BaconCamp SF 2010

We went to BaconCamp SF2010 today in the Mission District of San Francisco.

My wife talked about the food that we had prepared, then she introduced me to talk about the special sauce.

I started like this. "Not long ago, I called mayonnaise "white death." Like so many others in this country, I was brainwashed to believe that fat, especially "artery clogging saturated fat was unhealthy." It could only lead to an early grave."

You see we had made some homemade mayonnaise, but instead of using normal cooking oil, we used rendered bacon fat to make it. It is delectable. Baconnaise is the new black.

Here is the handout we prepared for the group at BaconCamp.

BET (Bacon Endive Tomato): - Organic red endive, organic cherry tomatoes, baconnaise, crumbled bacon

Baby artichokes:  Steamed organic baby artichokes, baconnaise crumbled bacon

http://whatscookingamerica.net/History/SauceHistory.htm

“There are five foundation sauces or basic sauces, called in French grandes sauces or sayces meres. Two of them have a record of two hundred years behind them; they are the "bechamelle" and the "mayonnaise." They have lasted so long, not only because they are very good, but also because they are so adaptable and provide a fine basis for a considerable number of other sauces.”

Baconnaise Recipe

Adapted from Serious Eats and the book Fat by Jennifer McLagan

http://dinersjournal.blogs.nytimes.com/2008/08/25/introducing-a-recipe-contest-with-prizes/  basic recipe from Fat

http://www.seriouseats.com/recipes/2009/10/baconnaise-meat-mayos-mayonnaise-recipe.html  basic recipe from Serious Eats

http://www.seriouseats.com/2009/10/the-food-lab-meatonnaise-mayonnaises-mayos-bacon-lamb-duck-beef-fats-science.html  info about the science

Ingredients

3/4 cup rendered bacon fat, melted
, slightly warm, but not hot (don’t cook the eggs!)

3/4 cup canola oil
 or other lightly flavored, less-saturated oil (e.g. avocado)

2 egg yolks


1 tablespoon Dijon mustard


1 tablespoon water, plus more to correct consistency

about 1 tbsp 
lemon juice (more or less to taste)


salt and pepper to taste


4 strips crisp bacon, crumbled

Procedure

1. Combine bacon fat and canola oil in 2-cup liquid measuring cup. Whisk to combine.

2. Add egg yolks, Dijon mustard, mayonnaise, and water to bowl of food processor. Run processor for 5 seconds to combine. Scrape down sides of processor bowl with rubber spatula. With processor running, slowly drizzle fat into bowl in a thin, steady stream (added over about 2 minutes), stopping and scraping down sides as necessary. Add lemon juice, salt, and pepper to taste, and adjust consistency with water until thick, smooth, and creamy, but not mouth-coatingly waxy. Stir in crumbled bacon bits, if using. Store in refrigerator in airtight container for up to two weeks.

For our contributions at BaconCamp SF 2010, we used Farmers Hickory Brand Natural Applewood Smoked Center Cut Bacon (CostCo), cage-free eggs, juice from a Meyer Lemon, and canola oil.

Healthwise
Look at the ingredients: a simple emulsion of egg yolk, bacon fat, canola oil, lemon juice, and water. By far, the worst ingredient in there is canola oil, and a lot of folks believe that it is actually good for you. I have moved to the belief that if the food is something that we, as a species, could have eaten 15,000 years ago, it's probably ok. Food that has been around for less time than that carries more risk. So pork, lemon, and eggs are good, whereas canola in my mind is a question mark.

So, we aren't going to eat the stuff by the tablespoon, but it is delicious as a condiment. Try it on a baconburger or BLT.

Results
The judges at BaconCamp overall liked the BET, but I think one of them got a piece of endive from which the baconnaise had fallen out. The baby artichoke was blander. We would have been much better off if we had really heaped on the baconnaise. One judge dinged it because he could "taste the artichoke."

All in all fun. We will be back next year.

By the way, we met a guy, Tom,  from the Wooly Pigs Company. He sold us a package of jowl bacon from their Mangalitsa herd. It was like a drug deal--cash for a package. They have been in business a few years. I can't wait to try it. I won't blog a review, but watch my tweets.

White Death

By the way, I got the name white death from a comic strip from the 80s called Arnold. It was a favorite of mine. Arnold was a sick little dude.

Perhaps he was talking about Hellman's mayonnaise
Soybean oil, whole eggs, vinegar, water, egg yolks, salt, sugar, lemon juice, natural flavors, calcium disodium EDTA (used to protect quality)

Short Term Personal Healing vs. Long Term Public Health

The Rise of the Superbugs has been in the news lately. 

Dave at Spark of Reason tweeted an article about disinfectants promoting the growth of superbugs.

