More Thoughts on The China Study

If there’s a definition of irony, eating peanut butter and cream cheese on a Wasa Fiber Rye while reading Colin Campbell must be it.

OK, you only get the irony if you’ve read Campbell.  He did a bunch of experiments where he fed aflatoxin (a fungal toxin and known carcinogen sometimes found in peanuts) to rats.  The aflatoxin-dosed rats who also had casein, a milk protein, added to their rat chow all died of liver cancer, while the aflatoxin dosed rats who did not have casein added to their rat chow did not die of liver cancer.

I must admit, this gave me pause.  I looked at my half-eaten snack and wondered how my ol’ liver was doing.

Campbell’s book is fascinating, but he tries my patience.  If I had a dollar for every time he notes a correlation and then says, “From this we can conclude that A causes B,” I would be a very wealthy woman.  If I had another dollar for every time he says, “A Western diet high in meat and refined carbohydrate causes <insert name of evil disease here>,” I would be obscenely, filthily wealthy, rolling around naked in piles of dollar bills every day instead of going to work.

(Oh, excuse me, did I say naked?  No, no, rolling around fully, decently clothed in piles of dollar bills, of course.  This is a PG-13 blog.  Most of the time.)

High in meat and refined carbohydrate.  As if the two were inseparable!  What about diets high in meat and low in refined carbohydrate?

Finally, and this one goes beyond annoyance into the realm of hurt – he refers to the late Dr. Robert Atkins as “an obese snake oil salesman with high blood pressure.”  I am so sick of the accusation that poor Dr. Atkins, suffering from edema due to treatment for the head injury which killed him, was “obese.”

I understand that nutrition inspires the kind of passionate debate usually reserved for things like religion, politics, and the Red Sox-Yankee game.  But could we please try to avoid hitting below the belt, distorting facts about people’s personal lives, and otherwise behaving like an ass?  (Oh, wait, is that hitting below the belt?)

I still don’t know about cancer, but after reading Campbell’s distorted description of Dr. Atkins, and seeing how he muddies correlation with causation, and how he lumps meat and sugar together as if they are inseparable, I have to wonder what other facts he’s playing fast and loose with.  Maybe he’s right; maybe he’s wrong.  Should I eat peanut butter and dairy products together?  Who the heck knows?

But I can say that he’s flat out wrong about diabetes.  He claims it is caused by high consumption of animal protein and animal fat.

(Dan, if you’re reading this, try not to snort coffee through your nose onto your keyboard, hon, OK?  Cause that hurts.)

This is particularly ironic because Campbell does a very good job early in the book of explaining the difference between correlation and causation.  He says that people in countries have more telephone poles have more heart disease, but you can’t conclude from this that telephone poles cause heart disease.  One thing that’s required to convert correlation to causality is the ability to suggest a mechanism by which one thing causes another, and that is missing with the telephone poles-heart disease correlation.

So, pray tell, what is the mechanism by which excessive consumption of either animal protein or animal fat might cause diabetes?

Hello?  I’m waiting …

So, there might be a correlation between animal product consumption and diabetes, but without that mechanism, it’s gonna be hard to show causation.

Meanwhile, there is also a correlation between carbohydrate consumption and diabetes, and there is a mechanism that explains it:  carbohydrate consumption leads to an insulin response; excessive carbs mean excessive insulin; after a while the insulin receptors in the cell wear out, leading to higher blood sugar; pancreatic beta cells try to compensate by producing more insulin, while at the same time, chronic high blood sugar causes more beta cells to die.  Where does excessive consumption of protein and fat fit into all this?

Other things that maddened me:

• Campbell notes, quite rightly, that in spite of the mainstream medical position that cholesterol levels above 200 (or is it 180 now? they keep lowering it) are a risk factor for heart disease, about one half of all heart attacks occur in people with cholesterol between 150 and 200.  Since the all-cause death rate starts to rise when cholesterol levels fall below 170, a sane person might conclude that a) cholesterol levels are not an accurate predictor of heart disease risk, and b) one should not aim to lower cholesterol levels excessively.  Campbell, however, fails to mention the all-cause death rate, which enables him to conclude that we are not lowering our cholesterol enough, and recommends that we try to get our cholesterol lower than 150.
• Campbell discusses vitamin D synthesis at length, stating that vitamin D is produced when sunlight acts on a precursor substance in the skin.  He does not once name that precursor substance, which is, of course cholesterol.  Why doesn’t he mention this?  Could it be because for Campbell cholesterol is the antichrist?

