bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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Insane in the Grain Brain

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My library hold finally came in! No way was I paying to read Grain Brain. I like to financially support quacks as little as possible.

First thought: Including a quote from Dr. Oz on the front cover of your book does little for your credibility.

Second thought: I really like the font used for the Contents page.

Introduction“I’m also a founding member and fellow of the American Board of Integrative and Holistic Medicine.” Cue alarm bells! He said the “H-word”! I promptly googled the organization to learn more. Hmm… While I like the general notion of treating the patient as a whole I’m not sure about this principle: “Integrative holistic physicians strive to relate to patients with grace, kindness and acceptance, emanating from the attitude of unconditional love as life’s most powerful healer.” Love as the most powerful healer?? Call me crazy but I’m not going to my doc for love to heal me when I have an injury or infection. For more about the ABIH check out this post on Science-Based Medicine. Which confirms my fear that this certification has essentially zero meaning. Okay… So the author, David Perlmutter, is the founder of a quack organization. Still, just for fun, I’ll keep reading and see what his “proof” regarding the toxicity of grains is.

Modern wheat is not the same as the wheat of our ancestors. Yeah, yeah. We’ve heard this all before.

“Why is precious little information made available about how we can keep our brains healthy and stave off brain diseases?” I do like this question. Also, I suspect the answer is the same for the brain as for other organs: get plenty of exercise, avoid being sedentary, cook for yourself, and eat more veg. Oh, wait. Not according to Perlmutter, “it’s pointless to consume antioxidants.” Forget the veg, apparently we should all be eating more fat and cholesterol.

Self-Assessment: Ooh! This should be fun! I got 7 out of 20. Zero is optimal but at least I’m not in the “hazard zone” which is anything over 10.

Chapter 1“As many as 40 percent of us can’t properly process gluten”. Reference please. Where did this figure come from and what precisely does inability to properly process gluten mean?

Yes, cholesterol is essential in our bodies. However, a dietary source of cholesterol is not essential. Our bodies can make it. Also, what does this have to do with grains being the cause of brain degeneration and diseases?

Chapter 2: I wonder what this “test for gluten sensitivity” he’s ordering for his patients is. I can’t dispute these tales of improvement in patients following elimination of gluten. However, it’s important to note that we don’t have all of the details and elimination of gluten may not have been the “cure” for migraines and bipolar disorder Perlmutter wants us to believe it is.

A lovely image of a brain scan of a “gluten sensitive” patient versus one of a “normal” patient shows extensive damage in the GS brain. Obviously, this is proof that gluten causes brain damage. Or is it? Remember, correlation does not equal causation. And one brain scan image does not mean gluten will destroy your brain.

In the chapter about gluten Perlmutter says, “one of the main reasons why consuming so many grains and carbs can be so harmful is that they raise blood sugar”. Huh? So the cause of brain disorders is gluten, which is a protein, which would not impact blood sugar. So why are we now talking about carbs?

Chapter 3: “I’ll explain why consuming excess carbohydrates – even those that don’t contain gluten – can be just as harmful as eating a gluten-laden diet.” Sigh. Carbs are evil, fat is good. This is just Wheat Belly redux. Also, while I’m in agreement that all fats (with the exception of man-made trans-fats) can be part of a healthy diet and some of us need more (or less) than others, I think we also need to remember that fats contain more calories per gram than other macronutrients. Thus, if weight control is a concern, we must be careful not to consume overly large portions of calorie-dense high-fat foods.

Perlmutter argues that elevated cholesterol is not only not a risk factor for cardiovascular disease, it’s actually protective against CVD, ALS, and other diseases. The primary basis for this claim was a large study in Norway. The researchers found that there was a U-shaped association between total cholesterol and mortality from CVD. This would suggest that cholesterol has an optimal level (between 5.0 and 7.0 mmol L -1). People below 5.0, or at 7.0 or above, were more likely to die from CVD during the course of the study. Interesting indeed. However, those who had CVD at the start of the study were excluded and the researchers didn’t look at the difference between HDL and LDL profiles. I can’t help but wonder if examining these things would have made any difference to the findings. Even assuming their findings are accurate, they still don’t suggest that high levels of serum cholesterol are protective. They merely suggest that both high and low cholesterol may be associated with CVD.

