Category Archives: Uncategorized

Low Carb Whole Food Plant Based

I try to eat low carb or at least low net carbs, that’s carb content minus fibre. The reason for this is that I want to gain the health and weight benefits of straight low carb without the drawbacks of animal protein in particular red meat, whilst gaining the health benefits of a whole food plant based diet. Is there evidence that this can be done and offers benefits, well yes. It has tended to go under the title of Eco Atkins and has shown benefits.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989112/

https://www.atkins.com/how-it-works/library/articles/the-eco-atkins-diet

Which is referring to

https://www.ncbi.nlm.nih.gov/pubmed/19506174

Critics will suggest that correlation does not mean causation. In other words finding that people who eat this way among a myriad of other factors does not prove that the low carb low meat aspect is responsible. This is a typical cop out when results dont seem to be the way you would like them. It would have more validity if these critics were also citing equal number of meat based diets that outperform plant based on heart disease and longevity

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Personalized Diet

One current interesting area of nutritional research is the idea of personalized dietary advice. It seems that Dr Segal at the Weizmann institute have found that we do not all react in the same way or to the same degree to various foods. For example some people can eat ice cream and get outrageous blood sugar spikes whilst others only modest increases. It made me realise that I was perhaps making assumptions about how I respond to various foods that I have adopted in the belief that they are healthy choices. Maybe on the whole I eat well but perhaps there are some weak links in there dictated by my own personal metabolism.
To try an answer this question I have started a series of tests. I am trying a variety of food substances for breakfast and then testing my blood glucose level. I know that my fasting levels is around 80 and that a couple of years ago I tested my levels on a breakfast of 6 bananas and it came in at 92, but I do not know what effect my standard breakfast or indeed other possible foods that I eat during the day have on my blood glucose. For example I do not eat bread but I do eat rice.
I controlled to some degree the experiment by always eating the same evening meal at the same time the night before.
On the first test day I ate 2 slices of white toasted bread with butter. The blood sugar reading after 1.5 hours came in at a surprisingly high 100. Given that some people eat around 6 slices if they have sandwiches for lunch, I feel justified in removing bread.
On the second test day I had a bowl of white rice, about the amount you get with your curry in an indian restaurant. The blood sugar reading came in at 82. Seems to add sense to why the Japanese and Chinese have low levels of heart disease.
On the third test day I had my customary breakfast of-
Porridge oats with Kiwi,Blueberries,Turmeric and Flaxseed
One pink grapefruit
5 Walnut halves
Cup of Hibiscus tea
I have to admit I was hoping that this would come in at around 90 to 95 but I am afraid it hit 113. Not a particularly high post meal reading but if you want to try and start the day below 100 then this clearly is not going to do it. My next test day might provide a viable alternative. Eggs,tomatoes,mushrooms,spinach,avocado and coconut oil

Update –
Today took another unexpected twist. Deciding to drill down into the 113 I got for oats plus fruit on the last test before going onto perhaps a high fat breakfast I today tested oats with just the usual almond milk (flaxseed as well to be honest). I was hoping for around 85 in which case fruit is certainly the main culprit behind the previous 113. However I came in today at 99 way over the previous rice only of 82. It would seem I have been seduced by the 3g per 100g of sugar on the label of the almond milk, sounds low but hey the final numbers dont lie. Cows milk does not seem to be an alternative as google tells me it has 5g per 100g. I need to be absolutely sure about all this so the next test will have to be oats made with water but given the oats with almond milk still tasted reasonably sweet today, when I expected it to be bland, I have to presume at this stage that its the milk.

Update –
Bit of a disappointment today, my previous blood test came in at 99 for oats and almond milk only and I thought that this may be due to the almond milk. Today I tested oats with water only and was kind of expecting around 85 to 90 but got a 101. Clearly the oats are making a fair contribution unlike white rice which previously came in at 82. I am away for a couple of weeks but will resume on return when I will test egg,onions,mushrooms and tomato breakfast. I will also test the high fiber bread only option as someone asked me to do that. At the moment coming in under 100 may be the sole domain of the egg breakfast as I cannot see me eating rice for breakfast, we will see.

