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Jay Wright’s Weight Loss Journey

Posted by on December 1, 2011 133 comments

Jay Wright, who comments as “Jaybird,” has had a remarkably successful weight loss story. He adopted our diet in March at a weight of 250 pounds, and reached his normal weight of 170 pounds at Halloween, seven and a half months later.

I met Jay at Wise Traditions in November and can attest that he is now a handsome, slender man.

Jay’s weight loss was remarkably consistent at about 2.5 pounds per week. He agreed to describe his weight loss journey in a guest post; my questions are in italic, Jay wrote everything else. Welcome, Jay! – Paul

I would like to thank Dr. Paul Jaminet and Dr. Shou-Ching Jaminet for writing a great diet book and website!  You have been instrumental in helping me achieve the long elusive goal of great health and weight. For me, this truly is the Perfect Health Diet!

Before PHD

Paul: Jay, what do you think caused your overweight condition in the first place?

1. Ignorance and confusion. I believe I would have eaten the PHD way and remained at a healthy weight if I was taught to eat this way from the beginning. Instead, the government promotes the anti-saturated fat, pro-seed “vegetable” oil, and whole grains food pyramid. The belief formed from trusting the experts is a lot to overcome. I remember a decade ago during the Atkins’ hype that I thought that he must be crazy to recommend such a dangerous diet that would go against the “entire” medical establishment.  Then, even after I stopped believing the Lipid Hypothesis, I was still confused by all of the rest of the diet claims out there. While I was uncertain, I thought I might as well enjoy a “normal” diet until I can figure it all out.

2. Eating Habits. Besides the high carbs, food toxins, and malnourishment of the food pyramid diet, a few other factors may have affected my eating habits. I was a normal weight child growing up and I could eat anything and everything in sight and not get even pudgy in the slightest. When all foods have the same effect – none – you don’t worry about whether the food is healthy. Also, I spent my childhood playing one sport after another which might have actually worsened my eating habits. At least here with Texas football, we were constantly encouraged to stuff ourselves and put on more weight.  When sports ended for me after college, normal amounts of food looked like a starvation diet on a plate!

3. Carelessness toward health.  Was I careless because I was told “healthy” meant a yucky salad and “unhealthy” meant a yummy steak?  A young boy always chooses the steak especially when I was constantly hungry from 3 hour practices!  This all started to change after my dad was diagnosed with heart disease and started eating a “healthy” low-fat diet. However, the real wake-up call came when my mother was diagnosed and eventually died of breast cancer! To fight the cancer, she put up a courageous fight by being the most dedicated eater of an “alkalizing” vegetarian diet ever! Yet, even though I began to care more about health, I continued to allow myself to eat anything while I learned more and took breaks from trying different diets.

4. Lack of exercise because of a bad back.  I have had a herniated disc in my lower back for about 10 years now. When I changed careers and became even more sedentary, my back problem only worsened from bad posture while sitting. I should have at least continued to walk short amounts, but at the end of the day, I didn’t even feel like tolerating even a little pain after dealing with it so much during the day. The recliner offered relief.

5. Convenience.  As a single guy, I relied on eating out for convenience over the years and pre-made frozen dinners when I ate at home mostly. Starting a diet always meant making big changes to my routine and giving up a lot of time to cook.

6. Diets were Too Low in Food Reward.  Looking back, all the diets I tried were much lower in food reward than the “regular” American diet with lots of sweets that kept calling to me! All of the previous diets required a Herculean will power just to fight the temptations. It was mental torture being on a diet!

Paul: Jay, what were your experiences on the various diets you tried – and what caused you to give them up?

Here is my weight history:

After college sports, I struggled with my weight. I was a yo-yo dieter – I could lose weight but it always ended up even higher. I tried meal shake replacements, frozen dinners to limit calories, no meat/meat, no dairy/dairy, acid/alkaline, exercise/no exercise while dieting, no cash or credit cards in my wallet going to work so I wouldn’t stop at a fast food, punishment where I had to eat a raw tomato if I cheat (I hate raw tomatoes), and many other vegetarian leaning and mental tricks.  A pattern emerged with these diets.  I would starve with low energy for about a week or two until my will power ran out. Then, I would go eat something “bad.”  If I continued to repeat the pattern and managed to be “successful,” I stayed hungry even once I reached my goal weight.  I tried to transition to a “regular” amount of food to stop starving and just maintain but to no avail.  My weight went right back up even higher than before even without cheating on the diets.

Paleo was finally the exception to the starving rule, but only at first.  I felt great on a very low carb paleo for a couple of months.  I ate a pound of meat a day and mostly vegetables with a little fruit and nuts and a lot of coconut oil. The extra fat and meat seemed to enable me to lose weight and not be hungry. I lost nearly 40 lbs and halfway to my goal.  However, I started to not feel so well and hunger was returning, too. I had headaches and energy fluctuated throughout the day. I never liked the taste of vegetables and I began dreading the need to eat more vegetables than I had ever cared to eat in my life. Also, the sugar cravings never stopped just like on the vegetarian diets. Eventually, will power ran out eventually on paleo just like on the other diets.

