Wednesday, December 12, 2012

The Mediterranean Diet Secret: Olive Oil or Low Fat Plant-Based 200 Days A Year?

In the early 1950s, the population of Greece had a very low incidence of cardiovascular disease, particularly on the island of Crete, compared to the incidence in the U.S..  In 1948 the Rockefeller Foundation did a majory epidemiological study on the island of Crete, part of which included investigation of the food habits on Crete. 1

The following table shows the results of that investigation by a seven day food record. 

 The table shows the following:

    •    Cereals, pulses, potatoes, nuts, vegetables, and fruits supplied 61 percent of the total energy in the diet of Crete, compared to only 37 percent of energy in the U.S. food supply.
    •    Items of animal origin provided only 7 percent of the total energy in the Cretan diet, compared to 29 percent of the energy in the U.S. food supply.
    •    Table oils and fats, primarily olive oil, supplied 29 percent of the energy in the Cretan diet.

Cereals provided thirty-nine percent of the 2500 kcal of energy supplied by the Cretan diet, or 975 kcal.  Since cereals supply about 70 percent of energy as carbohydrate, cereals alone supplied 170 g of carbohydrate in the Cretan diet.

Since 28 g (1 ounce) of bread supplies about 60 kcal, the typical diet of someone living in Crete about 1950 may have included up to 16 ounces of wheat bread daily. 

Regardless of relative proportion of bread and pasta in the Cretan diet, a very low rate of heart disease occurred in Crete in conjunction with a high intake of wheat.

Meat, fish, eggs, and dairy products provided only seven percent of energy of the Cretan diet, about 178 kcal per day.

Dairy products such as feta cheese and yogurt supplied only three percent of energy, or about 75 kcal per day.  Since one cup of Greek yogurt (10% milkfat) supplies 290 kcal, and one ounce of feta cheese supplies only 75 kcal (6 g fat, 4 g saturated, 25 mg cholesterol), apparently in 1950 the people of Crete consumed no more than one ounce of cheese or about one-quarter of a cup of yogurt (6 g fat, 4 g saturated fat, 19 mg cholesterol) daily, far less than the three servings daily currently recommended by the USDA food guide. 

Meat, fish, and eggs supplied about four percent of calories or 103 kcal per day.  One egg supplies about 80 kcal, and one ounce of roasted goat flesh or grilled sardine (items consumed historically in Crete) supplies about 40 kcal, so the Cretan diet of 1950 contained an average of no more than 2.5 ounces of meat or fish daily for individuals expending 2500 kcal per day, or about one ounce of animal flesh per thousand kcal consumed (i.e. someone consuming only 2000 kcal would consume only two ounces daily).

Two and one-half ounces of roasted goat meat supplies only 19 g protein, 2 g of total fat, 0.5 g saturated fat, and 52 mg cholesterol, and 2.5 ounces of grilled sardines supplies about 12 g protein, 7 g of total fat, about 2 g saturated fat (yes, 29 percent of the fat in sardines consists of saturated fatty acids, a higher proportion than in the goat flesh). and 100 mg cholesterol (yes, the sardines supply more cholesterol than the goat meat).

Thus, from meat, fish, and dairy products, the Cretan diet circa 1950 would have on average supplied  8 to 13 g total fat, 5 to 6 g saturated fat, and 70 to 125 mg cholesterol per day.   In comparison, NHANES found that the average U.S. male consumes 307 mg cholesterol daily, and the average U.S. female 225 mg, two to four times the amount consumed by individuals in Crete 62 years ago. 2

Evidently, in 1950, people in Crete ate a starch-based diet with quite limited amounts of animal flesh, eggs, and milk.