The New York Times had an op-ed piece on antibiotics in the the food supply (Cows on Drugs).

Nicholas Kristof at the NY Times did a good article about this. The Rise of the Superbugs the view expressed in that column is that the large scale use of antibiotics that we feed to cattle is the leading cause of the evolution of the antibiotic resistant bacteria.

The articles are about microevolution in action, and more broadly about the tragedy of the commons.

In simple terms, it works like this. If you clean something with a disinfectant, there is a chance that some of the bacteria and germs will survive. The ones that survive are, in principle, those best adapted to repel the disinfectant. Their offspring will then be more fit, meaning that we would need stronger or different disinfectants to kill them, etc. The Kristof article goes further, and in fact, the microbes become more immune to antibiotics as well.

This is one of the reasons that when you get antibiotics from your doctor they tell you to finish the prescription. If you take a few pills and it kills only some of the microbes--enough to make you feel better--the remaining microbes will be those most immune to the drug.

It's escalation at a microscopic level. The more people that use disinfectants and clean the beejeezus out of themselves, the more likely that strong bugs will proliferate. So for all of us, keeping ourselves clean with soap and other anti-bacterial agents is, at some level a disservice to society. Just sayin'.

Many workplaces have taken to putting out alcohol based hand cleansers to help prevent the spread of colds and flu. Is there an unintended consequence waiting to happen. I would recommend vitamin D, over using sanitizers.

There is also an idea that our children are more prone to disease and autoimmune issues because of the relatively sterile environments in which we live today (hygiene hypothesis).  There is even a type of therapy called helminthic therapy in which you are infected with hookworms, which has the effect of reducing allery symptoms.

My father was a doctor. Some years ago, I asked him about antibiotics and strengthening the enemy. His response was that if a patient came to him with a disease that could be treated by antibiotics, he would not hesitate to prescribe them. His focus was on treating the person, and for him a worse case scenario was something like, person comes in, he doesn't prescribe, and that person dies.

In my own mind, I have arrived to the conclusion, after reading the articles above that fundamentally, my father's view is a good perspective.

Judicious treatment of large numbers of symptomatic people with antibiotics, may result in some cases of creating stronger bugs, but the benefit to individual humans can't be ignored. However, blanket antibiotic treatment, as happens in the meat and dairy industry, is not good for anyone.

E4E Recommendations:
1. Keep adequate vitamin D levels in your body. It strengthens your body's ability to repel the invaders.
2. Consider organic and grass fed meat raised without the use of antibiotics. Corn is not a normal diet for cattle, and they tend to get sicker on that diet, thus the antibiotics. If you're worried about some of the recent press around beef and global warming, Spark of Reason has something to say about it.
3. I won't recommend hookworm (helminthic) therapy, don't worry. It is intriguing though.
4. If you are sick, and your doctor recommends antibiotics, take them, get yourself well. Consume the entire bottle, don't stop partway through the course.
5. You should still wash your hands with soap after using the toilet and before cooking. There are nasty bugs that can live in the digestive tract and nether regions.
6. Consider going soapless. I don't do it myself, but personally know one person who has done it, and Richard over at Free The Animal has also done it. Wash yourself, but use cloths, brushes, and water to get clean, not soap.

Thanks for reading. I hope you follow my tweets on twitter as well. My tweet handle is ee4ee.

Eat Food, Light on Carbs, Mindfully - E4E Nutrition Recommendations Revisited

In 2008, I published a series of nutrition posts.

The final entry was a set of dietary recommendations.

Since then diet and health has continued as a full blown obsession a special interest, I have read and studied a lot and and done a little self-experimentation. I have evolved my thinking to believe that something resembling caveman or paleo diets is the most healthful way to eat. Eat natural foods (don't shy away from meat), stay away from processed sugars, grains, and seed oils (which are relatively new in the human diet).

As I look back, I realize that I have a few modifications on the original post.

First, the original post recommended 1 gram of protein per pound of bodyweight. Although that amount won't hurt anyone, it is probably more than many people need. If you are a. engaged in intense physical activity or b. trying to seriously lose weight, that amount is probably ok. If you are not a serious athete and not trying to lose weight, most people can knock that back a bit. The US RDA is 0.8 g/kg of body weight (.36 g/ lb). I think that, as a minimum, most people should be in the 0.5 - 0.75 range. Protein has a lot of benefits including being the best food type for promoting satiety. (Aug 20, 2010 Edit: Some of my recent reading indicates that rather than bodyweight, lean body mass is a better benchmark. So a person who weighs 200 lbs and is 20% body fat should use 160 [200-(200*.2)] as the reference weight for protein consumption. This is still consistent with the above recommendations for most, but people with very high body fat may need to dial protein back a little).