Perlmutter moves on to argue that the use of statins increases the risk of developing Type 2 Diabetes (remind me again how this pertains to grains and gluten being toxic?). He cites a 2012 study that found a 48% increased risk of developing diabetes for women who took statin medications in contrast to women who did not. That sounds huge but it’s actually not as big as it sounds; 9.93% of statin users were diagnosed with DM2 versus 6.41% of non-statin users. This was also an observational study so causal claims cannot be made. While researchers did control for some confounders it’s entirely possible that there was another reason for the relatively greater risk experienced by the statin users, like, oh, say elevated LDL or another related health condition. There was also a large difference in the sample sizes for each group (10, 834 statin users and 143, 006 non-statin users) which makes me leery about drawing precise comparisons.

Chapter 4: Near the end of this chapter Perlmutter cites a 2012 study of weight loss maintenance (he fails to make the maintenance part very clear) as proof positive that a low-carb, high-fat diet is “the best diet for maintaining weight loss.” To be clear, the study had participants lose weight and then put them on one of three possible weight-loss maintenance diets for 4 weeks. They did find that the low-carb diet “produced the greatest improvements in most metabolic syndrome components examined herein” with a couple of caveats: 1. participants also experienced elevated urinary cortisol excretion 2. C-reative protein was found to be higher in this group. So, while some areas, such as resting metabolic rate, were better for participants on this diet, there were also negative effects. In addition, it’s important to note that the sample size was very small, only 21 people. Also, four weeks is not the same as a lifetime. It’s impossible to extrapolate from this experiment that a low-carb, high-fat diet is the optimal diet for health. Nor can we tell if it’s a realistic diet. Even if it does prove to be optimal for health it doesn’t really matter if nearly no one finds it possible to adhere to. I think that Perlmutter is taking it a little too far (yes, I’m being kind) to draw the conclusion that we should all switch from carbs to fats on the basis of this study.

Chapter 5: Perlmutter is making the argument for neurogenesis and discussing the benefits of exercise (I fully support this) as well as caloric restriction (I think the jury’s still out on this one). I do find it interesting that he’s advocating for a high-fat, low-calorie diet. I would think that this would be very difficult to follow; eating small amounts (Perlmutter recommends reducing caloric intake by 30%) of calorie-dense foods likely wouldn’t be very satiating. Just me speculating though.

I can’t help but think that Perlmutter is cherry picking research that supports his hypothesis. Grain Brain reminds me of how I used to write research papers in high school. I would develop an outline, start writing, and find sources that supported my hypothesis to use as citations.

Chapter 6: In this chapter, Perlmutter discusses the possible connection between gluten sensitivity and various mental illnesses; including: depression, autism, tourette’s, and ADHD. Complete with compelling tales of curing patients by placing them on gluten-free diets. While there may be some connection to gluten sensitivity in some of these illnesses (a recent study found a correlation between autism spectrum disorders and positive serologic celiac disease – but not for gut mucosa – test results) I think that without the corresponding evidence that Perlmutter is providing many individuals with false hope. Anecdotal evidence is not the same as scientific evidence and it’s important to note that, in most cases, no link (correlational or causal) has been drawn between gluten and mental illness. That’s not to say that gluten-elimination isn’t worth trying but in the majority of cases it’s unlikely to alleviate symptoms.

I’m reading about how a study of children with celiac disease found an increased risk of headaches of 833% in comparison to the general population. I decided to take a look at the original research Perlmutter cited with the hope of going on a little rant about relative risk (after all, it was 5% of the children in the study with celiac disease who experienced “headache”, versus 0.6% in the general population, still a small minority of children). However, the article that I found that matches the citation by Perlmutter doesn’t contain any such information. In fact, it contains zero mention of celiac disease or gluten whatsoever. Perhaps the citation is mismatched? (Let’s give Perlmutter the benefit of the doubt here). Regardless, it makes it that much more difficult to dispute (or support) his claims when the claims and the citations don’t correspond.

Chapter 7: In this chapter Permutter states, ” many of today’s physicians… don’t have a firm grasp of nutrition and its effects upon your health.” Hear hear! Cue the opportunity to promote the services of registered dietitians. Oh, wait. Perlmutter simply says that he hopes this will change with the next generation of doctors. Sigh. He then goes on to list a number of supplements that apparently we should all be taking.