Seven Countries Study Links Olive Oil To Health

In 1986, Keys et al reported the results of a 15-year follow-up on 15 cohorts in the prospective ecological Seven Countries Study  (which by the way involved original data collection from the 15 cohorts, not sorting through and arbitrarily selecting previously collected data, as so often incorrectly claimed):
"Death rates were related positively to average percentage of dietary energy from saturated fatty acids, negatively to dietary energy percentage from monounsaturated fatty acids, and were unrelated to dietary energy percentage from polyunsaturated fatty acids, proteins, carbohydrates, and alcohol. All death rates were negatively related to the ratio of monounsaturated to saturated fatty acids. Inclusion of that ratio with age, blood pressure, serum cholesterol, and smoking habits as independent variables accounted for 85% of variance in rates of deaths from all causes, 96% coronary heart disease, 55% cancer, and 66% stroke. Oleic acid accounted for almost all differences in monounsaturates among cohorts. All-cause and coronary heart disease death rates were low in cohorts with olive oil as the main fat. Causal relationships are not claimed but consideration of characteristics of populations as well as of individuals within populations is urged in evaluating risks."3
Notice that Keys et al specifically disclaimed assertion of causal relationships based on their data.  However, the team found a strong positive relationship between saturated (i.e. animal) fat intake and coronary heart diseaes, cancer, and stroke; and a negative relationship with olive oil. 

However, of the seven countries involved in the study (Japan, Italy, Greece, USA, Yugoslavia, Finland, and Netherlands), only two (Italy and Greece) had significant olive oil consumption.  Of these two, one had a significant brake on olive oil consumption for many days of the year, and this may have given olive oil an undeserved good reputation.

The Orthodox Mediterranean Diet Secret:  Avoid Olive Oil 180 Days A Year

Few popular or scientific accounts of the Mediterranean diet mention the fact that at least 95 percent of Greeks belong the the Eastern Orthodox Church, and a high proportion of Greeks follow the dietary directions of the Church which involve avoiding olive oil, meat, fish, milk, and dairy products on as many as 200 days every year:

"Orthodox Christian holy books recommend a total of 180–200 days of fasting per year. The faithful are advised to avoid olive oil, meat, fish, milk and dairy products every Wednesday and Friday throughout the year. Additionally, there are three principal fasting periods per year: i) a total of 40 days preceding Christmas (meat, dairy products and eggs are not allowed, while fish and olive oil are allowed except on Wednesdays and Fridays), ii) a period of 48 days preceding Easter (Lent). During Lent fish is allowed only two days whereas meat, dairy products and eggs are not allowed. Olive oil consumption is allowed only at weekends, iii) a total of 15 days in August (the Assumption) when the same dietary rules apply as for Lent with the exception of fish consumption which is allowed only on August 6th. Seafood such as shrimps, squid, cuttlefish, octopus, lobsters, crabs as well as snails are allowed on all fasting days throughout the year. The Greek Orthodox fasting practices can therefore be characterized as requiring a periodic vegetarian diet including fish and seafood." 4

Thus, on many days of the year, many Greeks eat a primarily plant-based diet without the olive oil so often identified as the secret to health and longevity.  Apparently, the Seven Countries Study did not account for this.  In fact, up until the year 2000, no scientific study, including the Seven Countries Study (SCS), had evaluated the impact of Greek Orthodox Christian fasting on serum lipoproteins or risk of cardiovascular disease or cancer.

At the ten-year follow-up of the SCS, Greece had the lowest CHD mortality of all seven countries: a remarkable 0/1000, compared to the next lowest in Japan, 7/1000. 5  This means that the Greek data would most strongly influence the appearance that a diet high in olive oil protects against CHD, when as a matter of fact, some significant portion of Greeks actually avoided eating olive oil on many days of the year. 