I don’t know if I have the patience to finish this book.  Campbell has some good things to say.  He’s absolutely right that the standard American diet is what’s killing us.  I’ll give him the benefit of the doubt that he himself is as healthy as he claims to be.  I’ll grant that vegetarians and vegans who eat whole foods are healthier than people who eat the standard American diet.  But because the standard American diet conflates so many other factors with meat eating, how can you tease out whether it’s the meat or the sugar or the artificial flavors or the fluoride in the drinking water or what?

So What Are You Trying to Say There, Colin?

It [empirical research] is a type of science advocated 2,400 years ago by the Father of Medicine, Hippocrates, who said, “There are, in effect, two things:  to know and to believe one knows.  To know is science.  To believe one knows is ignorance.”  I plan to show you what I have come to know.          T. Colin Campbell, The China Study, p. 21

I don’t know about animal protein, but a small dose of irony is good for the blood, eh?

Yes, friends, my number finally came up at the library, and The China Study will be my reading during my morning and evening commutes for a while.  I decided to give the book a chance, but I must admit, I’m fighting down my skepticism at every word.  I have seen recordings of presentations that Campbell has given (here’s one), and thus far I am unimpressed.  What his research seems to show is 1) if you add fractionated casein to laboratory rat chow, the rats get cancer, and 2) Chinese people are healthier than Americans.

I promise not eat any rat chow fortified with fractionated casein.  Or feed it to any rats, either.  I’m not going to move to China just yet, however.

I’m trying not to be dismissive, though.  When Campbell appeals blatantly to our emotions by telling us about how his dairy farmer father died of heart disease, I remind myself I’ve made the same sort of appeal talking about my mother’s diabetes.  When Campbell argues that his point of view must be valid because he started his career believing the exact opposite (I call this the it must be convincing if it convinced me fallacy), I tell myself that I use the same technique when I talk about all my years believing the low-fat dogma.  Strictly speaking, these are logical fallacies (appeals to emotion or to the zeal of the convert do not in fact prove the point in question), but writers, even very good writers, use such rhetorical flourishes all the time.  Maybe Campbell and I are not so different.  After all, he thinks that most of the major chronic health problems of the West could be defeated by diet.  Most people who espouse a diet low in grains and high in animal products think the same thing.  We differ from Campbell in the details, of course.

But I’m already guessing that I differ from Campbell on the idea that there is only One Right Way.  (He sure comes across as confident in that video, doesn’t he?)  I am sure I come across as very confident on this blog, too, but I have a confession.  I think that a vegetarian, or even a vegan, could be a whole lot healthier than someone following the Standard American Diet.  But simply giving up anything that comes from an animal will not be enough.  So, to all those people I see in Whole Foods every week with carts full of frozen vegetarian entrées and boxes of white flour pasta and packages of Quorn and Morningstar Farms breakfast “sausages” and Tofu Pups and bags of vegan sugar – you are harming your health.  That’s right, you heard me, your diet is not merely neutral, it’s just plain bad.  If it is a perfect rectangular prism that stacks neatly in your cupboard or fridge, it will not promote well-being.  Eat something that looks like the plant it came from, I beg you.  Asparagus will be in season soon, and it’s tasty with olive oil.  Put the vegan sugar back on the shelf – thus far it has not harmed any animals, but you, my primate friend, are going to be the first.

But a vegetarian, or even a vegan, who eats a diet composed mostly of fresh, minimally processed foods, with lots of fruits and vegetables and very little added sugar will undoubtedly be healthier than someone who skips breakfast, chows down on Taco Bell for lunch and Dinty Moore Beef Stew for dinner.  Or, yikes, SlimFast.

