PUFAs and Heart Disease: Where's the Beef?

I don’t like coming down for or against any macronutrient or any food, even sugar. I have a lot of rants. Just looking at the American Heart Association webpage right now is making me think of some blog posts I need to write. Ok… I’m closing the webpage.

Anyway, I felt I needed to do a post on PUFAs (poly-unsaturated fatty acids). Previously, I did a post on how saturated fats are not bad for you. I don’t care what everyone else says. I don’t care what established authorities say. I’m an ISTJ. If you can’t provide a logically consistent argument. If you can’t adequately answer all the counter-arguments. If your conclusion isn’t in sync with other studies, or even with your own data. If your research techniques leave much to be desired. Then forget it, I’m not jumping on your bandwagon.

So, like, several years ago I was researching all this saturated fat nonsense and really trying to understand the process of lipid metabolism and atherosclerosis. I mean, LDL particles are getting damaged, and a bunch of cholesterol lipids are piling up in plaques in peoples’ arteries, and this does seem to be a pretty significant nationwide problem.

Forget that from my best scientific understanding, saturated fats would actually be protective. Forget that cholesterol isn’t even the main issue. Let’s get to the main issue as I identified it in my research: oxidation and inflammation.

Daniel Steinberg alludes to oxidation in his book The Cholesterol Wars when he starts talking about the scavenger receptor on macrophages and oxidatively modified LDL. He then talks about some study in which pobucol was able to arrest the progression of lesions in rabbits by blocking endothelial cell-induced LDL oxidation and that specifically the effect was not due to probucol’s LDL-lowering effect.

Anyway, where was I? Oh right, oxidation. So here’s the thing. Atherosclerosis is all about damage to your LDL particles. Steinberg may not have followed up on these insights, but I sure as hell did. The thing is macrophages are there for cleaning up. They don’t chomp up healthy LDL. There are some slides I’d like to share, but viewing them doesn’t make the whole thing much simpler.

As I studied all this, I started to come up with my own ideas what promotes atherosclerosis. My conclusions run fairly counter to Daniel Steinberg’s. Since PUFAs contain at least two double bonds, they are highly volatile*. This means prone to oxidation and free-radical damage. It is this sort of damage that macrophages are going to detect**. A diet rich in PUFAs would seem an undue risk for oxidative stress***.

Despite the very apparent risk in using PUFAs, which come mostly from seed and nut oils, we pretty much guarantee these oils will be rancid**** in the way we prescribe their use. I.e. using them as cooking oils and providing no warning about the solvents and heating processes that are used to extract these oils.

And it’s worse than that. As I’ve learned more, I’ve come to discover the high omega-6 ratio of most seed oils may itself be an issue, throwing the O6:O3 balance in our tissues out of whack and making them more pro-inflammatory.

Anyways, suffice it to say, I really haven’t seen any evidence exonerating seed oils, so I started to wonder, is there any context in which these oils would’ve been used in a traditional manner? I.e., would traditional cooking methods ever have had any use for canola, soybean, or corn oil? As far as I can tell, not on any massive scale, and certainly not for cooking. Thing is, seed oils are not like olive oil or palm oil. They’re not that easy to extract. What would extraction look like? Here’s Catherine Shanahan’s take on it in Deep Nutrition:

If we could somehow get canola oil out of the seed without exposing it to heat, it would be good for us, but nobody can.

Well, that’s not entirely true. In the old days, flax and rapeseed (a relative of canola) were gently extracted in the home using a small wedge press. Over the course of a day, the wedge would be tapped into the press a little further until, ever so slowly, the golden oil would start to drip, fresh and full of natural antioxidants and vitamins. These oils were not used to fry food, and therefore never exposed to damaging heat. If you aren’t up for installing a wedge press in your kitchen, a few small enterprises can provide flax, hemp, and other healthy omega-3 rich oils – none of which should ever be used for cooking.

So there’s the gist of it. Other than eating nuts straight up, this was about the extent to which seed oils were extracted and used in the diet. So what about expeller-pressed canola oil? Well, commercial extraction of seed oils involves hexane, followed by twenty or so additional stages of bleaching and deodorizing. Organic, expeller-pressed oil has only skipped the initial step of extraction using hexane.