Here’s what I looked like at 250 pounds. I’m the one on the left in the gray shirt; the one on the right is my brother Craig Wright:

I knew I had better find an answer when my family and friends would laugh each time I declared, “Diet starts tomorrow!”

Paul: Jay, it’s very interesting that on pre-Paleo diets you were always hungry, and when you ate to satisfy your hunger, your weight returned to as high or higher than when you began. That’s consistent with the set-point theory of obesity: your set-point hadn’t changed, and so when you reduced weight below the set-point, you got hungry; when you ate to satisfy your appetite, you were obese. The Paleo experience could also be said to be consistent with the set-point theory: it reduced the set-point so you lost 40 pounds without hunger, but weight was still above normal and hunger returned as your weight got below the new set-point.

An interesting data point, which I see as a challenge for the setpoint theory because it suggests an alternative view, is that on VLC Paleo your hunger returned at the same time you began to feel unwell. This suggests that hunger and setpoint are really an index of health, and when the body is not being properly maintained the brain manufactures hunger. When nutrients are abundant and the body has all it needs to establish good health, the setpoint is reduced to normal weight, hunger disappears, and weight loss resumes.

Perfect Health Diet

Paul: Jay, what was your experience on PHD? I’m especially interested in whether you experienced plateaus where weight loss stalled, and whether you experienced hunger as on other diets.

I recorded my weight every day from April 15 through November, and enough days in March and early April to give a clear picture. Here is what happened:

As you can see, there was no stall in weight loss until I hit my target weight of 170 pounds.

Here’s my after photo, again with my brother Craig. This time Craig is on the left in black, I’m on the right in green:

Interestingly Craig has eaten pretty much the same foods as I have throughout life, and always maintained a normal weight. On my recommendation he adopted PHD soon after I did, and he also experienced health improvements – psoriasis, which he’s had for 20 years and used to leave red scales over much of his body, is nearly gone.

Hunger

I followed the PHD weight loss protocols and felt virtually no hunger throughout the 7 months. Intermittent fasting with one meal a day worked best for my schedule; I coconut oil fasted earlier in the day and 1 day per week.  After the first month, I coconut oil fasted for an entire week since I figured I should clean out my system. Then I dropped the calories to only 1200 to get some faster results early on to help my back. I thought I would readjust the calories up or the eating schedule according to my hunger, but I did not experience any hunger and had great energy so I left the plan alone. What little hunger I did experience was very mild and just meant it was time to drink another bottle of water or swig a tablespoon of coconut oil before the evening dinner. Interestingly, I ate some birthday cakes toward the end and experienced stronger and more uncomfortable hunger the following days than the previous months. The lack of hunger was definitely a key to my weight loss success.

Food Reward

For me, PHD is a high food reward diet. It tastes great every meal! Even in the beginning of the diet, I enjoyed the PHD meal just as much mentally as thinking about eating my old food. Later, my taste buds changed and PHD became clearly the more rewarding food. However, at least part of the PHD was bland. The coconut oil provided calories with no taste and helped keep my calories low. Yet, I really believe I would not have lasted on the diet if the food was bland. Having a neutral taste reminds me of the very low carb paleo diet that didn’t allow the safe starches and even small amounts of dairy. The white rice and white potatoes enabled me to eat vegetables regularly by buffering the taste until my taste buds adjusted and I began to like them. Avoiding milk but having small amounts of other dairy also went a long way in the enjoyment of the food and menu options. The safe starches, dairy, and a little bit of fruit also seem to be responsible for satisfying my sweet tooth cravings. I’m not sure if the high food reward PHD would have controlled my calorie intake since I counted calories. Nonetheless, compared to the other past diets I dreaded to eat, I prefer the high food reward of PHD. I use to say, “Why does all of the food that’s good for you taste so bad and all of the food that’s bad for you taste so good?” I don’t say that anymore with PHD.

Plateau

My belief is that total calories do matter. I’ve always been able to lose the fat and get back to my original weight provided that I lower my calories enough to accomplish it. However, my will power usually ran out before I accomplished it many times. The constant hunger and low energy with lower calories exhausted my desire to lose the weight on previous diets. In contrast, I experienced the opposite on PHD. While the PHD food and supplements provided satiety and energy, I controlled my calories by exercising, counting calories, eating only a single meal, and having oil fast days. Even after only a month, I experienced such a surge in energy even on lower calories that I increased my exercise to 2 hours of walking. Having established such a low calorie amount in the beginning with a challenging exercise and eating plan, I simply had to maintain the routine until the goal was reached.

I believe the key was PHD enabled me to maintain low enough calories to not experience a plateau as on other diets.