Second, I recommended 50-100g of carbohydrates. I still think that's ok, even though many people can tolerate more than that without ill effects. Previously I said that healthy whole grains were ok. I'm retracting that now.

The carbohydrates you eat should come largely from vegetables. Not from sugar; not from grains.

Many people can tolerate grains (wheat, rice, etc.). But, I am hearing more and more about people who have coeliac (pronounced see-lee-ack) disease or an intolerance to gluten, a composite protein found in many grains. It also contains phytic acid, which, despite some potential therapeutic uses, also has myriad bad effects on teeth and mineral absorption. Bottom line is that grain provides nothing that is not easily found in other foods, and has lots of potential downsides. If you must eat grains, consider the advice given at Food Renegade (sprout, ferment, or soak). Stephan Guyenet at Whole Health Source has a number of informative articles about grains and phytic acid.

Compounds found in vegetables and many fruits are healthful (as opposed to the relatively empty calories of grains). Fruits may be over-sugary, so stick mainly with vegetables as the source of your carbohydrates. If you exercise intensely or are a competitive athlete, you may need to refill muscle glycogen. You can use starchy vegetables like potatoes or other tubers to do that, with little danger of ill-effects. If you must eat sugar, do so within about an hour of intense exercise (preferably after). Then your body will simply store it as muscle glycogen. That is pretty good advice for carbs in general as well.

Sugar, like grains, has little upside (besides the taste). Neither of these are required to sustain life, and there is lots of potential downside. One of the main issues with sugar is the fructose in it (see this video for an interesting perspective on fructose). This leaves vegetables as the best source of additional carbohydrates.

As a final note on sugar, fruit juice is not much different from a can of Coke. A 12 oz glass of orange juice has about the same sugar, and all you get extra is a little vitamin C and folate. That glass of sunshine is not what it's cracked up to be.

Third, I want to put a little more emphasis on the fats and oils in the diet. I said that you should stay away from trans fats, and that's still good. In general, oils made from grains (canola, corn) or soybeans requite a lot of processing to be edible. These unsaturated oils tend to oxidize easily and can lead to inflammation. I would lean more towards oils that require minimal processing. Do not be afraid of saturated fats like those found in dairy, coconut oil, and animal fats. A recent meta-analysis study shows that there is no evidence that saturated fats increase the risk of heart disease.

There is also the possibility that omega 6 to omega 3 ratio in our diet is causing problems across our population. Vegetable oils tend to be higher in omega 6. The best sources of omega 3 are fatty fish or fish oil and grass fed and finished beef. This is another reason to stay away from vegetable oils.

Fourth, I said to stick to the basics until you are on the right track. To clarify that a little bit, the basics include getting your macronutrient amounts about right (Protein: (20 - 40%), Carbohydrate: (10 - 20%),  Fat: (40 - 70%)). Minimize sugar and grain consumption. Cut back, in general, on vegetable oils. The more processing required to be edible, the more you should stay away from them. Use butter instead of margarine; lard instead of crisco (crystallized cottonseed oil). Do NOT stress over meal frequency. If you don't feel hungry, (more than just a grumbling belly), there's no pressing urgency to eat.

The basic concept is to establish a metabolism similar to what ancestral humans had pre-agriculture. This is not to say that you should do caveman food re-enactment, just that you want to eat foods that have the same overall effect on your metabolism.

One other thing, you don't have to be perfect about all this. Don't kick yourself if you blow one meal (or day). Sometimes, it is just a good thing to live a little. Don't ruin your health by eating something to which you are allergic, but if one night you have a scoop of ice cream, or you have some pasta with your daughter at her team's pasta feed, it's ok. Food events can be very personal bonding events, and it's ok. In fact, some of the diet folks, especially Lyle McDonald, incorporate carbohydrate refeeds to help normalize leptin, which then helps to suppress appetite. So once in a while, ease up a little, call it a carb refeed, forgive yourself, and move on.

Just doing the above will make a huge difference to many people. Going beyond that, some things to consider in my view of order of importance:

1. Take a vitamin D supplement, especially if you have darker skin, live in high latitudes, or get little unprotected sun exposure.
2. Consider pasture-fed meat and dairy products. The fat in those tends to be higher in omega-3 fatty acids and lower in omega-6. A corollary to this is to consider cutting out milk products altogether. Many people are sensitive to dairy and some do not think it is appropriate for humans. Here is Mark Sisson's take.
2a. If you do not implement 2, take a few fish oil capsules to supplement omega 3 fatty acids.
3. Consider consuming more organic produce in general. Less pesticides, chemicals, and other gunk.
4. Consider a vitamin K2 supplement or increasing foods with K2.
5. I do not encourage a vegetarian or vegan diet. It is obviously fine for some people, but many will have trouble meeting the protein requirements without lots of soy, and the oil content may be a problem. This is probably offset in many cases by overall reduced calories. Lierre Keith, a former vegetarian, recently wrote The Vegetarian Myth. I have not yet read it, but have seen a number of interesting and excellent reviews.