So where does this lead me? It leads me to the point that I personally try to avoid all “vegetable” oils except olive oil, palm oil, or coconut oil. Note that seed oils are used in everything from “healthy” salad dressings to “unhealthy” mayo (so like, what’s the difference?). Eating out or eating processed foods or just stopping by the local deli, almost all the fats are from vegetable oils. It’s both sign and symptom of our major industrial agricultural system. There are actually very little saturated or animal fats in any of our restaurant or processed foods (unless you like French food). Show me a place that still cooks french fries in beef tallow, popcorn in coconut oil, or bakes pie crusts with lard. They exist, but they are few and far between. You can’t even buy decent lard, beef tallow, or coconut oil unless you know where to look.

No, I’m sorry, it’s not the saturated fats that are killing us. That’s just an easy scapegoat to a complex problem the heart***** of which lies with our industrial food system. But that system will not change easily. The real solution, on the individual level is to eat real foods. And I’m sorry to say it, but canola oil, soybean oil, safflower, sunflower, what have you… more often than not are part of the industrial food system.


*Compared to mono-unsaturated fats, having two places for oxygen to ineract doesn't make such interactions twice as likely for PUFAs. It makes them billions of times more likely.
**Again, macrophages are there to scavenge the junk. They will not soak up healthy LDL. Part of the whole process is that a macrophage sucks up a modified LDL, which then becomes a "foam" cell, and begins the whole atherosclerotic process.
***The body can protect PUFAs in serum for a short period, but it needs an adequate supply of anti-oxidants. If there is some disorder of your lipid metabolism and your LDL particles are spending more time in serum than they should (possibly indicated by high LDL particle count (LDL-P, not LDL-c)), then there is a much greater risk for oxidation.
****Rancidity refers to the chemical decomposition of fats, one pathway of which is oxidation.
*****No pun intended.

Random Thoughts

So lately I’ve started to wonder how necessary it is to get your RDA of all the vitamins and minerals every day. Or how necessary it is to get those vitamins and minerals mostly from plants. Or how important it is to get protein, fat, and carbs at every meal. Or how important it is that you always eat breakfast. Or that you don’t snack at bedtime.

Here’s my thinking on this. The body would obviously need to be able to adapt to surpluses and shortages of most nutrients, as well as daily variations in macro-nutrient intake. Maybe calcium is abundant in the summer. Maybe beta-carotene is abundant in the fall. The body obviously has storehouses. It packs excess glucose in the liver, excess calcium in the bones, and so forth. As one item becomes abundant or deficient, your taste preferences change to guide you towards what the body needs next.

So often these guidelines are based on a reductionist understanding of some hormone or chemical pathway. This is what some call Nutritionism and it is next to worthless for making statements with any certainty for a complex, dynamic system like the human body. Sometimes, there may be an epidemiological study… but often, certain questions still aren’t asked. For example, studies show correlation between skipping breakfast and long term weight gain, so what’s the cause? Are those skipping breakfast doing so because they are on a diet and the diet is the reason for the weight gain? Or are they eating in an unrestrained manner, listening to their body, yet somehow some aspect of skipping breakfast is causing weight gain? The question I have, if breakfast is so necessary, what were the hunter-gatherers chowing down on before they went out to go hunt and gather? Learn the eating patterns of actual non-industrialized groups and you’ll find the breakfast/lunch/dinner eating pattern isn’t that common.

As for eating lots of vegetables, I’ve never understood this. Isn’t the point of the human species to maximize our resource usage? So why go through all the effort of assimilating all these vegetables into our diet (which often requires a lot of preparation) when other animals have done this already? Just eat the animals… which is precisely the point of eating organ meats. They’re also more bio-available. Liver knocks the charts off any plant for any of the nutrients it provides, which is probably why some people do well getting it only once a week. And again, there’s that concept of getting nutrients over time rather than every day.

We act like phytonutrients are so super-great, but it just means nutrients from plants. And then we say get a variety of colors. Well, it’s polyphenols that are responsible largely for color, but polyphenols are often defensive compounds (what, you didn’t think plants evolved defensive strategies?). So my question is, why would you ingest something designed to interact with your body in a way to give you a selective disadvantage? Wouldn’t that imply negative health consequences? Animal defenses are more about tooth and claw than chemical compounds, which would seem to imply, ingesting nutrients from animal sources would be the optimal strategy.