Will a vegetarian eating whole foods be any healthier than someone who eats meat but avoids grains and sugar?  Honestly, I don’t know.  I tend to view questions of health through the lens of that constellation of health problems known as metabolic syndrome – high blood pressure, obesity, Type II diabetes, and heart disease.  There is little question in my mind that restricting sugars and starches is the best treatment for these conditions.  But cancer?  Who knows?  I haven’t given it nearly as much thought as how to keep myself from ending up like my mother, a double amputee who lived her last few years in fear of dying during a reactive hypo.

Oh, wait, there I go appealing to emotion again.

What the World Eats

Check out this wonderful photo essay from Time Magazine showing what one week’s food looks like for families around the world.

http://www.time.com/time/photogallery/0,29307,1626519,00.html

A few things that struck me:

• The sheer amount of processed food that all but the world’s very poorest people eat.
• The virtual omnipresence of Coke or Pepsi.
• The popularity of bottled water, even (or especially) in countries that have high standards of water sanitation.
• The relatively large amount of meat and small amount of vegetables in the Chinese family’s diet, contrary to what we’ve been told.
• How come the British family is not smiling?  Could it be all those Mars Bars have rotted their teeth?
• Look at all the beer the German family consumes!  Why don’t we see beer in the American families’ photos?  Do they not drink it, or do they not admit to drinking it?
• I couldn’t help wondering whether this included meals eaten out, or only meals prepared at home.
• The more natural foods, and the fewer industrially processed foods, the more beautiful the photograph.  I am not sure if that is my cognitive bias toward whole foods, or some deeper aesthetic sense.  I think the reason the processed foods mar the beauty of the photographs is that each has a logo that is designed, by itself, to look good and capture our attention.  But when you clump a bunch of them together, their industrially bright, overpigmented, highly geometric designs clash every which way.  To me, the ugliest photograph is of the North Carolina family with the tiny island of fruit in the sea of clashing food logos.
• Speaking of which – the North Carolina folks had one of the largest food bills, larger even than the family in notoriously expensive Japan.  Only the Germans spent more on food (and they, of course, have all that beer).  So much for the idea that eating whole foods costs more than eating processed foods.
• I would love to see food expenditure expressed as percentage of income.

It would be difficult for me to do a photo shoot like this for my family.  Our car-free lifestyle means that we don’t go for a single large grocery run every week.  Instead, we pick up things piecemeal.  Often we go together in a medium-sized, planned Saturday or Sunday run (two healthy humans can actually carry quite a lot of food – four large canvas bags worth – for a distance of half a mile or a mile); this is supplemented by more frequent, smaller trips on our way home from somewhere else.  (I love this because I get to try different stores; there are at least five near my office and three near our home that I use for different things.)  So gathering a week’s worth of food all at once and photographing it would be hard for us.

But here’s what it would look like.  My husband eats a few things that I don’t, though he’s scaled back his carb consumption quite a bit.  So there are a few things in our weekly food supply you wouldn’t expect just from reading my blog.  There would be a lot of eggs, two to three dozen; a half gallon of milk; a pint of heavy cream.  Rather a lot of meat, too, and some fish.  A few potatoes, a little bread, maybe a few other grain products.  Some coconut.  Some dark chocolate.  Some coffee for me and tea for my husband.  Very few bottled beverages except wine and an occasional sip of liqueur and a very rare diet Coke for me (maybe one every two weeks) or beer for my husband (maybe once a week, not sure since we seldom have it in the house).  Lots of non-starchy vegetables.  (From June to November the composition of the produce would vary depending on what our CSA delivers.  From November to June, we avoid buying anything the CSA delivered mountains of in the prior season!  We try to eat seasonally, but it’s a daunting challenge in New England to acquire fresh seasonal produce during the CSA off season.  There’s a reason the CSA doesn’t deliver during the winter.)  Greek yogurt.  A little fruit.  A few frozen meals (my husband’s lunch).  Lots of nuts, including nut butters.  A tiny amount of real sugar.  Butter, lots.  Olive oil, lots.  Mayonnaise, mustard, capers, etc.  Lots of spices.  Cheeses from all over the world.  I’m not totally sure what my husband eats at work.  One donut, every Friday, I’m pretty sure of that.

One advantage of our car-free lifestyle is, without that giant weekly trip to the store that lots of American families make, we don’t have to worry so much about freshness.  Our food is about as fresh as it can be in the modern agricultural system where food is two or three days old before it ever gets to the market.  So it actually makes it a bit easier to rely less on processed foods.