In 2000-2001, scientists from the University of Crete School of Medicine compared the blood lipids of Greeks who adhered to the fasting periods to those of Greeks who did not adhere during that year. They found that by the end of the year the fasters had significantly lower total cholesterol, LDL, and body mass index.  They also found that "when fasters returned to their usual dietary habits (non-fasting periods) total cholesterol and LDL cholesterol were increased by 6% and 9% respectively."4

Therefore, considering that the olive oil users of Roman Catholic Italy did not have the very low incidence of CHD and other diseases of civilization found in Greece in the 1950s, it seems possible that the Greeks enjoyed better health than the Italians because they avoided olive oil more often than the Italians, resulting in lower total cholesterol, LDL, and body fat levels.  

Greek Data Supports The Lipid Hypothesis

In 1997, an earlier team from the University of Crete School of Medicine reported that between 1962 and 1991, individuals participating in the Crete cohort of the Seven Countries Study had increased their intake of saturated fats and decreased their intake of monounsaturated fats, with corresponding increases in body mass index, adipose palmitic acid, diastolic and blood pressure, and by 1991,  "all age groups were characterized by central obesity."6
“Over time, the diet of Crete has changed remarkably and is now characterized by higher intake of saturated fat and cholesterol, and reduced intake of monounsaturated fat.  At the same time, total fat consumption has fallen.  These trends have been accompanied by a stead rise in CHD risk during 25 years of follow-up of the Cretan cohort (Menotti et al. 1999). Hence, as the Cretan diet increasingly resembles a Western diet, there has been a concurrent rise in CHD risk.”5

Tuesday, October 30, 2012

Healthy Longevity: Diet, Blood Cholesterol, Blood Pressure and Risk of Stroke

Healthy Longevity: Diet, Blood Cholesterol, Blood Pressure and Risk of Stroke:  Part I

The controversy surrounding the lipid hypothesis, in particular the relationship between elevated total and LDL cholesterol and coronary heart disease was considered largely resolved and regarded as scientific fact within the scientific community by 1984 when the expert panel from the National Institutes of Health (NIH) reviewed the relevant literature and agreed that the relationship was causal.1 2 The panel concluded:
Elevated blood cholesterol level is a major cause of coronary artery disease. It has been established beyond a reasonable doubt that lowering definitely elevated blood cholesterol levels (specifically blood levels of low-density lipoprotein cholesterol) will reduce the risk of heart attacks due to coronary heart disease… Further, we are persuaded that the blood cholesterol level of most Americans is undesirably high, in large part because of our high dietary intake of calories, saturated fat, and cholesterol… There is no doubt that appropriate changes in our diet will reduce blood cholesterol levels.
Since 1984 evidence accumulated from over 100 randomized controlled trials of various medical and dietary based lipid modifying interventions has further established that lowering LDL cholesterol significantly decreases the risk of coronary heart disease and all-cause mortality, independent of changes to HDL cholesterol and triglycerides, and non-lipid effects of specific drugs.3 4


Tuesday, October 23, 2012

Humane Slaughter?


Humane rape.

Humane murder.

Humane slavery.

Humane genocide.

Humane pedophilia.

This YouTube video carries the title "Local Flavor TV: From Grass to Grill - Part 2 - Certified Humane Slaughter."

If you have the guts, put yourself into the cow's place and ask:

If like this steer you had not committed any crime, yet someone tricked and prodded you into walking into a device that closed down on your neck to restrain you would you call their trick humane?

If that someone then shot a bolt into your cranium while you struggled to free yourself (as did this steer), would you call him or his process humane?

If the butcher then hung you up by your legs and cut your throat while your heart continued to beat, would you call him or the process humane?

Humane decapitation?

I don't think that humane slaughter can exist.  I think the phrase provides a euphemism intended to put you back to sleep. 



Tuesday, October 9, 2012

Animal flesh is a good source of vitamin B12?

Perhaps not.

According to the Framingham Offspring Study, 39 percent of people aged 26 to 83 years, primarily flesh-eaters, have low B12 levels.  Since vegans form less than one percent of the population, this study indicates that B12 deficiency plagues nearly 40 percent of people who eat animal products.

