn syrup, genetic changes in wheat, more sedentary lifestyle and so on. We will be discussing some of these theories as the weeks progress, but I think the ultimate answer is a combination of "no one knows" with "yes, each of these things are important." But there is another factor that has been developing over the last 100 years that I think has an impact.

Look at this very well-made piece of propaganda:

The idea behind this commercial is to relive one’s youth through cereal consumption. Should we really care that now it is “whole” wheat? It is still a huge sugar load that will eventually zap your energy when your blood sugar level crashes. The reason that so many dietitians advocate many meals a day, or substantial snacks, is that eating products like this lead to sugar highs and crashes. You need a snack at 11 and 3 to keep up your sugar level in the blood. But if you have meals higher in protein and fat, the meal stays with you.

Experiment on yourself. Have a high cereal/carbohydrate breakfast and see how hungry you feel at 11. Then the next day have a higher fat breakfast like eggs with meat and see how you feel at 11. Most people will be less hungry. This kind of experiment on oneself is very important and I will recommend a few in the coming weeks.

Why do the cereal companies want you to eat their product? Obviously they make money.

Here is what one commentator had to say about boxed cereal costs:

"Normally one would not eat these colors.
How do the prices of cereal compare to other foods, like meat?  Well, whole chicken, at $1.29 per pound, is 8.1 cents per ounce; chuck roast, bone in, is 12.4 (both cheaper than Raisin Bran); New York steak is 40.6 cents per ounce; and top round (London broil) is 24.3.  I suppose we might expect a higher quality cut of meat to be more expensive than breakfast cereal, but it could come as a shock to learn that for the same price you pay for Cocoa Puffs or Froot Loops, you could be eating London broil.  Either that, or you can’t compare Raisin Bran and roast beef."

While these figures are from 1999, I doubt that the relative comparison has changed much.

Try a little experiment the next time you go to the grocery store. Take a calculator, or use your phone and take the price of the boxed cereal and divide by the ounces—then multiple by 16. That is the price per pound. Then go to the meat department and compare.

I did this in 2012 in the mountain community where I live. The Lucky Charms cost $6.66 a pound. Hmm.

The most expensive cuts of meat were 8 to 12 dollars per pound. Perfectly fine sirloin was $4.99, and you could get 2 pounds of chicken for $6. Or one could get 2 1/2 dozen eggs instead of one pound of that cereal. Lucky Charms were not a good value.

Whenever you see an ad, for anything, they are trying to persuade you to buy a product. Advertising is expensive. Only brands with high profit margins are going to be advertised by the manufacturer. (Of course there are ads by retailers that advertise a product at a cheap price to get you into the store. You can do well if you take an ad, buy those items in the ad that you need, and then leave the store. The store will lose money. Do this to every store and then shop for those items not on sale that you still need.)

Naturally high-profit items like cereal support a higher ad budget, but while saving money is good, there is a greater principal involved. Ads actually influence the choices we make in our everyday food consumption. Who doesn't want to have it their way at Burger King? Or be all they can be? Surely you want to Eat More Chikin! After all, its good to the last drop.

Advertising influences us in ways we cannot even begin to imagine--until we start to think about it.

Why is Bacon and Eggs a popular breakfast today? Bernays, the man who made Breakfast and Eggs the standard breakfast tells us how he did it:



Obviously Bernays, the nephew of Sigmund Freud, might be exaggerating his importance. Pam Dewey, the beloved editor of this blog, has written a whole series on the power of advertising and public relations (a term invented by Bernays because the more proper term propaganda is so colored as a pejorative word.) Your homework is the section on the adoption of Bacon and Eggs as the stereotypical all-American breakfast that she wrote.  You might consider reading another series she did on propaganda. If you really want some extra credit you can watch part I of a documentary on Bernays I have been going on and on about for years! 

Quit watching ad-supported entertainment as much as you can. It is not free, it costs you more than paying for your entertainment. You may think you are not being influenced, but you are. This is a part of leaving what the Bible calls Babylon the Great.

You might just cut the cable and save that $50 to $100 a month it is costing you. That is what I did. The Charlie Chan movies I am watching? All are free on Youtube. Netflix, no ads, and Hulu, no ads if you pay extra, can keep you up to date on most of your favorite programs. Another option is to get a DVR and record everything. I remember the great satisfaction the first time I recorded a football game and started watching it one hour after it started and I fast-forwarded through all the boring parts and the commercials. When you do, you give yourself an extra hour in that day. I find the time saving alone important.

No matter how sophisticated you think you are, you are being filled with propaganda all the time. Understanding this intellectually helps, but until you quit watching the commercials you will be influenced by them. You will be buying food you really do not want to buy, and may, no will, sabotage your health.

Week 10: What the Fructose?

There were some surprises in various foods and their effect on blood sugar that we talked about last time. Being aware of these surprises is crucial to having a good mix of foods. The general rule was that starches and sugars converted quickly into sugar and that vegetables and fruit are converted more slowly. For metabolically-damaged people this is important.  