How about you?  What jumped out at you in the Time photo essay?  What’s in your weekly shopping cart?

tip of the hat to Mark’s Daily Apple for pointing out the essay

Slow Food – Chicken Tagine with Quinces

I have a post about time and money sort of queued up for when I have time to focus. For now, just in time for the weekend, I bring you a slow recipe, just the thing for a nice cozy Saturday or Sunday afternoon in the kitchen. I’m mindful of the irony of calling a recipe that takes an hour and a half or so “slow,” when that’s how long my mother spent on dinner almost every night of her married life, but what can I say? Times have changed. (And more on that when I get to that post about time and money.)

It all started with the quinces.

About a month ago, my husband and I agreed that, while at Whole Foods, we’d pick up some sort of produce we’d never tried before. At one point, this was supposed to be a weekly practice, but frankly it’s hard to find something in an American grocery store I haven’t eaten at least once. I’ve always been drawn to exotic foods. I am the person who introduced my family to that strange vegetable, broccoli, in the 80s. So often, something we haven’t tried becomes something he hasn’t tried. And if he hasn’t tried it, I probably haven’t eaten it in the last five years (the length of our acquaintance), so it’s still an experiment in food diversity.

That particular week, he and I had not managed to pick out our strange produce before he got bored and wandered off to the seafood department. That’s when I happened upon a mound of quinces. I recognized them immediately; I’d seen photos of them; but I couldn’t remember ever eating them. Mission accomplished – I put two into our basket, after first inhaling their deep, round, sweet fragrance. Quinces smell like a combination of tropical flowers and tropical fruit, with the faintest aroma of maple, vanilla, pears, and apples. These last two are unsurprising, since all three fruits are in the same family. Deborah Madison described the aroma as a combination of narcissus and oak leaves, and I sorta see her point, too. Really, they’re hard to describe. Go get your own quince and sniff it.

It was fun trying to get past the checkout clerk. “Is this an apple?” he said.

“It’s a quince,” I said.

“Is it a pear?” He was trying to find the price code on his alphabetical cheat sheet.

“It’s a quince,” I repeated. I wasn’t really sure what more to say to help him here. I was pretty sure he wasn’t going to find it under “P.”

“Is it an apple?”

Oh, boy. “It’s a quince. Q-U-I-N-C-E.” By now I felt like a jerk. Why couldn’t I just buy apples like everyone else?

He looked puzzled.

“Look,” I said, finally figuring out how to help him. “It’s got a sticker with the price code on it.”

“Oh!” he said, brightening, and that cleared the matter up for him.

Once we had them, we had to figure out what to do with them. And for a devoted low-carber married to an, um, moderate-carber, this turned out to be quite a challenge. Every cookbook I consulted offered pretty much the same advice – poach them in a sugar syrup, using equal weights of quinces and sugar, or make quince paste, using equal weights of quinces and sugar! I was wondering if I was going to have to prepare them and freeze them in tiny containers for a very rare high-carb visit to the honey tree.

In the meantime, they sat in that pretty blue and gold pottery bowl you see above, a wedding present from a friend with good taste. Every night after dinner we’d pass them around and smell them. (The Victorians used to use them to scent their dresser drawers.)

Searching through my forty cookbooks, I found a recipe in Deborah Madison’s Vegetarian Cooking for Everyone for an applesauce laced with quinces, and I thought that sounded pretty good and maybe not too egregiously loaded with sugar. Then, as a last resort, I looked them up in Larousse Gastronomique and found a recipe for chicken with quinces! And no added sugar!

Usually my husband cooks on the weekends, but the tagine, which required two simmering periods of a half hour each, was not weeknight fare for a two-job family. I traded nights with him, bought a chicken, and prepared to start simmering. Then, looking again at the Larousse recipe, something didn’t sound right. The dish claimed to be a tagine, which is a sort of spicy Moroccan stew cooked in a heavy clay pot. But this dish was seasoned solely with a pinch of ground ginger and a little parsley and coriander. Wrong, wrong, wrong, said my inner lover of exotic food. (I have long suspected Larousse, in spite of its French name and the preponderance of French cuisine, of being British.) So I consulted a bunch of other cookbooks (the latest edition of Joy of Cooking, Dana Carpender’s 500 Low-Carb Recipes, and Diane Kochilas’s Against the Grain) to get a sense of what spices go into a real tagine. This recipe uses the cooking method (and quinces!) of the Larousse recipe, with a spice mixture adapted from the other books.