None of that’s to say plants are for sure bad for you. Doing so based on an argument like the above would just be Nutritionism again. Personally, I find they add flavor, color, and texture. Plus I don’t like eating a lot of meat. I argue for the sake of argument. But things like color, flavor, and texture (assuming you are eating non-industrialized, non-processed foods) are your drivers to maximum nutrition.

Personally, what this comes down to are things I don’t think it’s healthy to worry about:
• Eating too many meals a day
• Eating too few meals a day
• Eating at the wrong time of day
• Anything else that isn’t following your own internal hunger/satiety cues.
• Eating an incorrect ratio of fats/protein/carbs
• Eating too few vegetables
• Eating too many vegetables
• Eating too much animal fat
• Eating too little animal fat
• Eating too much animal protein
• Eating too many refined (non-nutritive) calories in an otherwise nutritionally dense diet
• Anything else that isn’t following your current preferences at the moment you are eating

Health vs. Weight: Do they always correlate?

I guess I like to talk about weight more so than health because there are more misconceptions surrounding it and I’m more about dispelling bad advice than giving good advice. The wrong advice can lead you very quickly into a hole, whereas good advice is very difficult to vet. Besides, the basics of good advice are more easily summarized: eat plenty of nourishing nutrient dense foods, get adequate sleep, minimize your stress, don’t diet, and don’t stress the small stuff. Oftentimes, offering good advice is more about clearing our heads of all the junk. Nutritionism suffers from too many concepts, not too few.

Diana Schwarzbein has a saying: “You need to be healthy to lose weight, not lose weight to be healthy”. I’m sure I’ve repeated it on this blog in the past, but I’m not going to check right now. The main point I want to get across is that the direction your weight is going doesn’t always correlate with the direction you health is going.

I know I’ve brought up Health at Every Size in a previous post, and from there we know that adopting healthy lifestyle practices is enough to ensure good health whether weight comes off or not. We also know that calorie restriction (whether by reducing food intake or increasing exercise) is not an effective long-term means of improvement in health or weight. Yet, there is an intuitive part of us that says weight and health should correlate. Is that cultural conditioning? Above a certain point, probably not.

The concept I really want to go after here is that you have to lose weight to be healthy, or that if what you are gaining weight, you must be doing something wrong. This brings us into discussion of the starvation response of the body. The best study on this is almost certainly Ancel Keys semi-starvation study.

Ancel Keys performed a controlled experiment, where the caloric intake of 32 healthy young men was cut in half for a period of 24 weeks. The men suffered a wide array of negative side effects. And yes, they all experienced weight loss, but what I’m concerned about here is the hormonal changes in the body that are a response to famine.

All men, after the 24 week period was over, gained fat above and beyond their original starting point, despite not having weight or health problems before the experiment began. Moreover, the fat gain occurred before lean body mass was restored and consisted primarily of visceral (or ‘belly’) fat. This gain in visceral fat did not even begin to reverse itself until 33 weeks of eating to appetite.

I consider this a clear famine response of the body. The body needs sufficient nutrients and calories, adequate sleep, and low stress and it should be able to sort itself out. Many of us start out with what is a small weight problem and immediately start dieting. It doesn’t matter if it’s calorie restriction, fat restriction, or carbohydrate restriction. They are all forms of deprivation. Currently, I am unaware of a way for somebody in a dieted state to not go through the fat gain phase while bringing their body out of the famine response. The fat may not be permanent though, as the men in Ancel Key’s study eventually lost a lot of their rebound fat by not dieting and continuing to obey appetite.

But think about this for a moment. How many people in our society are dieting? How many people automatically assume that health is all about body weight and getting fit? The answer is a lot. And the result is that there are a lot of people actively attempting to ignore their bodies’ queues in an effort to lose weight. That’s a lot of people in a state of partial deprivation.

Now consider that every one of these people have placed their bodies at least partially into the famine response state. Consider that every one of them is suffering a lot of side effects. Consider that almost none of them will be able to carry this on indefinitely. And finally, consider that when the rebound occurs, virtually none of them will be willing to wait out the 40 to 50 weeks it would take to confirm rebound fat gain is reversing. Pretty soon a person in this position falls into guilt and self-loathing, and restarts the diet long before the body has had the opportunity to heal. This is how yo-yo dieting works, and it is a societal problem, not a personal one.