B12 Deficiency May Be More Widespread Than Thought / August 2, 2000 / News from the USDA Agricultural Research Service

In this study, consumption of supplements and fortified foods (i.e. foods with the supplement added) markedly reduced the risk of low serum B12 levels:

"The researchers also expected to find some connection between dietary intake and plasma levels, even though other studies found no association. And they did find a connection. Supplement use dropped the percentage of volunteers in the danger zone--plasma B12 below 185 pmol/L--from 20 percent to 8. Eating fortified cereals five or more times a week or being among the highest third for dairy intake reduced, by nearly half, the percentage of volunteers in that zone--from 23 and 24 percent, respectively, to 12 and 13 percent."
This report does not make it clear whether or how the researchers sorted the effect of supplements and fortified foods from the effects of dairy.  I predict that since people commonly pour cow milk over their fortified cereals, and that people who consume more milk tend also to be more likely to use fortified cereals and supplements, because these behaviors would characterize people who have conventional health consciousness. If so, high dairy intake would strongly correlate with intake of supplements and fortified cereals, making it very difficult to separate the effects of these three potential B12 sources.  

However,  the research found no relationship between flesh intake and plasma B12 levels.

"Oddly, the researchers found no association between plasma B12 levels and meat, poultry, and fish intake, even though these foods supply the bulk of B12 in the diet. “It’s not because people aren’t eating enough meat,” Tucker said. "The vitamin isn’t getting absorbed.”"

Well, apparently the vitamin is getting absorbed from supplements, fortified foods, or dairy.  Tucker seems to have presented evidence to make this statement more correct: "The vitamin isn't getting absorbed from meat, fish, or poultry."

Got Vitamin B12?  Source.

Regarding dairy, a cup of milk supplies 0.9 mcg of B12, and an ounce of cheese supplies about  0.5 mcg.  In comparison, one serving of Kellogg's All Bran cereal provides 5.8 mcg of B12 (more than twice the RDA).  One-half cup of All Bran provides about 10 times the amount of B12 found in one-half cup of milk or one ounce of cheese.  Most people will eat more than one-half cup of All Bran in one sitting (it only provides 80 calories), probably more like one- and one-half or two cups (17.4 to 23.2 mcg of B12).  Three-quarters of a cup of General Mills Cocoa Puffs provides 1.5 mcg of B12, three times what is found in one-half cup of milk used to top it.  Again, three-quarters cup of Cocoa Puffs only provides about 100 kcal; I think most kids would consume two to three of those servings, providing 3.0 to 4.5 mcg of B12.   I would guess that odds favor that a person who eats milk, cheese, and fortified cereal will probably get a larger dose of B12 from the cereal than from the milk products. 

Now take a look at supplements.  Bayer's One-A-Day for Women contains 6 mcg of B12, and the One-A-Day for men contains a whopping 18 mcg.   A woman would have to consume more than six cups of milk, or 12 ounces of cheese to get the same B12 intake as found in her One-A-Day for Women; and a man would have to consume more than 18 cups of milk and 36 ounces of cheese to get the B12 in his One-A-Day.

So these Tufts University researchers have found some evidence suggesting that animal flesh does not reliably constitute a good source of B12, and that among omnivores, the people who consume B12 supplements or fortified foods have the best B12 status.

Seems we have to say goodbye to these ideas:

Eating flesh reliably prevents B12 deficiency. -- False

Only vegans get B12 deficiency. -- False

Since only microbes produce vitamin B12,  I guess modern antibiotic hygiene and agricultural practices, which have reduced the number of B12-producing bacteria in our soils, water, and general environment, have caused this epidemic of vitamin B12 insufficiency.

Vegan or flesh-eater, this research suggests you probably need to get your B12 from microbes by taking a B12 supplement or eating B12 fortified foods, which provide microbial-source B12 in adequate quantities.