Some of my favorite sources:
Whole Health Source - refined grains, sugar, industrial seed oils are bad
Lyle McDonald - Nothing is good or bad per se. Food can help achieve specific goals.
Protein Power - More protein, less carbs. Drs. Michael and Mary Dan Eades. Also Sous Vide Supreme.
Summer Tomato - Foodie blog by a San Francisco Neuroscientist
The Paleo Diet, Loren Cordain - Paleo/caveman - No dairy, limited saturated fat ok
PaNu - Paleolithic nutrition. Establish an "Evolutionary Metabolic Milieu (EM2) not about food reenactment. Dairy ok.
Spark of Reason - Dave posts good info with sound logic. Give us more...
Free the Animal - Richard is a self-experimenter and paleo nutrition enthusiast. Lots of good info.
Zeroing In On Health - espouses zero carb lifestyle
Nephropal - Good science and understanding of hormones and biochemistry. Great information with a paleo bias. Here are their dietary recommendations.
Fat Head Blog and Movie - I highly recommend the movie. The blog has interesting and funny perspectives on many diet topics.
and of course, Good Calories, Bad Calories by Gary Taubes - I am not sure he gets everything right, but most of it is really good.

Interpreting Science Writing

Note to readers: This column is coming out much later than I had intended. I apologize for that. I think I may have blown my resolution from earlier this year to put out one post per month. I really struggled with this one. As I wrote, the article kept getting longer and more detailed. There is no shortage of bad science coverage out there. I was stalled and my wife helped me break out of it (thanks). Ultimately, I probably should treat this as an overview post, then put in detailed posts in the future on some of the individual points.

So please let me know in the comments if you are interested in reading more detail about any of the points made in this post. --e4e


Writing about science writing is like writing about vocabulary or word usage. There is a really good chance that you will find inconsistencies in some of your own practices. Shame and ridicule have never stopped me though, so here goes.

Sensational headlines call to us to stop eating saturated fat. Or to stay out of the sun. Do more cardio (or less). How can we make sense of this hodge-podge?

First, research has a well-defined and specific structure and process. The researcher states a null hypothesis, e.g. saturated fat does not cause heart disease. Then they determine a protocol for testing that hypothesis. Run the research and analyze the results. In standard scientific method, the results do not prove the hypothesis--they either reject it or fail to reject it. This is similar to a court case, where a defendant is found guilty or not guilty. A "Not guilty" verdict does not prove innocence, only that there was not sufficient evidence to prove guilt.

Repeating studies and testing variations of the hypothesis are an important part of this as well. For example, if the researchers use palmitic acid (a saturated fat) in the original protocol, someone else might try a similar experiment with lauric acid (another saturated fat) to see if the result is generalizable to another saturated fat. Or perhaps they would try a similar test with fewer refined carbohydrates in the diet to test a suspected interaction.

In the final analysis, only when a hypothesis has been tested multiple times with valid well-designed studies, along with reasonable variations, and has been peer-reviewed, can we begin to say that the hypothesis or its evolved state is very likely. This is even more true in human studies, where numerous factors can confound results.

Sadly, in the current state of our society and even perhaps in research communities, we take as given, hypotheses that are much less well-founded. A typical flow is more like this. A researcher analyzes a data set and looks for relationships in the data. If he or she finds one, he builds a hypothesis that rationalizes what he thinks he sees in the full data set, or even worse, a filtered or smoothed one. So far, it's not too bad. If he then takes his analysis and designs a good intervention study he may be on to something.

Unfortunately, too often, a science writer gets wind of his hypothesis (the researchers are not innocent in this), and publishes a sensational story before the real work begins.

As always, you are your own n = 1. Read carefully, learn voraciously, and caveat emptor.

Following are some considerations to think about when reaing and interpreting science writing.

1. Many, or perhaps most, mainstream science writers are much stronger at writing than science. They do not have the ability, inclination, or motivation to discriminate between important and unimportant results. Question mainstream media (MSM) reports of science. Gary Taubes is seen by many as one of the better science writers around. Who are some others?

2. Correlation does not imply causation, however, lack of correlation does imply lack of causation - If you are reading about an epidemiological (observational) study it proves nothing. Epidemiology is the study of factors affecting the health and illness of populations. Not long ago they tracked thousands of people over 10 years based on what they reported eating, then said that eating more red meat was "linked to early death." That's fine as far as it goes, but then the reporting (and the "scientists") took the next step and said that therefore, eating meat causes cancer. That's not science.