Still mindful of all those recipes calling for bucketloads of sugar, I was curious about how a raw quince would taste. While preparing the dish, I cut myself a very fine sliver and ate it. The texture was like an Asian pear, pleasingly granular, but a lot drier. Mostly I got that wonderful flowery fruity fragrance. Encouraged, I cut myself a larger chunk. Wow! Talk about pucker. It was like sucking on an inferior teabag – quinces are clearly loaded with tannins. So, no, I don’t think quinces can be eaten raw. However, I am encouraged by this recipe to think that quinces do not have to be sweetened.

I think – I hope – you should be able to find quinces in the store for a week or two more, though the supply at Whole Foods is starting to dwindle. If there are none where you are, you could try the recipe with firm, tart apples, though the carb count would be different.

Chicken Tagine with Quinces

Serves 4

This is pretty darn hot. If you, or someone you are cooking for, doesn’t like spicy food, cut the cayenne and black pepper in half. If you really don’t like spicy food, cut all the spices in half.

1 whole chicken, cut into parts, or about 3 lbs of your favorite bone-in chicken parts
2 tbsp fat for cooking (olive or coconut oil, rendered chicken or duck fat, or butter)
2 cups chopped raw onions (about 1 medium-to-large onion)
1 tsp cinnamon
1/2 tsp each ground coriander, ground cumin, ground ginger, paprika, turmeric, and black pepper
1/4 tsp cayenne
generous pinch of saffron (optional)
1 cup chicken broth or water
2 large quinces
1/4 cup butter (half a stick)
chopped parsley and cilantro for garnish
add salt at table, if desired

Remove the skin from the chicken. (You can save this for the stockpot or brown it in the oven for a snack. You’re removing it because chicken skin is unappealingly flabby when it’s cooked with moist heat, as you’re doing here. But chicken skin is loaded with monounsaturated fat and vitamin A, so do try find a way to eat it.)

Brown the chicken pieces in a large, deep skillet or a Dutch oven in the 2 tbsp of fat until nicely, attractively browned. (Depending on the size of your pot or pan you might have to do this in 2 batches.) Add the onions and cook until beginning to get soft and translucent. Add the spices and stir to distribute through onion mixture. Add the chicken broth or water, cover, and simmer on medium for 30 minutes.

While the chicken is simmering, wash the quinces, cut them into eighths, and remove the cores. Brown the quinces in the butter in a separate skillet. (Again, you might need to do two batches.) The whole washing, cutting, coring, and browning step took me the same 30 minutes that the chicken was simmering.

Add the quinces to the chicken mixture, cover, and simmer on low for another 30 minutes. The sauce will be quite thick – quinces contain pectin, the same substance that makes jams and jellies thick and jiggly.

To serve, give each diner about a quarter of the chicken parts and four quince wedges. Spoon the sauce over the chicken and fruit, and garnish with parsley and cilantro.

Analysis (from Nutritiondata.com)

Calories: 421; Calories from fat: 206; % calories from fat: 49%. Total fat: 23 g. Total carb: 17 g. Fiber: 3 g. Usable carb: 14 g. Protein: 37 g.

To me, 14 g of carb for an entree is not bad. (We did this last weekend, and I forget what we had as a side dish, maybe broccoli with olive oil.) If you would like to reduce the carb count, you could use 1 cup of onion and one quince for a net carb count of 7 grams. But the quinces are so luscious, you might find yourself staring longingly at your plate, wishing for more quinces! You could compromise by using the smaller amount of onion but the full amount of quinces, for a net carb count of 11 grams.

How Many Teaspoons????