Update – Today I tested a breakfast of two egg omelette with mushrooms, onions and two fried tomatoes, all frying was done in Coconut oil. My usual chemist was closed so I had to use an alternative which used a simpler blood sugar tester, the type you use at home. The sugar reading came in at low 73. Even allowing for the machine this suggests that this breakfast is a very low blood sugar option and could herald a breakfast changing moment.

Update – Today I tested two slices of buttered toast but this time using higher fibre bread. The fibre content was 18g per 100g. The readings came in at 85 which is much improved on the lower fibre bread tested earlier

http://personalnutrition.org/AboutGuests.aspx

https://nutritionfacts.org/video/kempner-rice-diet-whipping-us-into-shape/

Update – Low sugar baked beans on single slice of whole meal bread comes in at 95, excellent as I love beans on toast.

Update – Steel cut oats came in at a whopping 129 using a home monitor. Porridge has to go

China Study 3

In his rebuke of Denise Minger Campbell makes a valid point that univariate analysis is fraught with danger.
What he means is analysing one variable to an effect can be misleading as other variables may be playing a part.
For example he cites that with wheat there is a predisposition for higher wheat consuming regions to be lower green plant eating regions. This would tilt the results somewhat if we accept that green plant is protective.

Indeed there are 23 regions where wheat exceeds grenn plant consumption and 41 where green plant exceeds wheat.

Looking at wheat alone and comparing it with average consumption of wheat across all regions, when it is above average heart disease stands at a high 23.24

But what would we expect to happen if wheat was greater than average wheat consumption but so too was green plant greater than average green plant consumption. Would we expect HD to be below 23.24 ?. Well it comes in at 26.33 from 7 regions

Wheat greater than average but plant less than average HD = 21.8 from 15 regions

Wheat less than average but plant greater than average HD = 8.91 from 19 regions

Wheat and The China Study

I have been taking a look at the raw China Study data and in particular with regard to wheat. I loaded the data up into Excel and tidied up the data to do a simple check on wheat and Heart Disease.

The average incidence of heart disease across all regions is 20.38 (HEART DISEASE AGE 35-69 (stand. rate/100,000)
The average intake of wheat is 130.08 grams per day

Now if we look at the numbers for heart disease when the wheat consumption is below average we get heart disease at 15.32
However for heart disease when wheat is above the average of 130.08 we get heart disease at 28.56

As we increase wheat to >140.08 we get HD at 29.49
Wheat > 150.08 HD 29.68
Wheat > 170.08 HD 30.6

The other interesting feature is that if you lower wheat consumption below average HD does not drop it remains fairly constant suggesting that there is a level in which when exceeded HD starts to take off. That levels appears to be 210 grams per day, above that and HD starts to take off. In summary the numbers tend to suggest that eating up to 210 grams per day of wheat is not a big deal but after that HD kicks in. Note I am simply relaying the figures here, sure maybe low wheat eaters are non smokers or whatever

Now finally with regard to wheat V Rice. There were 51 regions with data for rice and wheat. Not surprisingly there were 35 where rice eclipsed wheat consumption whilst wheat was greater than rice in only 16 regions. The average Heart Disease figure for the rice consuming regions was 10.4 whilst for the regions consuming more wheat than rice it came in at a whopping 24.6

Another bagel please waiter !

Total Cholesterol/Heart Disease by Country

Looking at the World Health Organisation data on average total cholesterol levels for men aged 25+ and then marrying that with the highest risk countries for heart disease and the lowest risk countries for heart disease one would expect, if the the doctors are correct, to see a glaring message. Well you decide. Which group do you think is the top risk group and bottom risk group for heart disease based on the countries average total cholesterol shown to the right.