In a similar vein, beware the expression, "...is a risk factor for...", e.g. "Obesity is a risk factor for diabetes." When I read that I interpret causality, as in obesity causes diabetes. The truth of the matter is more like, "people who have diabetes tend also to be obese, both conditions are related to a insulin-resistant metabolic defect."

The epidemiological studies can point you in the direction of something to test further, i.e. they can generate a hypothesis, but it can not establish causality. A great comment by "seyont" from Dr. Eades' blog. "An observational study is sort of a triple-blind study. The researchers do not know what experiment was performed, on whom it was performed, or even if it was performed. They grab a bunch of people and dream up an experiment which could plausibly have produced the correlations they see."

3. Mouse studies are similar. They can point you in a direction for further study, but are not conclusive. I'm sure you get that mice are not people (although some people are rats). Here's an example and an alternate hypothesis.

4. Look out for the word "adjusted." There are always confounding factors in studies that researchers want to adjust for. It is impossible to adjust accurately and there is always slop in it. If there is an adjustment factor applied there is doubt in the conclusions. This is especially an issue when the size of the adjustments (the noise) is of a similar order of magnitude to the quantity being measured (the signal). It doesn't mean the conclusions are wrong necessarily, but the basis of the adjustments has to be really strong for the conclusions to be valid.

5. Watch out for weasel words like "probably," "potentially," and "may." It doesn't mean that the conclusions are necessarily wrong, but often those words are inserted to make the sensational headlines true. Brad Pilon of Eat Stop Eat fame talks about an article with plenty of weasel words here.

6. Details are important and usually not covered in a 1,000 word article.

7. Randomized double-blind placebo controlled intervention studies are the gold-standard for nutrition research. Unfortunately they can be extremely expensive, especially for long term effects.

8. Follow the money - Look to see who paid for the research. If the results fit their commercial or social agenda, doubt the conclusions. There is a very strong bias in research publications that results that do not support the sponsors agenda do not get published or get spun. This article hammers the statin people for treating their agenda as science.

9. Focus on what you care about. Many studies support a very narrow agenda. For example, the American dermatologists association says to always protect your skin from the sun with sun screen. Their agenda is to prevent skin cancer. However, lack of sun can cause lack of vitamin D, which is associated with (causality?) higher incidence of other cancers, flu, and colds.

10. Question results that are not consistent with how mankind has lived for two million years. Using sun exposure as an example again, our bodies are finely tuned to an ancient lifestyle. It seems crazy in that framework to think that exposure to "normal" amounts of sun would be overall detrimental to health. Your mileage may vary if you are very fair for example, but keep things in perspective.

11. Beware statistical significance. Statistical significance is a term that tells how sure you are that a difference or relationship exists. If a relationship between to variables is found to be "statistically significant", it means that it is unlikely that the observed relationship is random. The relationship may be small or meaningless, but they are highly likely (generally 95%) to be linked.

12. Paradoxes aren't paradoxes. They are information that disproves the hypothesis of some preconceived notion or prejudice. Perhaps the most famous paradox is the "French Paradox." the French eat more saturated fat, yet have better heart health than Americans. Lots of hypotheses have been generated to explain this (more smoking, more red wine, etc). Yeah, that's it, that's the ticket. Drinking and smoking actually protect you from heart disease. Oh, but not too much. That will kill you. Dave at Spark of Reason wrote this article on paradoxes. Tom Naughton of Fat Head fame had this to say.

Let's apply Occam's Razor. There is a much simpler conclusion--the original hypothesis is wrong: saturated fat does not cause heart disease. From Dave at Spark of Reason: "A true paradox would indicate inconsistency in the rules and assumptions used to build the system."

13. Many intervention studies do not test the reported factor, but rather something entirely different. As an example, if you want to test the impact of a low carbohydrate diet on lipid profiles, there should be control of the actual ingestion of carbohydrates. However, some studies are actually designed to test compliance to that type of diet as well as the impact. It then becomes difficult to draw conclusions about the physical effect of the diet.

14. Statements of certainty, e.g. "the science is settled" or "it is universally accepted that..." can be used to bully people into alignment. It takes a gutsy and very confident person to argue against the "consensus." This doesn't mean that the predominant view is wrong, just raises a red flag to the possibility that people are trying to cut off additional inquiry.

15. It is possible that most published research is wrong. Bayesian analysis of false positives and negatives, combined with human nature and biases conspire to place a scary-high likelihood that any given research results are incorrect. Here's the original paper for anyone interested.


16. Look at the logic. If the author is simply focusing on the qualifications (or lack thereof) of someone. It may indicate that the substance is weak.