I just ran into this excellent, excellent post about sugar in foods that are supposed to be good for you.

http://mtbakercrossfit.blogspot.com/2008/01/coming-soon-my-newest-rant-poisoning-of.html

Try this exercise yourself some time.  One teaspoon of sugar weighs four grams.  If you can divide by 4 (and please tell me you can divide by 4!), you can visualize how many teaspoons of sugar are in that product you are about to consume.  If it’s more than one, maybe two, run, don’t walk, to the nearest garbage can.  Then go have a nice piece of cheese or a few nuts.

One thing that the author of this post does not mention is that all carbohydrates (other than fiber) break down into sugars.  This means that, if the label of a food says that it contains 40 grams of carbohydrate (as in 2 oz of dry pasta), you are putting 10 teaspoons of sugar into your blood.  And of course, many people eat more than one serving.  If you eat 4 oz, you are consuming 80 grams, or 20 teaspoons of sugar.  This is just under 7 tablespoons, which, in turn, is just shy of a half cup.  Would you serve yourself a half cup of sugar with a nice marinara sauce on top?

New Blogroll Category: Sources

After reading the absolutely sickening story of the largest beef recall in history, and the cruelty that led the Humane Society to intervene, I’ve added a new category to my blogroll.

It’s called Sources.  It lists web sites that will help you find meat and other products from animals raised in humane conditions, fed on pasture rather than grains or other animals, and allowed to move freely.

Quick Food

Observation:

It takes less time to toss a steak or a couple of pork chops into a hot skillet and steam or sauté some broccoli or green beans than it does to wait for a frozen pizza to bake, or to make pasta.  Yes, I know the pasta label claims it only takes 12 minutes to cook, but that doesn’t include the time required to boil the giant pot of water, now does it?  And the pizza only takes 25 minutes to bake, but how long does it take your oven to get to 400 plus degrees?

The skillet is hot in seconds, the chops are cooked in 10 to 15 (sprinkle with a little lemon pepper or something), and if you’re cooking your broccoli for more than 5 minutes, my friend, we need to have a little chat about overcooking the ol’ veggies.  So even if you’re a little slow with the knife, you ought to be able to have this entire meal on the table in 15 minutes.  OK, if you’re really slow, it might be 20.

Which is, by the way, less time than it takes that giant pot of water to boil.

I have to go make dinner now.

Breaking News – Does Tight Control Help or Harm Diabetics?

I don’t usually rush to report on news when I first hear about it, and in fact, there is a great deal of news that I don’t even bother discussing in my blog.  When I do discuss studies, I like to have time to think about them first.

But the news this morning that indicates that diabetics who “control” their A1c levels die faster than those who don’t has me fuming.  And when even friends who don’t read my blog, don’t even know that my blog exists, start shooting me e-mails with the “news,” I feel like I have to say something quick.

Here’s the article from the New York Times.  I haven’t yet read the study, but the article, which is probably largely cribbed from the press release, the way so much media science coverage is, gives me pause.

One thing that really jumped out at me was the discussion of just how A1c was “controlled.”

“Many were taking four or five shots of insulin a day,” he [Dr. John Buse, the vice-chairman of the study’s steering committee and the president of medicine and science at the American Diabetes Association] said. “Some were using insulin pumps. Some were monitoring their blood sugar seven or eight times a day.”

They also took pills to lower their blood sugar, in addition to the pills they took for other medical conditions and to lower their blood pressure and cholesterol. They also came to a medical clinic every two months and had frequent telephone conversations with clinic staff.

I love the way the article says, “This is what you must do to get normal A1c.”  No, no, no!  You can get normal A1c by drastically reducing carbohydrate intake – many diabetics who have tried this find they can get normal readings with little or no medication.  But of course, if the guy you are consulting is a shill for the ADA, which is in turn in the pockets of the pharmaceutical companies, of course your news report is going to suggest that the only way to get good A1c control is to down lots of pills.

So, why did so many more people with tight control die?  Not having looked at the study, I can’t say, but I have some hypotheses.  Cholesterol-lowering medications are toxic; they cause neurological problems, muscle weakness, and stroke.  Blood pressure medications are notorious for increasing insulin resistance, and conversely insulin raises blood pressure by instructing the kidneys to retain sodium – a vicious cycle.  Avandia, an oral hypoglycemic, is linked to heart disease, and that’s just the one we know about.

Of course people who take all this crap die sooner.  This is why it is my goal never to have to take any of it.