DHA – Yes, along with EPA in fish oil, this may provide some neurological and cardiovascular benefits (1). Resveratrol – The jury’s still out on this one but more recent research has put a damper on earlier studies praising it as a life-extender (2). Turmeric – This spice is still being researched, and while promising, no conclusions have been reached regarding its benefits. The study Perlmutter cites was epidemiological research which asked residents of Singapore how often they ate curry. Those who ate curry occasionally, often, or very often, performed better on a test of cognitive ability. Of course, there’s potential for missed confounding variables, as well as the possibility that the difference could be attributed to some other component of curry. Probiotics – Again, we are still in the early stages of research linking gut microbiota and brain health. Perlmutter advises against consuming some probiotic foods as they often come with too much sugar. Instead he suggests taking a supplement. As a dietitian, I always think that it’s best to obtain your nutrients from foods whenever possible. Add foods like plain yoghurt, kefir, sauerkraut, miso, and kimchi to your diet to obtain probiotics. Coconut oil – There is some interesting research underway investigating the effects of coconut oil on Alzheimer’s patients (3). I certainly think that it’s a good idea to incorporate a variety of fats in our diets. However, I don’t think that we should go overboard with any one food. Alpha-lipoic Acid – May have some neurological benefits but the research thus far is not strong (4). Vitamin D – It seems like for every positive study regarding vitamin D there’s another study claiming that it’s useless, or even harmful. In our Northern climate, until research shows otherwise, it is still prudent to supplement with Vitamin D during the winter months.

Chapter 8: Shocker: I wholeheartedly agree with everything Perlmutter has to say in this chapter. He is emphasizing the importance of exercise for brain health. Nothing about grains or carbs.

Chapter 9: Another chapter without mention of grains and carbs. Another chapter I actually agree with Perlmutter. Sleep is vitally important for health.

Chapter 10: We’re just getting into general healthy living tips now and recommendations for how to implement the Grain Brain diet. Most of them are perfectly reasonable. Following this, there are some recipes.

As I sat eating birthday cake (it’s birthday season in my family) and contemplating how to conclude this post I commented to my boyfriend, “Who knows, maybe eating cake will give me Alzheimer’s one day.” Considering how few people develop Alzheimer’s disease (14.9% of Canadians over 65 have some form of dementia) and how many people consume grains (statistics unavailable but I’m assuming it’s roughly 100%) based on the current lack of robust evidence it’s a risk I’m willing to take. I hope to celebrate my birthday tomorrow with some cake.


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Will teenaged milk consumption increase hip fracture risk in old-age?

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I recently saw someone touting the results of a study as indicating that milk consumption may increase the risk of bone fractures. Now, if you’ve been reading my blog for a while you’ll know that I’m not always on board with the promotion of milk. I question the inclusion of milk and alternatives as a food group on Canada’s Food Guide. However, I don’t believe that there’s anything inherently wrong with consuming milk (in moderation) if it’s a beverage that you enjoy. It’s certainly better than juice! Anyway… Despite my posts deriding “research” promoting the consumption of milk (usually of the chocolate variety) I lean towards siding with the milk-drinkers on this one.

The study looked at data from the Nurses’ Health Study and the Health Professionals Follow-Up Study in the US. Milk consumption of participants during adolescence was reported based on dietary recall ten years into the study. Considering that, depending on the study, participants were between 30-55 and 40-75 years of age at the start of the study, they would have been estimating their adolescent milk consumption anywhere from about 17 to 60+ years after the fact. Maybe it’s just me, but at 35 years of age I can’t recall how much milk I drank as a teenager. As dietary recall tends to be inaccurate the day following consumption I would hazard to guess that it’s even less accurate decades down the road.

“Participants were excluded at entry if they had reported a prior hip fracture, a diagnosis of osteoporosis or cancer”. I wonder if this exclusion affected the results. It would be interesting to look at the excluded participants to determine if they were milk-drinkers or not during adolescence. The researchers also divided the results into three groupings: those who consumed milk less than twice a week, those who consumed it once a day, and those who consumed it four or more times a day. Four or more times a day seems like rather a lot of milk to me. I would be interested to see the level of risk for hip fracture played out for those consuming the recommended number of servings based on the Food Guide (i.e. 3-4/day) also taking into consideration other foods from the milk and alternative group.

The researchers found an increased risk of 6% of hip fracture for each glass of milk consumed by men during teenaged-years (this was presumably over the average of 2.1/day reported). Interestingly, for women, there was no relationship between milk consumption and hip fracture risk. The researchers did rely on participants to report hip fractures so there may have been some degree of inaccuracy in the findings.

I think that this statement by the authors in the discussion is worthy of note: “it is not entirely clear that an early gain in bone mass will persist into adult years as the young skeleton is replaced through many years of remodeling, which may erase any initial advantage.” In other words, consumption of nutrients, and participation in exercise, which increases bone density when you’re young may not matter if you don’t carry on with these behaviours as you age. The argument here is less whether or not milk consumption during adolescence affects bone density and hip fracture risk during old age and more that it’s important to continue to be active and to consume foods that are rich in calcium and vitamin D as our bones are not static.