Pale Blue Dot -- Carl Sagan

Friday, September 28, 2012

Grass-Fed Animal Products Prevent Obesity and Cardiovascular Disease?

Not for Mongolians.

Mongols eat a diet largely composed of milk products, meat, and fat from free-ranging, organic, grass-fed animals.  They consume few plant foods because few edible plants grow in the cold continental climate of Mongolia.  The climate forced them into a natural experiment in low-carb nutrition based on grass-fed animal products.

In this 2010 episode of Bizarre Foods, Andrew Zimmern eats sheep head stew at a Mongolian cafe and goat carcass and intestine-wrapped liver on the steppes, samples "stomach butter" and fermented mare's milk, and has some pretty strong cheeses, among other full-fat bizarre foods as he calls them.   As Zimmern says, "its a faraway land of meat, meat, and more meat."  Of interest to the WAPF crowd, they use boiled milk, not raw milk, to make their cheese and some other processed dairy products.  Watch the markets for processed carbohydrates....

Most of them eat a WAPF low-carb primal paleo grass-fed animal fat dream diet (although the lean journalist admitted that she avoids fats).   According to Wikipedia, as of 2006, the United Nations reported that about sixty percent of Mongolians live in urban circumstances, so about forty percent live in rural areas.  Does their fleshy, fatty, milky diet keep them lean and healthy in either circumstance?

According to this World Health Organization document, in Mongolia in 2005,  fifty-six percent of men and seventy percent of women were overweight.  It is expected that by 2015, seventy-five percent of men and seventy-nine percent of women will be overweight.

Source:  World Health Organization

The WHO document also reports that chronic diseases cause sixty percent of deaths.  In 2002, thirty percent of Mongols died from cardiovascular disease, and twenty-one percent from cancer.

Source:  World Health Organization

No doubt, some will try to blame this on the introduction of plant foods into Mongolian diets.

In 2008, Bolomaa et al of the Nutrition Research Centre, National Public Health Institute of Mongolia reported that on average Mongolians consumed only 3.2 servings of fruit or vegetables daily.  They also found that one in every five people had three and more risk factors or was at high risk for developing non-communicable diseases, and "one in every two males aged 45 years and above was at high risk in developing NCDs. "

In 2008 Komatsu et al of Kagawa Nutrition University in Japan reported:

1.  Mongolians have a relatively short life expectancy.

2.  The residents of Murun, a north Mongolian city, eat large amounts of meat, milk, dairy products, and wheat flour products, but little vegetables, fruits, or fish.

3.  Compared to average values in Japanese, Murun residents have significantly higher levels of serum  serum triglycerides, low-density lipoprotein cholesterol (LDL) and homocysteine, and lower levels of high-density lipoprotein cholesterol (HDL), n-3 PUFA, folic acid and adiponectin.

4.   Mongolians also had significantly higher levels of oxidative stress markers, including oxidized LDL and serum reactive oxygen metabolites (ROM).

5.  The serum ROM in Mongolians correlated positively with their body fat ratio and inversely with their hand-grip strength.

6.  Mongolians aged 30 years or greater had a high incidence of obesity.

7.  Mongolians aged 40 years and older had markedly decreased handgrip strength.

Komatsu et al concluded that "These findings suggest that in the Mongolians the dietary habits associate with their lifestyle-related diseases and early aging, and the improvement of dietary habits is an effective strategy for health promotion of the inhabitants."

In 2009, Dugee et al (full text) reported that

"Mongolians have a distinctive lifestyle and dietary habits that are characterized by a preference for high protein and fatty foods of animal origin. Such a dietary preference is probably in keeping with the country’s extreme continental climate and nomadic lifestyle where meat and meat derivatives are the main sources of energy and nutrients during both winter and spring, while dairy products are commonly consumed during summer and autumn."  [Italics added-DM]
Dugee et al found three dietary patterns among Mongolians aged 25 years or more:

1.  A transitional pattern, high in grass-fed meats (beef, mutton, goat), pork, and sausages, but including some vegetables (cabbage, onion, carrot), potato, and bread.