The safest way for a diabetic to maintain A1c levels at normal levels is carbohydrate restriction.  This will also control blood pressure (because of insulin’s sodium-sparing effect), and has been shown repeatedly to raise good cholesterol and lower bad cholesterol.  It also lowers triglycerides, which are a much better predictor of heart disease than pool ol’ cholesterol.  A low-carb diet also reduces the production of advanced glycosylation end products (AGEs), hybrid chemicals created by the joining of a carbohydrate molecule to a protein molecule.  AGEs are thought by some researchers to be the cause of the damage to small nerves and blood vessels that leads to so many complications of diabetes, such as blindness, heart disease, gangrene, kidney disease, and neuropathy.  I wouldn’t expect a high-carb diet that is “controlled” with medication to reduce AGEs, because one is still consuming lots of glucose.

So the conclusion I draw from this is:  put down that darn piece of bread and eat some spinach.

Unfortunately, the conclusion the press, and most of its readers, will draw from this is:  don’t bother keeping your A1c (itself a glycosylated protein) under control.  Irresponsible!

Quantity versus Quality

I wrote this comment on a post on Mark Bittman’s new blog where he discusses his recent New York Times article about the meat industry. Some people react to exposés such as Bittman’s by swearing off meat altogether; others try to work to change the system. I try to respect both positions, even though I eat meat as much for health as for pleasure, and therefore have to do my best to be in the latter camp. What I don’t respect is the kind of insult-trading that too often accompanies any discussion of the virtues of vegetarianism vs. omnivorousness. I was sad, therefore, but not surprised, to see the amount of name-calling, self-righteousness, unsubstantiated claims in the comments (including a bizarre comment that, “Meat numbs the senses. When you don’t eat meat you become more sensitive to smells and flavors, and the enjoyment of well prepared food is much larger. Meat eaters are loosing in many pleasures.”)

I get a great deal of pleasure in these discussions from trying to raise points that people on both sides may not have thought of. Here’s what I wrote (the blog is moderated, so it may take a little while for my comment to appear):

In these arguments about providing an ample quantity of calories for the world’s population, what is too often lost is any sense that nutrition is about more than meeting the body’s energy needs.

Avoiding meat may not be anything remotely like healthy for a significant portion of the world’s population. With rates of metabolic syndrome (characterized by some combination of obesity, Type II diabetes, heart disease, high blood pressure, and maybe even gout) on the rise not just in the affluent developed world, but in developing countries as well, and with poorer people ever more susceptible to this syndrome, we might want to re-consider the notion that the cheapest way to feed a population is the best. It may be true that humans can get more calories by consuming corn than by feeding that corn to cattle, but nutrition is not solely about providing adequate calories. Corn is famously deficient in lysine and high in carbohydrates. You can improve the protein content of corn by adding another plant protein, such as beans, but the beans are also high in carbohydrates. The amount of carbohydrate you take in to obtain appropriate amounts of essential amino acids on a plant-based diet is much higher than on a meat-based diet. Some humans can tolerate and even thrive on higher-carb diets. But it is established fact, readily found in any college-level biochem textbook that 1) insulin production matches carbohydrate intake in a more-or-less dose-response manner; 2) insulin is the primary fat storage hormone, causing calories consumed to be directed to storage rather than metabolism; 3) excessive insulin levels prevent stored fat from being mobilized later for energy. So in some individuals, relying on plants and their large carbohydrate load to obtain adequate protein leads to hyperinsulinemia and is a prescription for obesity and diabetes.

We can probably keep everyone alive on corn and beans for a while, but we’ll pay for this in either rising medical costs for the relatively affluent or terrible deaths and disabilities from metabolic syndrome (diabetic gangrene, heart disease, kidney failure) for the relatively poor. Or at least for that proportion of the human population that cannot tolerate excessive carbohydrate. This raises the question – rather than concentrating on sheer quantity of calories, can we afford to feed 6.2 billion people an optimum human diet? And that question, in turn, raises another – why do we seldom hear, in these debates about what to eat, that part of the solution might be encouraging smaller families through effective family planning?

I’m interested to hear what you think on this issue of sustainability.

Oh, Lord!

Now when you google “obese mississippi,” you find my blog.