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Are these 27 foods you should never buy again?

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Reader’s Digest published the article 27 foods you should never purchase again. Reasons given include: being a rip-off, being gross, being fake, and being “drastically” unhealthy. Here’s my take on the list:

1. Parmigiano-Reggiano cheese is apparently over-priced in comparison to other flavourful hard cheeses. Depending on the prices at your grocery store this may be true. As they state, Pecorino Romano makes a nice substitute.

2. Smoked and cured meats are too fatty and are linked to a number of health problems. I certainly don’t think that bacon and sausages should be every day foods. However, I think that there is no problem with consuming them once in a while. Bacon is delicious.

3. “Blueberry” items often don’t contain any actual blueberries. Read the ingredients. Make an informed decision.

4. Multi-grain bread “is junk food masquerading in a healthy disguise.” They suggest checking the label for “whole wheat” as the first ingredient. Sure, the bread section of your grocery store can be difficult to navigate. However, it’s not necessarily a junk food and you should be looking for whole grain on the label, not whole wheat.

5. Reduced fat peanut butter fat is replaced with sugar. I’m on board with this one. Go with natural nut butters that contain nothing other than nuts.

6. Bottled tea is expensive and contains lots of sugar and calories. Good advice; brew your own at home and sweeten minimally.

7. Tomato-based pasta sauces are over priced. Sure, this may be the case but for those who are time-pressed taking an hour to make their own tomato sauce may not be viable. If you have the time, go for it. If you don’t, and you have the money, check the ingredients and don’t feel bad about buying a jar or can of tomato sauce. Add extra veggies for more nutrients.

8. Swordfish are high in mercury. True. Go for smaller fish, lower down the food chain.

9. Energy drinks are “sugar bombs” and have been linked to adverse health effects. No argument from me on this one!

10. Gluten-free baked goods unnecessary if you don’t have a condition that means you can’t have gluten, may be high in calories, and expensive. I agree that this items may be less nutritious than their glutenous counterparts. However, for those on gluten-free diets they can be nice to have. And some of them can be nutritious. As always, read the label.

11. Flavoured non-dairy milks are expensive and unhealthy. Well, yes, you should avoid the sweetened non-dairy milk, but you can buy unsweetened vanilla and chocolate non-dairy milks. For the many people who are lactose intolerant, allergic to cow’s milk, or vegan, nut, grain, and seed milks provide a viable alternative. They can also be a nice change for anyone. As always, read the label to make sure that it’s fortified (so that you’re getting the calcium and vitamin D and other micronutrients that you would get from cow’s milk) and also, be aware that these milks are not a good source of protein.

12. Foods made of WOOD - Cellulose is actually wood shavings. While cellulose is found in plants, it does appear that the cellulose used as a food additive is wood pulp used to add fibre and impart a creamy mouth-feel. I’m not sure if this is anything to get too worked-up about. Cellulose from a tree should be the same as cellulose from a plant. Still, it’s best to minimize your highly processed packaged food consumption so it’s something to bear in mind.

13. White rice is associated with higher diabetes risk. Yes, it’s always best to go with whole grains but having white rice every now and again isn’t going to kill you.

14. ‘Gourmet’ frozen vegetables are easily made on your own. Agreed. Unadulterated frozen veg are a great thing to have on-hand. They’re affordable, nutritious, and keep for months in the freezer. However, when you get into the “gourmet” ones you’re getting added fat and salt and probably other things. Far better (for your health and your bank account) to add your own herbs and spices when you’re cooking.

15. Microwave sandwiches you’re paying for packaging and additives. These things are so far off my radar! Definitely a waste of money. If you don’t have time and ingredients to make your own sandwich for lunch most grocery stores have delis at which you can purchase freshly made sandwiches which they can even grill for you.

16. Premium frozen fruit bars are overpriced; you should make your own. Yes, you can make far better flavours at home if you have time and freezer space and if they’re your sort of thing.

17. Boxed rice ‘entree’ or side-dish mixes may have added flavours but they also have considerable added cost. Yep, best to add your own herbs and spices. Try cooking in broth or coconut milk for extra flavour as well.

18. Energy or protein bars are expensive and full of sugar, fat, and calories. Yes, many of them (and granola bars) are candy bars masquerading as health foods. However, some of the better ones (again, read the label) can be handy snacks or meal replacements to have on-hand in a pinch.