Group1
Turkmenistan 4.5
Russia 4.9
Bulgaria 5.0
Romania 4.9
Hungary 5.1
Argentina 5.0

Group2
France 5.3
Australia 5.1
Luxembourg 5.5
Switzerland 5.3
Japan 5.2
Israel 5.0

LCHF Diets

Low carb high fat diets are very much in vogue at the moment and they are without doubt effective for weight loss, blood sugar control and epilepsy treatment. Evidence on how they effect long term CVD risk however is a bit thin on the ground. There was one accidental study referenced on Nutritionfacts.org and copied below. The slight worry however is that the author of the study was prosecuted for medicare billing fraud and failing to carry out research he was paid for by a soy product company. This does not mean what he highlighted below is worthless but then again on its own it would have not been conclusive anyway

There has only been one study ever done measuring actual blood flow to the heart muscles of people eating low-carb diets. Dr. Richard Fleming, an accomplished nuclear cardiologist, enrolled 26 people into a comprehensive study of the effects of diet on cardiac function using the latest in nuclear imaging technology–so-called SPECT scans, enabling him to actually directly measure the blood flow within the coronary arteries.

He then put them all on a healthy vegetarian diet, and a year later the scans were repeated. By that time, however, ten of the patients had jumped ship onto the low carb bandwagon. At first I bet he was disappointed, but surely soon realized he had an unparalleled research opportunity dropped into his lap. Here he had extensive imaging of ten people before and after following a low carb diet and 16 following a high carb diet. What would their hearts look like at the end of the year? We can talk about risk factors all we want, but compared to the veg group, did the coronary heart disease of the patients following the Atkins-like diets improve, worsen, or stay the same?

Those sticking to the vegetarian diet showed a reversal of their heart disease as expected. Their partially clogged arteries literally got cleaned out. They had 20% less atherosclerotic plaque in their arteries at the end of the year than at the beginning. What happened to those who abandoned the treatment diet, and switched over to the low-carb diet? Their condition significantly worsened. 40% to 50% more artery clogging at the end of the year.“.

This study seems to be the best I can come up with so far

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055030

It suggests a significant increase in overall mortality for LCHF and no significant increased risk for death from CVD or incidence of CVD. Interestingly though the risk ratios for CVD are a tad over 1.0 which would possibly add weight to the argument that setting out in life on LCHF is not particularly going to kill you from CVD, it is either neutral or at worse so marginally negative that something else is going to get you first. However perhaps in the battle to reverse heart disease (if you accept that this can be achieved) you need some protocol that can improve on neutral.

FOOTNOTE – The following from the Harvard school of public health offers more encouragement for LCHF but with a proviso from where the fat comes from

Low carbohydrate diets and heart disease

Research shows that a moderately low-carbohydrate diet can help the heart, as long as protein and fat selections come from healthy sources.

A 20-year prospective study of 82,802 women looked at the relationship between lower carbohydrate diets and heart disease; a subsequent study looked at lower carbohydrate diets and risk of diabetes. Women who ate low-carbohydrate diets that were high in vegetable sources of fat or protein had a 30 percent lower risk of heart disease (4) and about a 20 percent lower risk of type 2 diabetes, (34) compared to women who ate high-carbohydrate, low-fat diets. But women who ate low-carbohydrate diets that were high in animal fats or proteins did not see any such benefits. (4,34)
More evidence of the heart benefits from a lower-carbohydrate approach comes from a randomized trial known as the Optimal Macronutrient Intake Trial for Heart Health (OmniHeart). (35) A healthy diet that replaced some carbohydrate with protein or fat did a better job of lowering blood pressure and “bad” LDL cholesterol than a healthy, higher-carbohydrate diet.
Similarly, the small “EcoAtkins” weight loss trial compared a low-fat, high-carbohydrate vegetarian diet to a low-carbohydrate vegan diet that was high in vegetable protein and fat. While weight loss was similar on the two diets, study subjects who followed the low-carbohydrate “EcoAtkins” diet saw improvements in blood lipids and blood pressure. (36)

References

1. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364:2392-404.

4. Halton TL, Willett WC, Liu S, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-2002.

31. Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082-90.

32. Samaha FF, Iqbal N, Seshadri P, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003;348:2074-81.

33. Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859-73.

34. Halton TL, Liu S, Manson JE, Hu FB. Low-carbohydrate-diet score and risk of type 2 diabetes in women. Am J Clin Nutr. 2008;87:339-46.

