Monthly Archives: February 2011 - Page 3

Dong Po’s Pork

Posted by on February 13, 2011 13 comments

Su Dong Po is one of the two or three most beloved poets in Chinese history. So famous was he that the dish he loved most was given his name: Dong Po’s Pork.

It’s quite a treat: you’ll be unsure whether you’re eating the entrée or the dessert. Strangely this dish, one of the most popular in Chinese cuisine, rarely appears on the menu of Chinese restaurants in the U.S.

Preparing the Pork Bellies

Dong Po’s Pork is basically a high-class way of cooking pork bellies – the uncured precursor to bacon.

Buy the pork bellies in thick slices – at least a half-inch thick. Cut them into cubes about 1 inch on a side. You’ll also need a few slices from a ginger root and scallions:

The first step is to boil a pot of water. Add the cubed pork bellies, ginger, and scallion to the boiling water.

Boil for 30 minutes, it will look like this:

Drain the liquid, keeping the solids.

This boiling process removes unpleasant pork flavors, and leaves the pork with a very mild fatty flavor.

Preparing the Sauce

While the pork is being boiled, prepare the cooking sauce. Mix in a small bowl about 2 tbsp soy sauce – we use Kikkoman Teriyaki Marinade and Soy Sauce, but any naturally brewed soy sauce can be used – and a half cup of wine – we used Riesling since we frequently drink that, but any wine will do. Also, cut more ginger and scallions. The traditional Chinese recipe calls for star anise as well:

If whole star anise is unavailable, you can find ground anise or Chinese “5-star” spice in your supermarket spice aisle. However, it would also come out fine if you dispense with the anise; the pork, soy sauce, wine, and caramelized sugar provide most of the taste.

Traditionally, the remainder of the cooking would be done in a Dutch oven or similar pot that retains heat and can be tightly sealed to keep in steam. However, we’ll use a wok.

In the wok, warm some cooking fat. You can use any oil you like – olive oil or coconut oil are fine. We have been using beef tallow lately – here we are melting some fat from a block of beef fat:

Once the oil is warm, add about 2 tbsp rice syrup. Stir as the sugar caramelizes. It’s ready as soon as bubbles appear — about 30 seconds:

We have adopted rice syrup as our sweetener of choice. It is a zero-fructose sweetener, and we like that it provides glucose calories along with its sweet taste: it seems the body evolved to expect sweet tastes to be followed by an infusion of sugar, since zero-calorie sweeteners trigger insulin release. We like our food to fit the body’s evolved expectations. (The traditional sweetener is smaller amount of brown sugar.)

Caramelizing sugar will create some advanced glycation endproducts (AGEs), so this dish is not perfectly healthy – but it is healthy enough for us.

Completing the Dish

Immediately after the rice syrup begins to caramelize, and before it burns, add the cooked pork to the pan and stir to coat the pork evenly.

Then immediately add all the other ingredients.

Cover, briefly raise the heat to bring the wine and soy sauce mixture to a simmer, then lower the heat and let it simmer covered for 30 to 60 minutes.

The object here is to steam the pork and let the sauce flavors combine with the pork. The longer you steam it, the softer the fat becomes and the more it melts in your mouth.

Every 10 to 15 minutes, uncover and stir. If your soy sauce was not salty enough for you, you can add a bit of salt while it is cooking.

By the time you’re done, there will be only a little liquid left. Transfer to a serving bowl.

Dong Po Pork is fantastic with rice. Here’s how we ate it:

Enjoy!

Around the Web; and How to Shop for Salmon Cakes

Posted by on February 12, 2011 31 comments

Some interesting items this week:

(1) Peter’s back! And with a very interesting post about dogs with diabetes. One highlight:

[I]nsulin is normally produced by the pancreas and it travels directly to the liver. There is first pass metabolism by the liver, lots of it. The liver extracts between 50% and 80% of all of the insulin produced by the pancreas. Relatively little ever gets to the systemic circulation. This residue is what should be controlling adipocyte function.

This is why injected insulin is not as healthful as natural insulin – it acts too strongly on the rest of the body, not strongly enough on the liver. And it is why diabetics should eat a low-carb diet.

(2) In the comments, Doug linked to a 2009 paper [1] showing that eating blueberries with milk reduced the absorption into the body of the blueberry phenolics caffeic and ferulic acid. Doug wanted to know if this should cause him to stop eating his blueberries with cream.

I don’t think so! The greatest benefits from these berry compounds seems to come in the gut, where they act as toxins to pathogens and help promote beneficial gut flora. So if milk reduces their absorption, it must be increasing their presence in the gut.

Entry of these compounds into the body might even be harmful. Peter recently discussed two potential mechanisms by which berry compounds might be harmful: inhibition of the enzyme CETP, like the drug anacetrapib; and antioxidant activity which, paradoxically, increases oxidative stress by downregulating the body’s own natural antioxidants.

It’s hard to beat the delightful taste of berries and cream. Luckily this study gives us no reason to avoid them!

(3) A new study finds that vitamin A and mimics, such as the anti-acne drug Accutane, greatly amplifies inflammation in the bowels of people with food sensitivities. [2] This may be another reason not to supplement vitamin A.

(4) Kurt Harris offers a good breakfast tip for those who like cereal:

Rice Krispies have no added sugar. It’s just toasted white rice. A good sized bowl is maybe 40 g of starch, plus whatever lactose if you add H/H or milk.

(5) Melissa McEwen  passes on from Kathryn Clancy the news that anemia is usually a sign of internal bleeding:

Iron-deficiency is not something you get just for being a lady: … Almost all doctors seem to think that iron-deficiency is part of being a woman, but that doesn’t make sense evolutionarily. Turns out, it’s no normal and doctors who think it is often miss the true cause, which is internal bleeding. 

When I was a freshman college I had iron issues. Just like in the post my doctor gave me iron pills, which absolutely destroyed my stomach. Finally a better doctor found out I had a GI bleed. Now why do so many people get GI bleeds? In my case it was from taking NSAIDs, which is a fairly common cause.

(6) Across countries, higher disease burdens are associated with lower IQ. Here is a plot from Bill Gates’s annual letter:

There are many possible causes for this correlation, but none of them suggest it’s good to get a lot of infections.

(7) Jenny Ruhl tells us that colas – whether diet or sugared, it doesn’t matter – damage the kidneys and increase stroke risk. The culprit may be phosphoric acid.

(8) The New York Times reports that loneliness eliminates the benefits of exercise. You need to be sociable as well as athletic to achieve good health!

(9) Finally, our video of the week. Matt Brody enjoyed Rachel Albert’s salmon cake recipe. He used canned salmon, which reminded me of this classic advertisement: 

References

[1] Serafini M et al. Antioxidant activity of blueberry fruit is impaired by association with milk. Free Radic Biol Med. 2009 Mar 15;46(6):769-74. http://pmid.us/19135520.

[2] Depaolo RW et al. Co-adjuvant effects of retinoic acid and IL-15 induce inflammatory immunity to dietary antigens. Nature. 2011 Feb 9. [Epub ahead of print] http://pmid.us/21307853.

Jaminet’s Corollary to the Ewald Hypothesis

Posted by on February 11, 2011 46 comments

In Tuesday’s comments, Kriss brought up Paul Ewald, father of the “Ewald hypothesis.” (Also brought up by Dennis Mangan here.) Ewald did some of his work in collaboration with Gregory Cochran, who may be familiar to many for his appearances on blogs (notably at Gene Expression) and for his recent book The 10,000-Year Explosion.

In a 1999 Atlantic article, “A New Germ Theory,” Judith Hooper summarizes Ewald’s hypothesis:

Darwinian laws have led Ewald to a new theory: that diseases we have long ascribed to genetic or environmental factors — including some forms of heart disease, cancer, and mental illness — are in many cases actually caused by infections.

Regular readers won’t be surprised to hear that we wholeheartedly endorse the Ewald hypothesis. We believe that nearly all diseases are caused by infections and bad diet. Malnourishing, toxin-rich diets impair immune function and create vulnerability to infectious disease.

The Ewald Hypothesis

Ewald’s reasoning goes as follows. Quotations are from the Atlantic essay.

First, genetic causes of disease are unlikely. Any gene that led to impaired functioning of the human body would be selected against and removed from the genome. Therefore, genetic diseases should have the abundance of random mutations – about 1 in 100,000 people:

As noted, the background mutation rate — the ratate which a gene spontaneously mutates — is typically about one in 50,000 to one in 100,000. Not surprisingly, genetic diseases that are severely fitness-impairing (for example, achondroplastic dwarfism) tend to have roughly the same odds, depending on the gene.

Diseases that are fitness-impairing and reach higher prevalence – and this includes nearly all major diseases – must have a cause other than genetic mutations.

Germs, on the other hand, are plausible candidates as causes for disease. Germs can benefit from doing us harm. At a minimum, they would like to modify human functioning in order to make us better hosts for themselves — by suppressing immune function, for instance. Also, they wish to induce behaviors that help them spread to new hosts – like sneezing, coughing, diarrhea, or sexual promiscuity.

Germs evolve quickly. Gene exchange, and lack of error checking during gene replication, modifies genomes quickly. Short reproductive time scales – on the order of 20 minutes – mean that helpful mutations proliferate rapidly. Big evolutionary changes can occur in a few weeks:

“The time scale is so much shorter and the selective pressures so much more intense [in microbes]. You can get evolutionary change in disease organisms in months or weeks.”