Cut Calories to Gain Fat
Good overview of Ancel Key's study.

Ancel Keys and the Biology of Human Starvation
More extensive overview with a lot of quotes pulled out of the study. Definitely worth reading if you want to know possible side effects of dieting, why it is not healthy, and why it is not maintainable.

Animal Obesity
Obesity Paradox
A couple interesting blog posts that point out how obesity isn't always about the number of calories.

Deep Nutrition on Carbohydrates

I was going to write a full review of Deep Nutrition. The book contains such important, almost unheard information in the first half, I cannot help but recommend it. But I was so deeply dismayed by chapter nine that I felt it needed its own rebuttal. This also gives me the chance to present some of my arguments on carbohydrates. As readers of Gary Taubes and some of the other popular authors know, the low-carb message is still going strong and the arguments are usually very compelling. That's why it's important to get all the science. This entry is mostly a rebuttal of Shanahan's argument in Deep Nutrition. I may at some point create a future post focusing solely on carbohydrates.

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Here again we have the old argument that carbohydrates cause metabolic damage. But Shanahan presents the argument in an even more dissappointing fashion than most. Part of this is deliberate obfuscation, and part is just a general lack of scientific rigor.

The deliberate obfuscation is in not making a distinction between dietary sugar intake and chronically elevated glucose levels. Most of the damage Shanahan refers to throughout chapter nine are due to chronically elevated blood glucose. Shanahan speaks throughout the chapter as though we’re referring to dietary sugar, and this viewpoint is reinforced near the beginning with a statistic on average sugar consumption (consulting the endnote confirms the statistic refers only to refined sugars).

Shanahan then does an about face at the end of the chapter, saying that to your body, all carbohydrates are sugar and goes on to recommend strict limiting of all of them. How she comes to this conclusion when the previous chapter* makes clear similar logic does not apply to other macronutrients is beyond me. She even claims that excessive carbohydrate overloads the pancreas.

Really what we are concerned about here is diabetes and pre-diabetes, as it is the elevated blood glucose that causes all the disruption discussed in chapter nine. But if we want to know how most effectively to reverse and prevent diseases such as diabetes, then we must give seroius consideration to diets with proven efficacy, such as Joel Furhman’s Nutritarian Diet (a high-carbohydrate, low-fat diet with emphasis on plants and whole foods). Or, more simply, we can observe the many traditional cultures that enjoy high-carbohydrate diets, such as the Kitava and rural Zulu, yet do not suffer the maladies described in chapter nine. Since this is a book that focuses on what to eat by observing traditional cultures, omissions such as this are a great disservice.

Refined sugar is as dissimilar to sweet potatoes as corn oil is to coconut oil**, as far as your body is concerned. So anybody intuitively grasping the point of chapter eight should get this point as well. One is stripped of nutrients and has possible damaging side effects. The other is a whole food, in natural form, complete with all the nutrients available to metabolize it.

Perhaps it is the fact that the standard Western diet is so rich in refined carbohydrates, where such nutrients have been stripped, that so many people develop an inability to properly process carbohydrates. And perhaps it is why diets such as Joel Furhman’s, which would provide such nutrients in abundance***, are so successful at reversing conditions such as diabetes.



*Chapter eight focuses primarily on the distinction between traditional fats and vegetable oils and how vegetable oils are uniquely damaging while traditional fats are healthy. It is an argument I am so far in complete agreement with. Traditional fats are things like butter, lard, and coconut oil.

**I don't want to get too deep into specifics here, but food must always be taken as a whole, so any refinement is already potentially damaging. Also, there is evidence humans are primarily starch-based eaters, and long strings of glucose do not metabolize the same as glucose-fructose pairs.

***Specifically the nutrients that help the body properly metabolize carbohydrates are being provided by the dietary carbohydrates in the form of whole foods. Although this can initially cause high blood sugars in people with poor glucose metabolism, the problem typically corrects itself with very good fasting and post-prandial readings within a few days to a few weeks. See DrFurhman.com for more info.