Set Point

My experience might show some truth to the concept of a set point. For instance, prior to starting PHD my weight stayed consistently within a 5 lb range for about 2 years. During this period I was eating whatever I wanted. My experience on PHD could be construed as the resetting of my set point to my normal weight – 170 lb. I was never hungry on PHD as long as my weight was above 175 lb. I started feeling more hunger once I got close to my normal weight in the 170s.  Unlike previous diets, I was able to eliminate the hunger by eating a little bit more — just upping my calories slightly.

Although other diets could get me to this weight point before, I had to stay in a perpetual starving mode to remain at this level. Unlike on PHD, on other diets adding enough calories to stop hunger always led to a rebound of weight that leveled out at a higher level than before I started.

When I started PHD my intended target weight was 175 pounds. With PHD, I actually continued to lose a little more than the 175 down to 170 without planning on it. Then, my weight slightly increased with obvious cheats like some birthday cake. While eating the normal amount the following days without the cheats, the weight returned to previous levels without an effort to compensate. After the weight loss, my weight has become more stable. The last month I have had several repeating days on the weight scale with the same exact weight number to the tenth of a point. This occurred even though I ate more on a few of the previous days. My weight history shows a stair stepping up higher with each diet attempt until PHD stabilized my weight back to its original healthy level.

Closing Thought

During the middle of my weight loss, I was at a restaurant eating a salad with balsamic vinegar and olive oil dressing, 8 oz steak, and a baked potato with butter and sour cream and some water with lemon, but without a dinner roll.  I paused and proclaimed, “I can’t believe I’m eating this and still losing weight! This is the BEST DIET EVER!”

Around the Web; Snowy Halloween Edition

Posted by on October 29, 2011 18 comments

A storm today is supposed to turn to snow tonight – one of the earliest snowstorms in memory. Luckily trick-or-treating weather Monday should be perfect.

A few events are coming up. First, I’ll be speaking on Saturday Nov 12 at the Wise Traditions Conference in Dallas, doing the “Wellness Track” from 9:00 am until 12:15 am. The conference will be full of great speakers, including Sally Fallon, Chris Masterjohn, Dr. Joseph Mercola, Natasha Campbell-McBride, Denise Minger, Stephanie Seneff, Dr. Ritchie Shoemaker, Harvey Ussery (Harvey’s wife Ellen is one of our most frequent commenters), and many others. Please consider attending:

Wise Traditions Conference ~ Dallas, TX ~ November 11-14 2010

The following Saturday, Nov 19, I’ll be speaking at CrossFit NYC. I’ll have details about that next week.

Finally, on Sunday, December 4 at 3 pm I’ll be giving a talk and book signing at Green Meadows Farm in Hamilton, MA.

[1] The “Safe Starch Symposium” continues:

Jimmy Moore is graciously continuing the conversation about safe starches on his blog, with the latest installment coming from Dr. Ron Rosedale. For those keeping score, here’s how the discussion has gone:

On Tuesday I’ll explain why Dr Rosedale almost persuaded me to eat a high-carb diet.

Due to personal health considerations, Jimmy won’t be trying an n=1 experiment with safe starches. However, we’ll still develop a 7-day meal plan for those who want to give our diet a try, and Jimmy will invite his readers to try it and share their experiences. That will happen in December, and Shou-Ching and I are looking forward to it.

[2] Music to read by:

[3] Interesting posts this week:

Is radioactive cobalt improving the health of the Japanese?

Stephan Guyenet discusses the brain’s ability to regulate peripheral glucose utilization and lipolysis from fat cells. It makes sense that this would be the case: Apart from the brain’s advantage as a coordinating organ due to its access to signals from nerves, it is also the highest priority destination for glucose, and so the organ best informed about when glucose utilization should be suppressed elsewhere.

Dr Oz has a “Prehistoric Diet Plan”. I think of it as Loren Cordain merged with T. Colin Campbell, and then acquired by the US Department of Agriculture.

Dr Steve Parker reports that intentional weight loss doesn’t reduce risk of death … but it does prevent progression to type 2 diabetes.

Eating a fatty meal causes pythons to grow bigger hearts. Even more interesting, giving mice a transfusion of fed-python blood causes them to grow bigger hearts. Will Tour de France riders be adopting pet pythons?

Another mummy gets diagnosed with prostate cancer. The cancer has to have metastasized to bone to be visible in skeletal evidence. I have not heard of any Paleolithic skeletons containing metastases, but a paleopathologist states that bone cancer has been found in Paleolithic skeletons.

Can going Paleo strain a marriage? It did for Peggy the Primal Parent.

Aaron Blaisdell is teaching UCLA students to eat primally. What’s that illustration on the table?

CarbSane has been chipping in to the safe starches debate (Wednesday, Thursday, and Friday).

Melissa McEwen says, “The no-starch camp is in its death throes” … I prefer to think of it as “the pro-starch camp is in its prime of life”.