Some Examples of Analysis of Science Writing

1. This article, "A High Fat Diet During Pregnancy Can Lead To Severe Liver Disease in Offspring," as skewered here by Chris Masterjohn is an excellent example of several of the points above. First, the article talks about the mother or the woman or the child in several places, the headline talks about high fat, while the researchers talk about high saturated fat. Incredibly, they fail to mention that the "woman and mother" in question is a mouse. Oh and by the way, that low fat control diet was higher in saturated fat as a percentage than the high fat diet.

From Masterjohn:
"...less than seven percent of the calories from the 'unhealthy saturated-fat-enriched diet' actually came from saturated fat.

"The "unhealthy saturated fat-enriched diet" actually contained 44 percent of its fat as polyunsaturated fatty acids (PUFA) and almost twenty percent of its total calories as PUFA. This is in great excess of the PUFA consumption seen even in the Standard American Diet (SAD), loaded in processed PUFA-rich vegetable oils."


2. Design of experiments, Hypothesis Testing and Bayesian Inference are critical aspects of understanding the validity of ideas. It seems that many researchers are not skilled in the application of those aspects, especially in nutrition and exercise. We're left then with unskilled reporters and broscience.

One of the more famous occurred some years ago when an epidemiological studies demonstrated a correlation between hormone replacement therapy (HRT) in women and better cancer rates. For years after that millions of women were put on HRT, post-menopause. Only recently did they actually perform a placebo-controlled study and find that (oops), HRT actually increases breast cancer and heart attack and can lead to early dementia. It can also have some positive effects such as decrease in hip fracture and colorectal cancer. It seems that in the early epidemiological studies, the women on HRT tended to be more health conscious in general. This then masked the negative impact of the HRT.

But, here are some of the details in this. Even with the good study, the timing of starting the HRT made a difference, and it showed age variation in the impacts. Also, it could be that it was an indictment of the specific hormones used in the study and not HRT in general.

3. Another significant epidemiological study that is looking worse every day is the Ancel Key's Seven Nations Study. This may be of the most devastatingly believed studies in the history of the world. In a nutshell, Keys plotted cardiovascular disease against animal fat consumption in seven countries and found a very high correlation. However, he omitted 14 countries with data that did not support his hypothesis. This in turn led directly to higher sugar and carbohydrate intake and to reduced fat consumption. Some believe that this is one of the main causes of the obesity and cardiovascular disease epidemic in the world today.

4. Read Gary Taubes' article on epidemiology or better yet, buy Good Calories, Bad Calories


5. Here's another Taubes interview on Good and Bad Science

6. Michael Eades on epidemiological research

7. Staggeringly good 4-part example (1), (2), (3), (4) of analyzing a study and generating an alternate hypothesis from Whole Health Source

8. Interesting perspective on good science from OvercomingBias

A quote from one of the commenters, daublin

"There is a lot of confusion in both the cited article and in this article about what science is. For sure, it’s not the “scientific method”. That doesn’t mean science doesn’t happen, but that it’s being misdescribed. Here’s what science means, in the tradition descending from the Enlightenment. Science is study with the following properties:

"1. It’s about objective claims. There is no place in science for claims that different observers will, by definition, never agree on.

"2. It’s about falsifiable claims. There is no place in science for claims that could never possibly be decisively proven false.

"3. The evidence must be repeatable by other scientists. In particular, experiments must be communicated in enough detail that other scientists can repeat the experiment so as to verify the result.

"4. It follows Occam’s Razor. Simple theories are better than complex ones."

Which Vitamin D Test to Get? 25-hydroxy-vitamin D!

Swine flu and seasonal flu are in the air. We're close to panic season now. At work, more than 1500 people showed up in one day to get flu shots. They had to turn people away.

Some of my family members recently had flu-like symptoms for several days, then recovered. A family doctor said it was in all likelihood the swine flu. I didn't get (some really minor feverishness, followed by a nap and all was ok).

There is evidence that sufficient blood levels of Vitamin D is protective against colds, flu, and even cancer. Read about Vitamin D here. Also Grassroots Health is an excellent resource.

When I went to my doctor in the spring, he ordered a vitamin D test, but it was not the "right" one, so I had him change it.

For the record, you should get a 25-hydroxy-vitamin d test, and the results should be 50–80 nanograms per milliliter (ng/mL) or 125–200 nanomoles per liter (nM/l) year-round.

If you are below that range, consider supplementation with Vitamin D3 (cholecalciferol), not D2 (ergocalciferol). It makes a difference, although there is some controversy. Some claim that oil based caplets offer more reliable absorption than dry pills.

Many people like the Carlson Gelcaps.


I use Costco myself.