Health at Every Size

Most people are probably not familiar with the Health at Every Size / Fat Acceptance movement. One of the central pieces to this movement is the book Health at Every Size by nutritionist Linda Bacon. In it Bacon dispels the myths that overweight people have higher mortality and that losing weight is a simple matter of dieting that anyone can accomplish.

The book is based on solid science and I’m surprised the information within it is not more widespread. In my own limited research (using Google) to determine the long term benefits of dieting, I was unable to find any evidence that dieting led to long-term weight loss or to improved health measures.

Although I found some mixed messages and things that don’t correspond with my understanding of the science of nutrition, these inconsistencies were minor. The central message of the book is as powerful and necessary as ever. And I especially like that Bacon takes the medical community, the media, and the rest of us to task for how we really treat obesity: as a thinly veiled excuse for judgment and prejudice.

Not everyone will like the central message of this book: that you need to accept who you are right now and there’s no solid evidence dieting is effective for weight loss (or improved health) long term.

Having gone through that, I would like to add my personal statement on why nobody should be judged for being overweight. Obesity is a complex disorder and not directly related to amount of food intake. It involves factors such as stress level, emotional connectedness, nutrient quality, type of exercise (not quantity or duration), previous diet (famine) history, and others. The simple fact is that energy balance, just like water balance, internal temperature, or glucose levels, is hormonally regulated. An imbalance in any of these systems does not itself indicate the root cause of the problem. Trying to force one of these systems out of its current balance simply induces unwanted side effects and forces the body to compensate.

Most of us are not only growing up in a nutritionally depleted environment, many of the foods available to us are damaging in ways that promote poor health and obesity. On top of that, the advice we get on how to lose weight and be healthy could not be more counter-productive. At this point I could segue into several other topics, so I will end here. Below is the usual list of references and father reading.

http://www.lindabacon.org/HAESbook/
Website for the book. Also links to the HAES community.

http://www.rachelcosgrove.com/
Rachel Cosgrove coaches women on how to achieve their ideal body composition by dropping the cardio and doing the exercises that cause the adaptive changes most women desire. This is the different than simply being skinny-fat.

http://www.gabrielmethod.com/
Man that lost a massive amount of weight by giving up the diet mentality and focusing on simply nourishing his body and his mind. Although it may not work for everyone, it is definitely a first step. A lot of the messages he promotes are centered at removing our own internal judgments and getting us back in tune with our bodies so that we can listen and respond to its needs. This is from a person who had previously tried almost every diet imaginable.

http://fatfu.wordpress.com/
An almost militant attack on the poor science, perceptions, and judgment pervasive in our culture and all the pain it causes. Exposes a lot of the attitude in our culture for what it really is, just plain pure prejudice. This blog is worth a good perusal.

http://janetto.bol.ucla.edu/index_files/Mannetal2007AP.pdf
Where would I be without this gem? The result of my own short stint of Google “research”. If you want proof that dieting does not cause weight loss or improved health, look no further.

Off the Beaten Path

So I wanted to write an article about trust in the medical system. I’ve come to this conclusion that so much of what is going on in the blogosphere, so many low-carb and vegan diets, all happen because of a lack of faith. Once your faith in what passes as standard nutritional gospel has dissolved, you are at the whim of whatever scientific theory will sound most plausible.

It’s sad how little territory is explored off the beaten path. It’s sad how much interesting information or clear scientific evidence is just left by the wayside. It’s like this path was beaten out long ago, and now everybody just tramples along. Nobody looks up. And it takes so little critical thought, so little outside research to start poking holes in the standard nutritional dogma. You have to honestly wonder why so few are out there trying to truly map out what health is.

But nutrition is too complex to navigate without guidance. And with most traditional recipes wiped out by processed foods, modern lives, and poor science, those of us on the outskirts have to hobble together whatever we can from the little information that exists.

It’s ironic that this can lead to a much faster decline in health than simply following the conventional wisdom, but it makes sense when you think about it. If conventional wisdom leads to a decline in health across decades, or across generations, then there is no outcry, or even awareness. But if it led to a decline in health in a couple years, that would not be tolerated.

I know my own problems are largely related to my period of low-carb dieting. But I acted on the best evidence I had at the time. As they say, a little bit of information is not always a good thing. But neither would I take it back. I hate to imagine myself mindlessly following the herd when I know a lot of the information out there is wrong.