Lucas Tafur gives us a reason to put vinegar in our foods: gut bacteria can convert acetate to butyrate.

Chris Kresser warns of the dangers of estrogens in plastic containers.

Emily Deans considers whether ketogenic diets may help bipolar disorder. By the way, Emily is visiting Harvard Law School on Halloween. No word yet on her costume.

Danny Roddy defends fructose against charges it is emaciating.

Do you have heightened formation of fear memories? Randall Parker says you may be hypothyroid.

Bats are being decimated by a fungal infection: millions have died, and “mortality rates are staggering.” Bat physicians, however, insist the fatalities cannot be happening, because their patients do not have compromised immune systems.

“We are Heroes, They are Villains”: a must-read tribute to his students from Seth Roberts. Also, Seth tells us that bees make more honey with kombucha. I wonder how much they would make if given other fermented beverages?

NPR invites a vegetarian to critique the Paleo diet, and Paleo dieters dominate the comment thread.

Australian researchers published an interesting study on the lasting hormonal changes that occur in obesity, even if weight is lost. Weight loss in the obese triggered an immediate 2/3 drop in leptin levels, and a full year after weight loss leptin levels were still depressed by 1/3.

Richard Nikoley … rods … cat o’ nine tails … and a temptress who should have been named “Eve.”

Paul Halliday enters the Mesolithic.

[4] Cute animal photo:

From Oak0y via Meredith Harbour Yetter.

[5] Ah, romance:

[6] The Waterfall of Gulfoss:

Alone at the Raging Waterfall of Gulfoss

[7] Is this a CrossFit exercise?:

[8] Shou-Ching’s Photo-Art:

[9] Weekly video: A new font for dyslexics:

Via Tom Smith.

How to Minimize Hyperglycemic Toxicity

Posted by on October 20, 2011 124 comments

In my reply to Jimmy Moore’s safe starches symposium (see Jimmy Moore’s seminar on “safe starches”: My reply, Oct 12), I didn’t quite have time to fully address the issue of hyperglycemic toxicity.

As J Stanton commented, it would have been good to note that we recommend consuming “safe starches” as parts of meals, not as isolated snacks, and to discuss how meal design mitigates risk of hyperglycemic toxicity:

I’ve written entire articles on the fact that fat content is the primary driver of glycemic index. It’s silly to demonize white potatoes due to high GI when a couple pats of butter – or simply consuming it as part of a PHD-compliant high-fat meal – will drop it far more than substituting a sweet potato.

I thought I’d delve into the factors affecting blood glucose response to meals, and how to minimize the rise in blood sugar. It’s a topic of general interest, since hyperglycemia might have a mild detrimental health effect in nearly everyone; but of special importance to diabetics, since controlling blood sugar is so crucial to their health.

Glycemic Index of Safe Starches

The glycemic index (GI) is “defined as the area under the two hour blood glucose response curve (AUC) following the ingestion of a fixed portion of carbohydrate (usually 50 g).” Pure glucose in water is used as the reference and defines a GI of 100.

Our recommended “safe starches” are significantly lower in GI than glucose.

White rice is typically listed with a GI of 70 or 72, but it varies by strain: Bangladeshi rice has a GI of 37, American brown rice of 50, Japonica (a white short-grained rice) of 48, Basmati rice of 58, Chinese vermicelli of 58, American long-grain rice of 61, risotto rice of 69, American white rice is 72, short-grain white rice is 83, and jasmine rice 89 (source).

Potatoes are a high-GI food but again the GI is highly variable. Baked white potatoes with the skin have a GI of 69, peeled their GI is 98. Yams have GI of 35 to 77 depending on how they are prepared, sweet potatoes of 44 to 94 (source).

With some foods the GI varies strongly with ripeness. Plaintains when unripe have a GI of 40 but when ripe the GI can reach 90 (source).

Taro has a GI of 48 to 56. That’s similar to many fruits, such as bananas which have a GI of 47 to 62. Tapioca has a GI of 70 if steamed, but can exceed 80 if boiled (source).

Gentle Cooking Lowers the Glycemic Index

As a rule, gentle cooking of starchy plants leads to a lower glycemic index and high cooking temperatures lead to a higher glycemic index.

In general, industrially processed foods, which are often processed at very high temperatures to speed them through factories, have high GIs. A study in the American Journal of Clinical Nutrition [1] compared home-cooked corn, rice, and potato with processed foods based on them (instant rice, Rice Bubbles, corn chips, Cornflakes, instant potato, and potato crisps), and the processed foods had consistently higher GIs:

Another study in the British Journal of Nutrition [2] looked at 14 starchy plants prepared in different ways and found that roasting and baking raised the GI:

GI value of some of the roasted and baked foods were significantly higher than foods boiled or fried (P<0.05). The results indicate that foods processed by roasting or baking may result in higher GI. Conversely, boiling of foods may contribute to a lower GI diet.