35. Appel LJ, Sacks FM, Carey VJ, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005;294:2455-64.

36. Jenkins DJ, Wong JM, Kendall CW, et al. The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med. 2009;169:1046-54.

Why I am Pesco-Vegan ish

I dont think there is an official classification as Pesco Vegan but it comes closest to describing how I eat these days. I avoid dairy and meat but eat fish such as wild salmon, mackerel, sardines and my favourite anchovies on sliced tomato. I try not be too neurotic about food. For example if you invited me to your house and chicken was on the only choice I would eat it, happy that this means I am eating chicken only once every blue moon.

Getting into a debate on Vegan/Pesco etc Vs meat eaters with regard to health and longevity can be pretty hairy if you are in the wrong company. I must be one of few people who have taken a battering on Nutritionfacts.org ( a veggie based community) for my suggestion that cholesterol levels are not the main driver of heart disease whilst getting similar treatment on Dr Kendricks blog which is populated by saturated fat and meat advocates when suggesting that Pesco’s are the top dogs in the health game.

The main problem with the latter debate is the existence of confounders. For example randomly looking at meat eaters against vegetarians may well include more smokers in the former and the fact that the latter have made some conscious diet changing move could mean they are generally more health living types.

The study I like quoting however is the Adventist Health Study 1 and 2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191896/

In this study Pescos clearly came out top with the lowest risk ratio for overall mortality. I like this study because it has a relatively tight cohort in that all subjects are from the same religious group and hence have closer matched support networks than taking subjects from the general population.

Med’Diet V Statins

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312230/

“Recently, researchers in Lyon, France, prospectively studied the effects of the Cretan Mediterranean diet on a group of 605 postmyocardial infarction patients (9). Patients were randomized either to the Cretan diet or to a “prudent” diet similar in composition to the American Heart Association Step 1 diet (control group). All other aspects of the patients’ health care were identical. An astonishing 70% reduction in the incidence of subsequent death and nonfatal myocardial infarction was reported in patients on the Mediterranean diet after a mean follow-up of 27 months, a ratio that was maintained through a final 48-month mean follow-up (10). Even more remarkable is that this mortality benefit occurred despite no difference between the study and the control populations in follow-up LDL and HDL cholesterol levels and only a very modest 6% drop in total cholesterol levels in both groups from 250 mg/dL to 237 mg/dL. The magnitude of benefit reported with the diet alone should be contrasted with that achievable by other routine secondary prevention therapies, including statin drugs (35% event reduction) (11), beta-blockers (15% reduction), and angiotensin-converting enzyme inhibitors (20% reduction) (12).”

Pescitarians are the longest living amongst dietary categories. The success of the Med’ diet may have something to do with fish.

“Two large prospective studies have reviewed the benefit of fish oil. The Diet and Reinfarction Trial (DART) randomized 2033 men to either a low-fat diet, a high-fiber diet, or a 200- to 400-g per week fish diet (30). There was a remarkable 29% reduction in all-cause mortality at 2 years in the fish diet group vs the other 2 groups. An even larger 62% reduction in ischemic heart disease death was noted in those patients who chose to take fish oil tablets (900 mg omega-3 per day) rather than eat fish. Fish oil has antithrombotic, antiarrhythmic, and anti-inflammatory properties in addition to lipid-lowering effects, which probably account for these results. This may help explain the beneficial results found in the a-linolenic acid–rich Mediterranean diet, as alinolenic acid is converted to DHA and EPA in the body. DART, however, had a number of confounding factors in its intricate multifactorial design, and the results are tantalizing but not convincing.

The larger GISSI Prevention Study randomized 11,324 Italians with recent myocardial infarctions to 850 mg of omega-3 fatty acids per day, 300 mg of vitamin E per day, neither, or both (31). In the fish oil group there was a statistically significant 20% reduction in total mortality at 3.5 years and a more striking 45% reduction in sudden death, reinforcing a possible antiarrhythmic property of omega-3 fatty acids. Although this study was not designed to investigate this hypothesis, a large majority of the study subjects appeared to be eating components of a Mediterranean diet at baseline, and the extra fish oil produced additive benefits.”