So does understanding how fruit turns slowly into sugar in the blood mean that one should eat a lot of it? To answer this question one needs to study how the body converts fructose into energy. Alcohol, sugar alcohol, and fructose are taken to the liver and changed there into a type of fat, a triglyceride. (Sugar alcohol is a product often found in diet foods as it does not affect blood sugar and is regard by many as a free carbohydrate. I was always suspicious of this idea. Sugar alcohols are often found in low carb productions like diet bars and in some dietetic ice cream.) Note that individual cells can convert these items into sugar directly, but as a general rule it is the liver that does the "heavy lifting." This is why alcoholics often destroy their liver by overwhelming it with alcohol. The dosage is the poison, so a little of these products should not be a problem, unless your triglycerides are too high. Hopefully you have had your blood work done and you know how high your triglycerides are. 

When I began my quest for personal health, mine were crazy high at 268. Now they are at an "acceptable" 110. Several factors are involved in your triglyceride levels. If you a overweight then they will be higher than they should be. Losing weight by any means will reduce them. But ironically, losing weight will drop more triglycerides into your blood as you lose weight and your body burns your fat. So in the short run as you lose weight your triglyceride level should be monitored but not a high priority for intervention.  

So for me the answer to the question as to how much fruit, alcohol, and sugar alcohol one should eat depends on the level of triglycerides in the blood. If your level is over 150, the standard consensus level for danger, then one should be greatly limiting these items in your diet. There is considerable debate about what the best level of triglycerides is. Some want it to be less than 100. This is my personal goal. So as a result of this I try to limit my alcohol, fruit, and sugar alcohol consumption to one serving in total a day. This is usually some berries in the morning, although I have been known to have an adult beverage in the evening in addition to this. 

So our goal for this week is to consider how much we are eating that our body is turning into fat flowing in our bloodstream. Remembering that the dosage is the poison, have yourself tested to determine how much of these foods you need to be eating. If your triglycerides are more than 150, you need to consume very little to none. If you are in the 100 to 150 range then you need to limit your intake to one or two servings a day. If less than 100 then this does not seem to be a problem for you and you can consume more. Be sure to periodically retest your levels. And no, you cannot have your weekly allotment of alcohol all at once. 

The homework this week is a presentation by one of the main "fructose is evil" advocates, and my critique of his ideas from a previous blog post. 

I think he is greatly oversimplifying. Looking at other interviews he has done, he said that carbohydrate and fat cannot exist in the same food. This is really strange, because they do. To make the details of what he is proposing even more confusing, he said that fruits are all right because they have fiber. Well, that depends on the fruit. Bananas have little fiber.

Even vegans like Dr. McDougal recognize that fruits can play a negative role in the formation of triglycerides, which are associated with heart disease. More discussion of this would have strengthened Lustig’s case.

He also said in the video that early humans ate 100 to 300 grams of fiber a day. That is rather high. Most estimates I have read place it at 100 grams. The only way they got this much was that ancient foods had not been artificially selected to make them sweeter and have more carbohydrates.

The recommendation is that humans should consume 25 grams. The average in America today is 12. Obviously there is room for improvement. Today I ate 55 grams of fiber, 15 of it artificial from a protein bar. How did I get the other 40 grams naturally? I ate a grapefruit, a banana, an apple, and one cup of strawberries. I also ate 3 cups of Brussels sprouts and three cups of various types of lettuce. I also got fiber from nuts. I had some spinach and beans with my fish. With this huge fiber feast, I still only got 40 grams of fiber. To approach what our ancestors ate may not be practical. (For those curious I am trying various dietary combinations to see how I feel. Note that I am not eating that much fruit now but I am still getting a lot of fiber from vegetables.)

So while I have some reservations about Dr. Lustig's presentation due to oversimplification of complex issues, the reminder of the dangers of fructose is something that needs consideration. I doubt I will eat as much fruit as I did today on a regular basis. That seems like too much fructose. Lustig's explanation of fructose metabolism makes that clear to me.

Here is how Gary Taubes, no friend to sugar, describes "The Bitter Truth About Sugar" in the NY Times:

It doesn’t hurt Lustig’s cause that he is a compelling public speaker. His critics argue that what makes him compelling is his practice of taking suggestive evidence and insisting that it’s incontrovertible. Lustig certainly doesn’t dabble in shades of gray. Sugar is not just an empty calorie, he says; its effect on us is much more insidious. “It’s not about the calories,” he says. “It has nothing to do with the calories. It’s a poison by itself.”

Taubes presents a much more balanced approach, I recomend the whole article he wrote as a supplement, or substitution, to this viral video. 

So I am suggesting that during a perioid of weight loss that one needs to limit the fruits, alcohol and sugar alcohol one eats as this tends to raise triglycerides.