Perhaps cooking methods that dry out the plant increase the GI.

Meals Have Lower GI

GI is calculated by eating a single food and only that food.

But what happens when you eat a meal? You’re no longer eating one food, but a mixture of foods. The baked potato may come with meat and vegetables, and with butter on top.

You might think that a weighted average of the GI of the various foods might give a good indication of the GI of the meal. Then, since fat, meat, and vegetables have a low GI, you’d expect GI of the meal to be much lower.

It turns out that the GI of meals is low – in fact, it is even lower than the average GI of the foods composing the meal.

That is the result of a new study in the American Journal of Clinical Nutrition [3]. Three meals were prepared combining a starch (potato, rice, or spaghetti) that digested to 50 g (200 calories) glucose with vegetables, sauce, and pan-fried chicken. The GIs of the meals were consistently lower than the values predicted using a weighted average of GIs of the meal components:

Meal Actual GI Predicted GI
Potato 53 63
Rice 38 51
Spaghetti 38 54

So eating a starch as part of a meal reduces GI to the range 38 to 53 – below the levels of many fruits and berries.

Fat Reduces GI

J Stanton has noted that adding a little fat to a starch is very effective in lowering its GI. In a post titled “Fat and Glycemic Index: The Myth of Complex Carbohydrates,” JS states that:

  • Flour tortillas have a GI of 30, compared to a GI of 72 for wheat bread, because tortillas are made with lard.
  • Butter reduces the glycemic index of French bread from 95 to 65.
  • A Pizza Hut Super Supreme Pizza has a GI of 30, whereas a Vegetarian Supreme has a GI of 49.

JS suggests that the reason fat does this is that it lowers the gastric emptying rate, and cites a study which showed that adding fat to starches could increase the gastric emptying time – the time for food to leave the stomach – by 50%. [4]

What’s interesting to me here is that what we really care about is not the glycemic index, but the peak blood glucose level attained after a meal. It is blood glucose levels above 140 mg/dl only that are harmful, and the harm is proportional to how high blood glucose levels rise above 140 mg/dl. So it’s the spikes we want to avoid.

But another paper shows that gastric emptying rate is even more closely tied to peak blood glucose level than it is to glycemic index. From [5]:

So combining a starch with fat may reduce peak blood glucose levels even more than it reduces the glycemic index; which is a good thing.

Dairy reduces GI

Dairy is effective at reducing GI:

[D]airy products significantly reduced the GI of white rice when consumed together, prior to or after a carbohydrate meal. [6]

It is not likely that dairy fat alone was responsible, because whole milk worked better than butter. However, low-fat milk only reduced the GI of rice by 16%, while whole milk reduced it by 41%. So clearly dairy fats are part of the recipe, but not the whole story; whey protein may also matter.

Fiber Reduces GI

Fiber is another meal element that reduces the rise in blood sugar after eating.

Removing fiber from starchy foods increases their glycemic index [7]; adding fiber decreases it. For instance, adding a polysaccharide fiber to cornstarch reduced its GI from 83 to 58; to rice reduced its GI from 82 to 45; to yogurt from 44 to 38. [8]

So it’s good to eat starches with vegetables – the foods richest in fiber.

Acids, Especially Vinegar, Reduce GI

Traditional cuisines usually make sauces by combining a fat with an acid. Frequently used sauce acids are vinegars and citric acid from lemons, limes, or other citrus fruits.

It turns that sauce acids can substantially reduce the GI of meals. The best attested is vinegar. From a study in the European Journal of Clinical Nutrition [6]:

In the current study, the addition of vinegar and vinegared foods to white rice reduced the GI of white rice. The acetic acid in vinegar was thought to be responsible for the antihyperglycemic effect. The amount of acetic acid to be effective could be as low as that found in sushi (estimated to be about 0.2–1.5 g/100 g). The antihyperglycemic effect of vinegar is consistent with other studies performed earlier (Brighenti et al, 1995; Liljeberg & Bjorck, 1998). Although vinegar could lower GI vales, the mechanism has rarely been reported. Most studies accounted the mechanism to be due to a delay in gastric emptying. In animal studies, Fushimi (Fushimi et al, 2001) showed that acetic acid could activate gluconeogenesis and induce glycogenesis in the liver after a fasting state. It could also inhibit glycolysis in muscles. [6]

Other acids also work. Pickled foods, which are sour due to lactic acid released by bacteria, reduce the glycemic index of rice by 27% if eaten before the rice and by 25% if eaten alongside the rice [6].

Wines, especially red wines, are somewhat acidic. I haven’t seen a study of how drinking wine with a meal affects glycemic index, but it is known observationally that wine drinkers have better glycemic control and, often, long lives. [9]

So What’s the Healthiest Way to Eat “Safe Starches”?