Machine Learning Takes on Heart Disease Risk

Machine learning is a process where computers are used to analyse past data in the hope of predicting outcomes from future data. These outcomes can be anything in the modern world of Machine Learning, ranging from what type of book or CD you are likely to buy to predicting the outcomes of sports events such as horse racing. Various different Machine Learning methods have been devised each with different strengths that can make them more applicable to different types of problems. So a Neural Network may perform better on one kind of problem than say a Random Forest algorithm, but less efficiently on another kind of problem. Risk factor calculators that you plug your data into on the web are based on simpler models which assume a linear relationship between the factors eg LDL, blood pressure etc. Machine learning algorithms can dig deeper so to speak and amongst other things, uncover weightings to various factors. Figure out which are most important and weight them accordingly.

Such an approach was taken with a 10 year project tracking people with 48 factors. Four different algorithms were employed on the data. The data was split into 75% to find out what the relationships were within the data, usually called ‘training’ the model in machine learning parlance. The remaining 25% was used to test how well the model could predict cardio events such as heart attacks. The results were pretty good, out performing conventional risk assessors. Taking an average of how the four methods ranked the different factors we can see that LDL is well behind HDL, Trig’s and HbA1c as a risk factor. Here is an ordered table of those averages showing that age (not surprisingly) was the most impactful feature. Note that some are negatively significant eg Women are significantly less likely to have an event). ‘Missing’ means within the data a patient had this data missing. here is a link to the report

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174944#pone-0174944-t003

Age*
Ethnicitya: South Asian
Female*
SESb: 2nd Townsend quintile
Smoking*
Ethnicitya: Black/Afro-Caribbean
SESb: 3rd Townsend quintile
SESb: 4th Townsend quintile
HDL cholesterol*
Oral corticosteroid prescribed
HbA1c missing
Total cholesterol*
COPD
Systolic blood pressure*
Ethnicitya: Other/Mixed
SESb: 5th Townsend quintile (most deprived)
Atrial fibrillation
Triglycerides
Family history of CHD < 60 years
SESb: Unknown
HbA1c
AST/ALT ratio missing
Ethnicitya: Chinese/East Asian
BMI missing
Ethnicitya: Unknown
Serum creatinine
Immunosuppressant prescribed
gamma GT
Diabetes
Chronic kidney disease
BMI
Anti-psychotic drug prescribed
Severe mental illness
Rheumatoid arthritis
Blood pressure treatment*
Hypertension
LDL cholesterol
gamma GT missing
CRP
AST/ALT ratio
Serum creatinine missing
FEV1 missing
Serum fibrinogen
CRP missing
FEV1
Serum fibrinogen missing
LDL cholesterol missing
Triglycerides missing

Over the Pasta and discovering NLR

During February I had a reminder of the dangers of over consumption of simple Carb’s. I spent a week in Rome and if you have been there you will know its wall to wall Pasta and Pizza. After a couple of days I just gave up and decided to eat the stuff for the remaining 5 days. I normally never touch Pizza and Pasta but made an exception in Rome. Now I normally spend a few months away in the winter and return to the UK exactly the same weight courtesy of the excellent dietary habits of the Portugese. A week in Rome however found me 7lbs overweight. This was a stark reminder of how damaging these products are.
Perhaps on a more interesting note I have just stumbled upon an inflamatory marker that has been shown to be a very good predictor of future or current heart disease. It is called the Neutrophil to Lymphocyte ratio and has been show to improve the Framingham risk score for any one who believes in the Framingham score (probably the people from Framinghan do). As usual this test can be obtained cheaply in Portugal for 6 euros. More details on the ratio can be obtained from the link below.

https://www.ncbi.nlm.nih.gov/pubmed/24388541

Just got my NLR results back. My Neurtrophil reading is 3.57 whilst my Lymphocyte reading is 2.08 giving a ratio of 3.57 / 2.08 = 1.71. The acceptable range is 0.78 to 3.53. Higher than 3.53 would be considered a problematic reading.