2.  A traditional pattern consisting of foods Mongolians traditionally ate in summer: whole milk, yogurt, horse meat, wheat products, fats and oils, and confections (such as the milk-based item Zimmern tasted in the Mongolian market in the first video above).

3.  A modernized healthy pattern with greater intake of whole grains (rice, millet, barley, whole wheat), vegetables, and fruits.

As quoted above,  Dugee et al admitted that "meat and meat derivatives are the mains sources of energy and nutrients during winter and spring" in Mongolia.  Further, Dugee et al also say that they call the milk-based pattern "traditional" because "the food items reflect the diet of Mongolians during summer."  This suggests that what they called a "transitional" diet actually represents a pattern similar to the Mongolian winter/spring diet (meat products and hardy vegetables), while what they called a "traditional" diet is only traditional in Mongolia in summer and autumn.

 In other words, it suggests that they were actually comparing the "healthy" pattern to the two seasonal traditional patterns of Mongolian diet, and that labeling the one pattern "transitional" was misleading.  I think it would have been more appropriate to call the first pattern the meat-based traditional pattern, and the second the milk-based traditional pattern.

In studies of this type, researchers primarily compared the people who most closely adhered to one of these three patterns, simply because the less adherent any individual was to any one pattern, the more that individual's diet included elements of two or more patterns, making it very difficult to sort the different effects of the patterns.  For example, say someone in this particular study was trying to improve his health by eating more whole plant foods, but he was still eating meat and milk every day.  His diet would have a mix of all three patterns, and his weight would show the effect of that mix.  Therefore, when doing this type of study, the most clear information will come from comparing the individuals have the most distinct diets.

Dugee et al looked at the relationship between these patterns and obesity among the studied  Mongolians, and found:

1. For both sexes, those with the diet highest in whole plant foods carried the lowest risk of obesity, half the risk of other patterns.

2. For both sexes, those having the most "transitional" (i.e. animal flesh- and fat-based) diet pattern had doubled the risk of obesity relative to low intake of these meats and fats.

3. Greater adherence to a "traditional" (milk-based) diet pattern had the intermediate risk for both sexes.

4. Among women, adherence to a traditional diet pattern carried the highest risk of abdominal obesity, almost 5 times greater risk of abdominal obesity than those Mongolian women having diet pattern least like traditional.

Overall, these studies indicate that the Mongolians habitually eat a diet based on grass-fed animal animal products, those who eat in the most traditional pattern have an increased risk of obesity, cardiovascular disease, and early mortality, and those who eat more whole plant foods and less of traditional animal products have less obesity.

It really isn't news.  As noted by Healthy-Longevity in a comment left on a different post on this blog, the WAPF primal paleo grass-fed animal dream diet didn't keep the early 20th century Kirghiz plainsmen of paleo-Siberian origin lean or healthy either:

"These findings resemble the Kuczynski’s report in 1925, who observed that the nomadic Kirghiz plainsmen who habitually consume a diet with large amounts of organic meat and milk from grass-fed livestock had a high incidence of obesity, premature extensive atherosclerosis, contracted kidney, apoplexy and arcus senilis, which was not exhibited by their urbanized counterparts who consumed a more varied diet."  Source: Coronary Heart Disease Epidemiology, Second Edition, Oxford University Press, 2005, page 22.
You can't blame the obesity and poor health of nomadic Kirghiz plainsmen of 1925 on late-20th century processed foods or urban sedentary lifestyle.  The only dietary factors in common between the Kirghiz and the Mongolians are the grass-fed animal products.

The WAPF, primal paleo grass-fed animal dream diet didn't keep the Kirghiz people lean and healthy 100 years ago, and adhering more closely to it it still doesn't seem to be keeping the Mongolians lean or free of cardiovascular disease or cancer.