19. Spice mixes may seem like a good way to reduce the number of spices you have to buy but usually contain a lot of salt. Again, check the label. But, I generally agree with this. Best to keep staple spices on-hand and make your own blends and rubs.

20. Powdered iced tea mixes or prepared flavoured iced tea are expensive and full of unhealthy ingredients. Umm… See #6.

21. Bottled water is expensive and environmentally unfriendly. Not to mention, provided your tap water is potable, it’s usually less safe than tap water. As they mention, there are occasions when bottled water may be a necessary purchase. In general, stick with tap.

22. Salad kits are expensive. Those added croutons and chips and whatever else they come with these days aren’t great for you either. Yes, if you can use up all of the ingredients you’d need to make your own salad before they go bad, this is the best option. If you can’t, check out the ready-made salads in the deli dept.

23. Individual servings of anything are expensive; buy a big package and portion out your own. While most of the foods that come in this format tend to be nutritionally void, if you’re going to buy them anyway and you struggle with portion control I do think that they can serve a purpose.

24. Trail mix pre-bagged is expensive, make your own. Any way you slice it, nuts and dried fruit are going to be expensive. Sure, make your own if you want, but also go for mixes in the bulk food section or hit-up a bulk food store. Don’t forget that trail mixes are very calorie dense. Watch your serving sizes!

25. Snack or lunch packs are overpriced and full of salt. Agreed. These are not good choices. Make your own healthy bento-box lunches for your kids instead. Use fresh fruits and vegetables, whole grain crackers or flat breads, “real” cheese or meat.

26. Gourmet ice cream is expensive and there’s usually a cheaper brand that’s just as good. True, many store-labels are manufacturer by brand-name labels. Ice cream should be a “sometimes” food anyway though so price might not matter and you might be better off getting a small tub to avoid eating too much in one sitting.

27. Pre-formed meat patties are more expensive than making your own and may have an increased risk of bacterial contamination. Added bonus: when you make your own you can add special spices and chopped onion and jalapeno.

While it does seem that I agree with much of this list. There were a few additional comments I added that I feel are worth consideration.


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Why the home test for vitamin quality is crap

 

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I’ve had a number of people mention to me about testing vitamin quality by attempting to dissolve them. While this seems like a good idea, initially, upon further consideration, I can think of a number of flaws with attempting this at home.

The Consumer Lab provides a step-by-step guide to testing the disintegration of vitamins at home. They recommend putting the pill in water warmed to body temperature and then stirring continuously for 30 minutes, maintaining the water temperature. Unless the pill is chewable, enteric coated, or timed-released, it should break down. The implication is, if it doesn’t, it’s not breaking down when you ingest it and your body isn’t getting the nutrients from it. But, there are some problems with this premise.

First, your stomach is a highly acidic environment. Stomach acid usually has a pH of 1.5-3.5. Water, on the other hand, has a pH of about 7 (i.e. neutral). If you wanted to mimic the conditions of the stomach, you would need to use warmed lemon juice, or a similar acid.

Second, creating a warm, acidic environment isn’t enough. Most vitamins are recommended to be consumed with food. During digestion, the stomach releases a whole host of digestive enzymes which work to break down your food, and some of them would likely also have an impact on breaking down any vitamin and mineral supplements. Together the stomach secretions and jumbled-up food forms “chyme” which is generally ready to leave the stomach after 1 to 4 hours. That time-frame gives your vitamin a whole lot longer to break-down than the 30 minute warm water home test does. The stomach also secretes “intrinsic factor” which essential for the absorption of vitamin B-12 (don’t forget to add that to your cup of body temperature lemon juice).

Third, digestion doesn’t end in the stomach. After the chyme moves from the stomach to the small intestine which is actually where most digestion takes place over 3 to 10 hours.

Fourth, as the Consumer Lab test notes, a number of vitamins are designed to take long periods to break-down (i.e. timed-released). Others (i.e. enteric coated) are designed not to break-down until after exiting the acidic environment of the stomach and entering the neutral environment of the small intestine.

Fifth, have you ever shat out an intact vitamin pill? Unless your body’s stashing whole pills somewhere along your digestive tract, it’s probably safe to say that it’s being broken-down along the way.

Sixth, just because a supplement is breaking-down in your body doesn’t necessarily mean that it’s being absorbed. Determining that it dissolves in a cup of warm water won’t tell you if you’re obtaining any nutrients from it.

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