One way to limit the likelihood of reaching dangerous blood sugar levels after a meal is by eating a relatively “low carb” diet. We recommend that sedentary people eat about 400 to 600 carb calories per day. This limits the amount eaten at any one sitting to about 200 calories / 50 g, which is the amount of a typical glucose tolerance test. It is an amount the body is well able to handle.

But the manner in which carbs are eaten may be just as important as the amount.

Let’s look again at the Perfect Health Diet Food Plate:

The design of a PHD meal is found in the body of the apple. Assuming two meals a day, the recipe is to combine:

  • A safe starch (roughly ½ pound, which translates to 150 to 300 carb calories);
  • A meat, fish, or egg (¼ to ½ pound);
  • A sauce made up of fats and acids such as lemon juice or vinegar;
  • Vegetables, preferably including fermented vegetables with their healthy acids;
  • (Optionally) some dairy or a glass of wine.

This is precisely the recipe which science has found minimizes the elevation of blood glucose after meals.

It seems reasonable to expect that a meal designed in this fashion will have a glycemic index around 30. The odds of 200 carb calories with a glycemic index of 30 generating blood sugar levels that are dangerous – 140 mg/dl or higher – in healthy people is very low. Even in diabetics, it may be uncommon.

So, yes, Virginia. There is a Santa Claus, and you can eat safe starches and avoid hyperglycemia too!

References

[1] Brand JC et al. Food processing and the glycemic index. Am J Clin Nutr. 1985 Dec;42(6):1192-6. http://pmid.us/4072954.

[2] Bahado-Singh PS et al. Food processing methods influence the glycaemic indices of some commonly eaten West Indian carbohydrate-rich foods. Br J Nutr. 2006 Sep;96(3):476-81. http://pmid.us/16925852.

[3] Dodd H et al. Calculating meal glycemic index by using measured and published food values compared with directly measured meal glycemic index. Am J Clin Nutr. 2011 Oct;94(4):992-6. http://pmid.us/21831990.

[4] Thouvenot P et al. Fat and starch gastric emptying rate in humans: a reproducibility study of a double-isotopic technique. Am J Clin Nutr 1994;59(suppl):781S.

[5] Mourot J et al. Relationship between the rate of gastric emptying and glucose and insulin responses to starchy foods in young healthy adults. Am J Clin Nutr. 1988 Oct;48(4):1035-40. http://pmid.us/3048076.

[6] Sugiyama M et al. Glycemic index of single and mixed meal foods among common Japanese foods with white rice as a reference food. Eur J Clin Nutr. 2003 Jun;57(6):743-52. http://pmid.us/12792658. Full text: http://www.nature.com/ejcn/journal/v57/n6/full/1601606a.html.

[7] Benini L et al. Gastric emptying of a solid meal is accelerated by the removal of dietary fibre naturally present in food. Gut. 1995 Jun;36(6):825-30. http://pmid.us/7615267.

[8] Jenkins AL et al. Effect of adding the novel fiber, PGX®, to commonly consumed foods on glycemic response, glycemic index and GRIP: a simple and effective strategy for reducing post prandial blood glucose levels–a randomized, controlled trial. Nutr J. 2010 Nov 22;9:58. http://pmid.us/21092221.

[9] Perissinotto E et al. Alcohol consumption and cardiovascular risk factors in older lifelong wine drinkers: the Italian Longitudinal Study on Aging. Nutr Metab Cardiovasc Dis. 2010 Nov;20(9):647-55. http://pmid.us/19695851.

 

Around the Web; The Case of the Killer Vitamins

Posted by on October 15, 2011 56 comments

I’d like to thank Patrick Timpone for a very enjoyable interview on The Morning Show at One Radio Network. Here is the MP3; I’m on for the second half of the show. You can find a zip file at the archive for October 13. Patrick’s producer Sharon tells me that she’s already benefited from our book:

I was following The Primal Diet and since I read the book, I’ve been allowing myself potatoes and rice and doing very very well on them among doing some other things you recommend.

Also, I’d like to thank Jimmy Moore once more for hosting his highly entertaining “safe starch” symposium (Jimmy’s original post; my response, here and at Jimmy’s). It was great to get the opportunity to explain ourselves to so many people in the low-carb and Paleo movements.

Jimmy is planning to try our diet for a week in November, which will be a good occasion for us to publish a 7-day meal plan. We’ll invite anyone who’s curious to try the diet along with Jimmy, and compare notes.

[1] Interesting posts this week:

Angelo Coppola on Latest in Paleo wonders if Denmark’s saturated fat tax will apply to mother’s milk. If so, it’s bad news for unemployed infants! (He also discusses the “safe starch” debate.)

I once knew a French astronomer who died from snorting cocaine while observing at 14,500 feet. Emily Deans makes me wonder:  Did he have Crisco for dinner?

Stan the Heretic offers his mitochondrial dysfunction theory of diabetes. Peter Dobromylskyj and JS Stanton are also developing ideas along this line. Speaking of JS, his post this week has some great photos of Sierra wildflowers and reflections on the state of the Paleo community.