This means that germs quickly optimize their disease characteristics through natural selection. For example, virulence, or the severity of the disease that a pathogen causes, is rapidly optimized.

One factor determining virulence is how easily the organism can spread to a new host. If the organism can spread easily, there’s little cost to harming the current host, and microbes produce severe disease. If it’s hard to spread, on the other hand, organisms will be mild and peaceable toward their hosts. It pays to keep their hosts alive and healthy.

Ewald and his students collected empirical data supporting their explanation for virulence:

The dots on Saunders’s graphs made it plain that cholera strains are virulent in Guatemala, where the water is bad, and mild in Chile, where water quality is good. “The Chilean data show how quickly it can become mild in response to different selective pressures,” Ewald explained…. Strains of the cholera agent isolated from Texas and Louisiana produce such small amounts of toxin that almost no one who is infected with them will come down with cholera.

In the last few decades, evidence has only grown for the infectious origins of most diseases. In 1999, over 80% of serious diseases were known to be caused by pathogens:

Of the top forty fitness-antagonistic diseases on the list, thirty-three are known to be directly infectious and three are indirectly caused by infection; Cochran believes that the others will turn out to be infectious too. The most fitness-antagonistic diseases must be infectious, not genetic, Ewald and Cochran reason, because otherwise their frequency would have sunk to the level of random mutations.

If this analysis were repeated today, the percentage would be still closer to 100%. More cancers are now known to be caused by viruses, and the links between microbes and cardiovascular disease, dementia, and multiple sclerosis are stronger than ever.

I think Ewald and Cochran are correct in asserting that mental and neurological illnesses are especially likely to be infectious in origin. These illnesses tend to have a big impact on number of descendants, supporting the evolutionary argument for an infectious origin. And, due to their dependence on glucose, neurons are unusually susceptible to infections.

Schizophrenia is a good example of a disease that must be infectious in origin:

From the fitness perspective, schizophrenia is a catastrophe. It is estimated that male schizophrenics have roughly half as many offspring as the general population has. Female schizophrenics have roughly 75 percent as many. Schizophrenia should therefore approach the level of a random mutation after many generations.

Ewald and Cochran suggest we need a “Human Germ Project”:

In Ewald and Cochran’s view, evolutionary laws dictate that infection must be a factor in schizophrenia. “They announced they had the gene for schizophrenia, and then it turned out not to be true,” Cochran said one day when I mentioned genetic markers. “I think they found and unfound the gene for depression about six times. Nobody’s found a gene yet for any common mental illness. Maybe instead of the Human Genome Project we should have the Human Germ Project.”

I concur. Medical research should make much bigger investments in detecting, understanding the effects of, and developing treatments for human infections. Many existing lines of research, including many of the “autoimmune” and genetic hypotheses for disease origins, are not panning out, but continue to monopolize funding.

Jaminet’s Corollary

In the last century, sewage and water treatment has cleaned up our water supply and removed sewage and water as a vector for disease transmission. Hygienic methods, such as daily bathing and the use of soap, also tend to inhibit disease transmission.

Just as cholera is an extremely mild constituent of gut flora in hygienic Texas, but creates acute disease in unclean Guatemala, so we can expect that germs that created acute disease in (unclean) 1900 will have evolved to create mild chronic infections in (hygienic) 2011.

This is Jaminet’s corollary to the Ewald hypothesis:  Microbes are evolving away from severe acute disease toward milder chronic disease.

The focus of modern medicine on acute conditions, and its neglect of chronic conditions, adds to the selective pressures on microbes. Any pathogen that creates acute disease is subject to the full arsenal of modern antimicrobial drugs. But pathogens that create mild chronic disease are generally left untreated.

Modern medicine has created a powerful selective pressure on pathogens to generate chronic illnesses that are just mild enough, and that resemble aging closely enough, to elude the attention and antimicrobial arsenal of medical doctors.

Why No Dementia in Kitava?

Staffan Lindeberg in the Kitava Study found no evidence of stroke, diabetes, dementia, heart disease, obesity, hypertension, or acne on Kitava.

Why were these diseases absent? Partly due to the Kitavans’ excellent toxin-free diet, no doubt, but partly also due to an absence of the pathogens that cause these diseases.

Why was there no multiple sclerosis in the Faeroe Islands until British troops were stationed there in World War II? Because the pathogen that causes MS was absent from the islands, until the Brits introduced it.

Why has the incidence of chronic diseases increased tremendously in the last century? Partly due to longer-lived populations, but also, I believe, due to evolution of pathogens toward these diseases.

I predict the incidence of chronic disease will increase further in decades to come; and we will gradually come to appreciate that nearly all forty year olds today are not fully healthy, but are mildly impaired by a collection of chronic infections.

Conclusion

Fifty thousand years ago there were a few hundred thousand humans in the world. Today there are over 6 billion.