An excellent overall resource to learn about Vitamin D is the Vitamin D Council.

If you have trouble with your doctor, you can get a mail-order vitamin d test.


While you're at it, you might consider Vitamin K2 levels as well...





What Blood Test Should I Have?
from an article by John Cannell

"The only blood test that can determine vitamin D adequacy is a 25-hydroxy-vitamin D. Whenever I say "vitamin D level," I'm talking about a 25-hydroxy-vitamin D. Ask your doctor to order a 25-hydroxy-vitamin D blood test. Unfortunately, many doctors order an "activated vitamin D" level, thinking it better to measure the most active form of vitamin D. It is not. Activated vitamin D, also known as 1,25-di-hydroxy-vitamin D or calcitriol, should never be obtained to determine vitamin D sufficiency. Calcitriol is often elevated in vitamin D deficiency. You cannot tell anything about your vitamin D nutrition by measuring a calcitriol level. If your doctor insists on ordering a calcitriol level to determine your vitamin D nutrition, find another doctor."


"(Although 1,25 dihydroxy-vitamin D (calcitriol) should never be used to diagnose vitamin D deficiency, calcitriol is important in evaluating one cause of high blood calcium, called vitamin D hypersensitivity. High blood calcium rarely occurs due to vitamin D toxicity, but calcium is elevated in people who have vitamin D hypersensitivity, although their vitamin D level will be normal or even low. Primary hyperparathyroidism is a common cause of vitamin D hypersensitivity, as is sarcoidosis and other granulomatous diseases. It can occasionally occur in cancer; about 20% of patients with non-Hodgkin's lymphoma have vitamin D hypersensitivity. Any competent endocrinologist can treat vitamin D hypersensitivity.)"


"However, serious problems exist with the technology used by some laboratories to measure vitamin D levels. Different labs will report different results when given the exact same specimen of blood. Furthermore, the same lab often reports significantly different numbers when sent the same specimen of blood at different times. In general, low numbers are more reliable than high numbers because interfering substances can easily give falsely elevated results. Prominent scientists have issued urgent calls for standardization. ...

"If you take ergocalciferol, or "vegetarian" vitamin D, be warned. Ergocalciferol is not vitamin D, but a vitamin D-like patent drug whose patent has expired. It does not normally occur in the human body and is probably a weak agonist at the receptor site, meaning it may actually partially block vitamin D actions. Ergocalciferol is the villain in most of the reported cases of toxicity in the world's literature. All bets are off in terms of measuring blood levels if you take ergocalciferol. Some of the labs can pick it up, and some can't. Don't take ergocalciferol; it is not vitamin D."

The Causes of Gout

In a previous post, I mentioned that a bout of gout had been my wakeup call for getting my diet right. That wakeup call led to a much deeper understanding of metabolism and the biochemistry of the body.

I recently had a minor recurrence of gout and it followed a similar pattern to what happened in 2007, so I did more research on it.

The Pattern

I noticed in mid-2007, that the day after a really hard workout, usually a leg workout, my feet hurt--not badly though. It almost felt as if I had a bone a little out of joint or something. I attributed it to something about the way I was doing my calf raises. When I had bad gout in November of 2007, it was after a leg workout, and as it got worse, I thought it was related to an infection on my foot. Finally, it just went away on its own and my podiatrist told me it was probably gout.

I have had a few very minor cases since then, each time it went away after a day or two, So last week, after a leg workout, my foot hurt. It was just a little bit, and I thought that it was related to a splinter or something I had in the ball of my foot (my feet are a mess). But then it got worse, and I realized that it was the onset of gout. Again, it was following exercise.

Findings
First, it is generally accepted that gout is caused by the formation of crystals of uric acid in the joints. It usually expresses itself in the foot. The crystals form often when the blood concentration of uric acid reaches a high level.

For a long time, the standard cure was to lay off organ meats and red wine, because those contain purines (of which uric acid is a by-product). The problem is that I was not eating organ meat, and I wasn't drinking that much red wine. So the standard advice was useless for me.

I have found a number of interesting things about the accumulation of uric acid in the blood.

Under normal conditions, uric acid is pulled out of the blood and excreted in urine. However, there are some situations that can cause an imbalance and lead to higher levels of uric acid. According to Cordain, the problem in 90% of gout cases is that people underexcrete uric acid, not overgenerate it.

Production
1. +Uric acid production - fructose and alcohol both increase uric acid production in the liver.

Excretion
1. - Lactic acid, as can be generated by strenuous exercise, fructose (e.g. from high fructose corn syrup (HFCS)), or alcohol consumption, reduces the excretion of uric acid.
2. - Insulin in the bloodstream, as from high glycemic foods
3. - Dehydration/lack of proper hydration can inhibit excretion of uric acid
4. - Fasting or a starvation diet inhibits uric acid excretion
5. - The initial stages of ketosis can inhibit excretion of uric acid from competition in the kidneys with the ketones. Once the body is adapted to using ketones for fuel (6-12 weeks), this is no longer a problem for most.

Neutral Effect
1. +/-High purine foods (organ meat, seafood, protein) increase uric acid production and stimulate excretion. The net effect is very low. (references below)


Conclusions:
1. The standard medical recommendations--stop eating purine-containing foods and drinking red wine--are not well supported by research. Purine foods have only a minor impact on uric acid and red wine is part of the larger alcohol problem.
2. Sucrose and HFCS have a triple whammy effect on uric acid levels. They increase production and inhibit excretion through both lactic acid and insulin pathways.
3. Alcohol is a double whammy (increase production and lactic acid).
4. Strenuous exercise can inhibit excretion of uric acid via the lactic acid pathway.
5. Lack of sufficient water and nutrients can inhibit excretion of uric acid.


E4E Recommendations
If you find yourself with excruciating pain in your feet, see a doctor. He can make the gout diagnosis. He will likely give you a list of foods to avoid and a prescription for painkillers and/or allopurinol for treatment of chronic gout. Gout is really painful and this will help get you through any acute crisis.

Once allopurinol was instituted as a cure for gout, little research was done on prevention through other means. Allopurinol works well for many people. However, in my view, behavioral interventions are always better than chemical (if they work of course).

So longer term, reduce consumption of fructose, especially in the forms of sucrose (table sugar) and HFCS, and reduce alcohol consumption. If you feel gout symptoms coming on, reduce exercise intensity, make sure you are well-hydrated, and eat at maintenance calories.


Some References
Loren Cordain Paleo Diet Newsletter (The Insider) Vol 2 No 4 I have a pdf of the full article
Chris Kresser on Gout
Petro Dobromylskyj from Hyperlipid had two posts on gout here (1) and here (2). He puts the blame on excess fructose.
Very interesting article by Ed Yong (Not Exactly Rocket Science) on the evolutionary aspect of gout and the enzyme that breaks down uric acid in many animals.
Exercise and Gout from Journal of Biological Chemistry JBC
Taubes on Gout
Mark Sisson of Mark's Daily Apple totally agrees with me
Dr. Lustig from UCSF video about fructose
BBC article on Gout and sweet drinks
Gout website with some folk or popular remedies
Nice Google Answers site on gout.
Ketosis and Gout post from August 2018 by Amy Berger "... 10% of cases of hyperuricemia are caused by overproduction of uric acid; the other 90% result from impaired excretion."
Addendum: March 2, 2010
A paper with the purine content of many foods. Biological and Pharmaceutical Bulletin

A paper came out called Lack of association between dietary fructose and hyperuricemia risk in adults.  

It used a large database called NHANES to search for an association between dietary fructose and hyperuricemia. It found that there is no statistical association between even high "normal" fructose intake and hyperuricemia. Alcohol was positively correlated; fiber was negatively correlated with hyperuricemia. This does not mean you get a free ride on fructose--large amounts do cause hyperuricemia--just that you should not overdo it. Alcohol and fructose are metabolized similarly, but there was no mention in the article about whether the effects may compound.

References regarding Neutral Effect of Dietary Purines and Protein from
Cordain Paleo Newsletter, Vol 2, No. 4
"Further, the recommendation to reduce high purine foods such as fish, shellfish, meats, poultry and organ meats may be of dubious therapeutic value (11) because clinical trials of low purine diets only marginally reduce (1-2 mg/ dl) blood uric acid concentrations (15-17). Although high protein, meat based diets contain high amounts of purines and would be expected to promote gout symptoms, protein ingestion actually decreases blood uric acid levels by increasing uric acid excretion (18). This seemingly paradoxical effect occurs because the kidney increases its excretion of uric acid when faced with elevated dietary purines (19).
"So, let’s put 2 and 2 together. If high protein, meat-based diets actually increase uric acid excretion, and 90 % of all gout patients have the disease because they are underexcretors, it makes little sense to implicate meat and high protein diets as a fundamental cause of gout. What we really need to look for are dietary factors which can simultaneously increase uric acid synthesis in the liver and suppress its secretion by the kidneys – Bingo!"
18. Matzkies F, Berg G, Madl H. The uricosuric action of protein in man. Adv Exp Med Biol 1980;122A:227-31.
19. Loffler W. Grobner W, Medina R, Zollner N. Influence of dietary purines on pool size, turnover, and excretion of uric acid during balance conditions. Isotope studies using 15N-uric acid. Res Exp Med (Berl). 1982(2):113-123.