CarbSane partially confirms Dr. Ron Rosedale: eating carbs does raise leptin levels compared to eating fat, but it is a mild rise over an extended period of time, not a “spike.”

Beth Mazur explains why her bathroom door is always closed.

Chris Kresser discusses why chronic illness often generates a form of hypothyroidism, low T3 syndrome.

Joshua Newman knows how to flatter.

How solid is the case against Andrew Wakefield? Autism is certainly characterized by intestinal dysfunction, and Age of Autism notes that distinguished scientists are citing Wakefield’s work.

Richard Nikoley claims he doesn’t know the words to “Kumbayah.”

Seth Roberts points out that the Specific Carbohydrate Diet has been curing Crohn’s for 80 years, but still no clinical trial.

Jamie Scott, That Paleo Horse Doctor, asks: Why do horses get laminitis?

We’ve quoted vegetarian Dr. Michael Greger’s concerns about arsenic in eggs. I’m more concerned about soy protein in eggs.

Following Steve Jobs’s death, Tim asked for an opinion about the unconventional cancer therapies of Dr Mercola’s friend Nicholas Gonzalez. David Gorski, toward the end of a detailed examination of Jobs’s medical condition and treatment, links to his own claim that the Gonzalez protocol is “worse than useless.”

[2] Music to read by:

[3] Cute animal photo:

[4] Notable comments this week:

PeterC’s dad, who has diabetes, is doing well on our diet. Daniel’s stepdad had a similar experience.

Helen informs us that sweet potato intolerance may be due to raffinose.

Mario Iwakura gives us his infectious theory of diabetes. I think a lot of the cases of disrupted glucose regulation, where people get frequent hyperglycemic and hypoglycemic episodes, may be due to occult infections.

Dr Jacquie Kidd (who blogs at drjacs.com) has gotten some great advice from Jamie Scott.

Ellen tells us of cases of iodine supplementation controlling diabetes.

Ned is looking for grass-fed cowbells.

[5] Do Vitamins Kill?: An analysis of the Iowa Women’s Health Study came out this week, and it purported to show that nearly all supplements except calcium and vitamin D increased mortality, with iron being the worst. Oskar asked us to look into it, so we did.

The study followed a large number of women in Iowa, and queried them several times about supplement use. In 1986, the baseline, the women had an average age of 62 (range of 55 to 69) and 66% were taking supplements. By 2004, the surviving women had an average age of 82 and 85% were taking supplements.

Here is the data on overall mortality vs supplement use:

“Cases” are instances of someone dying. “HR” or hazard ratio is the likelihood of dying if you supplement divided by the likelihood of dying if you don’t. Note that all the hazard ratio estimates are “adjusted.”

Unadjusted Hazard Ratios

The left columns of the table give us death statistics and allow us to calculate raw hazard ratios, with no adjustment whatsoever. Seven of the supplements have unadjusted HRs below 1.00, eight have unadjusted HRs above 1.00. The 15 HRs average to 1.01. Without copper, which has an unadjusted HR of 1.17, they average to 0.998. In short, death rates among supplementers were almost identical to death rates among non-supplementers.

This is interesting because supplement usage rose rapidly with age. It was 66% at age 62 and 85% at age 82. Supplement users were, on average, older than non-supplement users. But mortality rises rapidly with age. So there should have been a lot more deaths among the supplement users, just because of their more advanced age.

The paper should have, but didn’t, report age-adjusted hazard ratios. Adjusting for age is very important, since mortality depends strongly on age, and so does supplement use. However, it’s obvious what the result of age-only adjustment would have been. Supplement usage would have shown a substantial reduction in the risk of dying.

Hazard Ratios Adjusted for Age and Energy Intake

The least-adjusted hazard ratios reported in the paper are adjusted for age and energy intake.

The energy intake adjustment is disappointing, because energy intake is affected by health: healthier people are more active and eat more, and obese people also eat more. Including indices of health as independent variables in a regression analysis will tend to mask the impact of the supplements on health, creating misleading results.

However, let’s go with what we have. Based on “Age and Energy Adjusted” hazard ratios, supplements generally decrease mortality. Nine of the fifteen supplements decreased mortality, five increased mortality. At the 95% confidence interval, five supplements decreased mortality, only one increased mortality.