If a pathogen today wants to adapt to a specific host, its best bet is to adapt to humans. And within humans, its best way to flourish is to develop a chronic infection that persists for many decades.

The evolutionary arms race is not over. It has simply moved to a new field of battle. And medicine will have to evolve as the microbes do. The microbes are developing a new style of fighting. Medicine needs to shift its focus toward this rising threat of mild chronic diseases.

They’ve Got Us Surrounded

Posted by on February 8, 2011 41 comments

Note:  Our best wishes and prayers for a quick recovery to erp, who has surgery tomorrow. Get well soon, e!

We think that pathogens – viruses, bacteria, fungi, and protozoa – are, along with toxic and malnourishing diets, the main cause of human disease.

People who think we exaggerate the impact of microbes on health may not have fully appreciated the ubiquity of these pathogens. We live in a sea of microbes, many of whom would like nothing better than to live at our expense.

So today, let’s look at just how abundant microbes are.

In the Water

When you swim in the ocean, how many viruses are you swallowing?

… pause … time for reader to guess …

The answer is in a fascinating story in The Scientist:

Once thought not to exist in marine environments, scientists now realize that there are some 50 million viruses in every milliliter of seawater.

These viruses can not only infect cellular life, they frequently kill it:

Every day, marine viruses kill about 20 percent of the ocean’s microorganisms, which produce about half the oxygen on the planet.

It’s not just viruses: Vibrio cholerae, the bacterium that causes epidemic cholera, is widespread in ocean water, and is the most common cause of food poisoning from eating shellfish.

In the Air

What about the air?  How many microbes do you inhale when you breath?

… pause … time for reader to guess …

The Scientist once again came to my aid:

Every cubic meter of air holds upwards of 100 million microorganisms …

Lungs contain about 2.4 liters of air, of which 0.5 liters is expelled every breath. A cubic meter has 1,000 liters, so a single breath takes in 50,000 microorganisms.

Some more information for the curious:

Recent research published in PNAS suggests that the diversity of microbial life in the air is on par with the soil, at least in urban areas, yet the air remains vastly understudied in comparison.

“Just seven or ten years ago we didn’t realize bacteria existed in clouds,” said Anne-Marie Delort, professor of microbiology and organic chemistry at Université Blaise Pascal in France. Now researchers know microbes act as a surface for the condensation of water vapor in the atmosphere, thus forming clouds. Recent research publish in Science shows microbes also play the same role during snowflake formation and other types of precipitation.

Which Is More Dangerous, Air or Water?

Not all microbes flourish in the human body, but all have to be dealt with by our immune defenses. And some can, and do, establish lasting infections in humans.

Since both air and water have pathogenic microbes, it seems fair to ask which environment is more likely to make you sick.

Luckily scientists have done a controlled trial. [1] They sent two sets of people to the beach, and instructed half to remain in the air and the other half to venture into the water. ScienceDaily has details:

A yearlong beach study led by a team of University of Miami researchers suggests that swimmers at sub-tropical beaches face an increased risk of illness….

B.E.A.C.H.E.S. (Beach Environmental Assessment and Characterization Human Exposure Study) enlisted more than 1,300 volunteers, all local residents who regularly use South Florida beaches. Researchers divided study participants into two groups: volunteers who went into the water and those instructed to stay out of the water. The group that went in the water was asked to dunk themselves completely in the water three times over a fifteen-minute period. A few days later both sets of participants received follow-up calls from researchers, checking on their health and well being.

“We found that when swimming in sub-tropical beach areas with no known pollution or contamination from sewage or runoff, you still have a chance of being exposed to the kind of microbes that can make you sick,” said Dr. Lora Fleming …

The study found that the swimmers were 1.76 times more likely to report a gastrointestinal illness, and 4.46 times more likely to report having a fever or respiratory illness. Swimmers in the study were also nearly six times more likely to report a skin illness than those volunteers who stayed out of the water.

The obvious flaw in this study was the lack of a control group placed in a vacuum. It would have been nice to know if complete isolation from microbes would have improved health even further. Perhaps the scientists lacked funding for this third group.

(Warning: inside joke coming.) Of course, it may be impossible for this study ever to be replicated in the US, since after these results how can an ocean swimming group ever be permitted by an Institutional Review Board? It seems that follow-up studies will have to be performed on foreign beaches, perhaps in Rio, the French Riviera, or Tahiti.

Conclusion

It seems the microbes have us surrounded. Whether you venture into the air or the water, you have a chance to get sick.

Is there anything you can do to protect yourself, besides staying home and cowering under your bed? Possibly. We’ll look into that in upcoming posts.

References

[1] Fleisher JM et al. The BEACHES Study: health effects and exposures from non-point source microbial contaminants in subtropical recreational marine waters. Int J Epidemiol. 2010 Oct;39(5):1291-8. http://pmid.us/20522483.