Looking at the specific supplements, results are mostly consistent with our book analysis. Let’s start with the five that showed harm:

  • Folic acid and iron – two nutrients we regard as dangerous and recommend not supplementing – both elevate mortality, as we would expect. Iron is particularly harmful, and should generally be avoided by women once they have stopped menstruating.
  • Multivitamins slightly increase mortality, a result that has been found before and that we acknowledge in the book. This is probably due to (a) an excess of folic acid, (b) an excess of iron (if the women are taking iron-containing multis after menopause), (c) an excess of vitamin A (this is no longer the case – multi manufacturers have reduced the A content of vitamins in response to data – but in 1986-2004 most multis contained substantial amounts of A) which is harmful in women with vitamin D and/or K2 deficiencies (both extremely common, and D deficiency in this cohort is supported by the benefits of D and calcium in the study and the northerly latitude of Iowa) or (d) imbalances in other nutrients; for reasons of bulk multis tend to lack certain minerals, notably magnesium and calcium.
  • Vitamin B6 is an anomaly, as we wouldn’t expect B6 to be harmful in moderation. I’m guessing B6 would have been taken to reduce high homocysteine and for this purpose would often have been taken along with folic acid, a harmful supplement. Also, B6 should be balanced by vitamin B12 and biotin, and may not have been. Perhaps people with cancer were unaware that B6 promotes tumor growth; (UPDATE: See comments; I was misremembering studies, B12 and folic acid can promote tumor growth, but in other studies B6 looks protective against cancer) indeed, in the breakdown by cause of death in Table 3, B6 increases cancer mortality by 6%, but CVD mortality by only 1%. (Folic acid and vitamin A were other cancer-promoting supplements.) The harm from B6 was not statistically significant and I wouldn’t read much into it.
  • Copper is another anomalous result, but this was the least popular supplement, taken by only 229 women or 0.59%. Copper’s hazard ratios were dramatically affected by adjustment: in the raw data, mortality is only 17% higher among copper supplementers, but after age and energy adjustment it is 31% higher, and multivariable adjustment increases it substantially again. Clearly the effect of copper is highly sensitive to adjustment factors, indicating that copper was being taken by an unusual population. I think the hazard ratio for copper is impossible to interpret without knowing why these women were supplementing copper. If we knew their situation, there would probably be an appropriate adjustment that would make a huge difference in mortality. I would say the numbers are too small, the population too skewed, and the information too limited to draw any conclusion here.

Overall, I would interpret the nine that showed benefits as being highly supportive of micronutrient supplementation. The fact that vitamin A, vitamin B complex, vitamin C, vitamin D, vitamin E, calcium, magnesium, selenium, and zinc all reduced mortality suggests that a well-formulated multivitamin would likely have reduced mortality.

Hazard Ratios After Multivariable Adjustment

Now, what about the “Multivariable Adjusted” results, which were responsible for the headlines?

We have to keep in mind a famous aphorism from the mathematician John von Neumann:

With four parameters I can fit an elephant, and with five I can make him wiggle his trunk.

The multivariable adjustments use 11 parameters and 16 parameters respectively. Using so many parameters lets the investigators generate whatever results they want.

I don’t think it’s a coincidence that both multivariable adjustments substantially increased the hazard ratio of every single one of the 15 supplements. The 11-variable adjustment increased hazard ratios by an average of 7%, the 16-variable adjustment by an average of 8.2%.

Rest assured, it would have been easy enough to find multivariable adjustments that would have decreased hazard ratios for every single one of the 15 supplements.

I believe it verges on the unethical that the variables chosen include dangerous health conditions: diabetes, high blood pressure, and obesity. These three health conditions just happen to be conditions that are often improved by supplementation.

Anyone familiar with how regression analyses work will immediately recognize the problem. The adjustment variables serve as competing explanations for changes in mortality. If supplementation decreases diabetes, high blood pressure, and obesity, and through these changes decreases mortality, the supplements will not get credit for the mortality reduction; rather the decreased diabetes, blood pressure, and obesity will get the credit.

Imagine we had a magic pill that completely eliminated diabetes, obesity, and high blood pressure, and reduced mortality by 20%, with no negative health effects under any circumstances. But if regression analysis showed that non-diabetic, non-obese, and non-hypertensive people had 25% less mortality, then a multivariable adjusted analysis would show that the magic pill increased mortality. Why? Because the elimination of diabetes, obesity, and hypertension should have decreased mortality by 25% (the regression analysis predicts), but mortality was only decreased 20%, so adjusted for diabetes, obesity, and hypertension the magic pill must be credited with the additional 5% dead. The multivariable adjusted HR for the magic pill becomes 0.8/0.75 = 1.067.

Of course, what ordinary people want to know is: Will this magic pill improve my health? The answer to that would be yes.

What (too many) scientists want to know is: Which methodology for analyzing this magic pill data will get me grant money? That depends on whether the funding authorities are positively or negatively disposed toward the magic pill industry. Once you know that, you search for the 16-variable multivariable regression that generates the hazard ratios the authorities would like to see.

My take? Judging by the data in Table 2 plus corroborating evidence from clinical trials reviewed in our book, I would say that a well-formulated supplement program, begun at age 62, may increase the odds of survival to age 82 by something on the order of 5% to 10%. Perhaps not a magic pill; but worthwhile.

[6] Not the weekly video: An exceptional magic show:

[7] Shou-Ching’s Photo Art:

[8] Weekly video: A new tool for stroke recovery: