PaleoFX, AHS, and Building Institutions

Posted by on November 1, 2012 13 comments

The next year could be huge for the ancestral health movement. We have a chance to leap into the mainstream. Shou-Ching and I will certainly be working hard to bring that about. A lot of other people are working hard at it, too.

In order to accomplish this, we have to work together, and to do that it’s extremely important to meet. That’s why I’m very excited about the two big ancestral health gatherings: PaleoFX and the Ancestral Health Symposium. Both have made announcements this week.

PaleoFX: Make Plans Now

PaleoFX will be held March 28-30 in Austin, Texas. March 30 is my birthday and I can’t think of a better way to celebrate than with lots of Paleo friends.

PaleoFX is a terrific event. The 2013 speakers include Mat Lalonde, Sarah Fragoso, Nora Gedgaudas, Kelly Starrett, Diane Sanfilippo, Jimmy Moore, Nell Stephenson, Cate Shanahan, Abel James, Emily Deans, Michelle Tam, and many more, including rising young stars like Dan Pardi of Dan’s Plan.

PaleoFX has strong fitness and food components, as you would expect given the backgrounds of Michelle and Keith Norris of Ancestral Momentum. Fitness sessions and cooking demos run alongside the talks, so PaleoFX is a great opportunity to improve body and spirit as well as mind.

It will be in a new location, the scenic Palmer Events Center, which unfortunately has space limitations placing a strict limit on the number of tickets that can be sold. PaleoFX 2013 is expected to sell out early, so it’s a good idea to make plans soon.

PaleoFX is offering a special deal on tickets purchased by December 1: you’ll be automatically entered in a contest to win access to a VIP dinner with speakers or a full refund of the PaleoFX ticket cost. Visit http://therealpaleofx.com/ to register for PaleoFX 2013.

Ancestral Health Society: Calling for Volunteers

The Ancestral Health Society has released a call for volunteers to help with the Ancestral Health Symposium 2013.

AHS 2013 will be held in Atlanta, Georgia on August 15-17. Right now the Society is looking for volunteers for the following positions:

  • Program Chair and Committee – invite presentation proposals, choose speakers, and craft the program schedule.
  • Public Relations Committee – help make the event successful.
  • Social Chair and Committee – arrange the parties!
  • Registration Chair.
  • Volunteer Chair.

If you’re interested, please let the Society know.

Building Institutions

At AHS 2012, I volunteered to help the Ancestral Health Society create a scholarly and clinical journal, the Journal of Evolution and Health. We’re currently choosing a publishing platform and solving technical issues; the editorial process is expected to begin in the new year.

We believe that this journal can bring scholarly, clinical, and popular communities together. The many health success stories that have appeared on Paleo/Primal/PHD blogs are strong evidence for the effectiveness of ancestral approaches to health. The journal will provide a forum to assemble evidence systematically and communicate it to a broader audience.

I know of a number of other promising initiatives underway in the community to bring ancestral health to the general public. Many, I’m sure, will bear fruit.

For our part, we’re hopeful that the new edition of our book can help the movement become more popular. We believe our diet is well-grounded scientifically, effective at healing, delicious to eat, and, because it supports gluten-free safe starches, easy for most people to adopt and maintain.

In the spirit of teamwork, we would like to introduce our readers to other worthy members of the ancestral health community. Toward that end, I would like to add a few “resource” pages to the site:

–          Food sites. A lot of great food bloggers post PHD-compatible recipes. Some of my favorites: Hilary Finch Hutler’s TummyRumblr; Russ Crandall’s The Domestic Man; Josephine and Henry Svendblad’s Nutty Kitchen; and Francesca, “The Italian Paleo,” at Francesca Eats. I’m sure there are other great food bloggers that should be on this list. All of them deserve more attention.

–          Healers. We often get emails from readers asking if we know of doctors, nutritionists, or alternative medicine practitioners in their area who are familiar with PHD and supportive of integrating modern medicine with natural, ancestral approaches to healing. Usually we don’t. Assembling a list of PHD-friendly healers would let us give a better answer.

If you’d like to be listed on one of these resource pages, please send me an email: pauljaminet at perfecthealthdiet dot com.

I have ulterior motives for discovering PHD-friendly foodists and healers. Identifying allies-in-spirit is the first step toward working together. For example, as the journal gets going, we will want to publish clinical case reports; to do so, the editors will need to be in contact with healers. There may be other opportunities. I organized a panel at AHS 2012 on “New Technologies, New Opportunities” to discuss how the ancestral community can take advantage of software technologies that are enabling new forms of collaboration, information sharing, and mutual aid. I don’t have anything definite in mind – yet – but I think there are opportunities to do a better job of bringing great food and ancestral healing to a broad public.

Conclusion

It’s an exciting time in the ancestral health movement. The community is growing fast, but is still small enough that it’s possible to know most of the players personally. If you’d like to be involved, there are many opportunities. Please consider getting involved!

Hurricane Sandy Approaches; meet Gabor Maté

Posted by on October 28, 2012 15 comments

I have a large number of half-completed posts and some will go up soon, but I thought I’d put up a note about the storm just so you’ll know what happened in case we lose power and disappear for a few days.

Hurricane Sandy looks to be an unusual storm: not terribly severe winds, but tremendous risk from flooding.

NOAA is projecting the storm will drop 6 inches of rain per day in some locations:

Wave heights are reaching 30 feet on ocean buoys:

The storm will make landfill with a full moon when tides are at their most extreme, so the potential for flooding to storm surges is severe. Widespread flooding means widespread power outages.

In Boston, they’re predicting four days of rain starting in a few hours.

If the rain has you at home looking for entertainment, here’s a very interesting talk by Gabor Maté, the Hungarian-Canadian psychologist (thank you, Kris!):

Be safe everyone!

Look AHEAD Scientists: Trying to Move the Deer Crossing

Posted by on October 22, 2012 78 comments

The Look AHEAD: Action for Health in Diabetes trial has been halted two years early. Here’s Gina Kolata in The New York Times:

The study randomly assigned 5,145 overweight or obese people with Type 2 diabetes to either a rigorous diet and exercise regimen or to sessions in which they got general health information. The diet involved 1,200 to 1,500 calories a day for those weighing less than 250 pounds and 1,500 to 1,800 calories a day for those weighing more. The exercise program was at least 175 minutes a week of moderate exercise.

But 11 years after the study began, researchers concluded it was futile to continue — the two groups had nearly identical rates of heart attacks, strokes and cardiovascular deaths.

It’s clearly a negative result for “eat less, move more” as a health strategy for obese diabetics.

Was “Eat Less Move More” Harmful?

A few Paleo bloggers are not surprised; indeed, Peter Dobromylskyj speculates that all-cause mortality – which Ms. Kolata and the NIH press release do not report – may have been higher in the “eat less, move more” intervention group:

It seems very likely to me that more people died in the intervention group than in the usual care group, but p was > 0.05.

Call me a cynic, but I think they stopped the trial because they could see where that p number was heading.

Peter may be a cynic but cynics are sometimes right, and I will bet that he’s right about this. In general, calorie restriction and exercise are better attested against cardiovascular disease than against other health conditions, so if death rates from CVD were identical in the two arms after 11 years, it’s quite likely death rates from other causes were higher in the intervention arm.

Our Theory

We discuss in our new Scribner edition two reasons why “eat less, move more” can backfire:

  • On a malnourishing diet, “eat less” means even greater malnourishment. Less of a bad diet is a worse diet.
  • Excessive exercise may over-stress the body and harm health. In diseased people, the volume at which exercise becomes excessive may not be that high.

On the other hand, ultimately some form of “eat less, move more” is needed if optimal health is to be attained:

  • An energy deficit – eating less than the body expends – is necessary to lose fat mass, and obesity is probably incompatible with optimal health.
  • About 20 to 30 minutes of exercise per day at the intensity of running or jogging is needed for optimal health, probably due to the role of daytime activity in entraining circadian rhythms (see “Physical Activity: Whence Its Healthfulness?”, October 11, 2012). Most people would need to “move more” to achieve this.

So the challenge in weight loss is two-fold: It’s necessary to adopt a healthy diet in which malnourishment doesn’t occur despite calorie restriction, and to find a healthy level of exercise that improves health without overstressing the body.

Look AHEAD: Bad Dietary Advice

The Look AHEAD Study Protocol tells us what the intervention group was told to do.

From page 29, here is the diet advice:

The recommended diet is based on guidelines of the ADA and National Cholesterol Education program [96,97] and includes a maximum of 30% of total calories from total fat, a maximum of 10% of total calories from saturated fat, and a minimum of 15% of total calories from protein.

This gives 55% carbs and probably 10% omega-6 fat. The omega-6 intake is far too high – for weight loss and good health, omega-6 intake should be less than 4% – and so is the carb intake – for diabetics, reducing carbs to 30% or less is highly desirable.

From page 30, here is the exercise advice:

The physical activity program of Look AHEAD relies heavily on unsupervised exercise, with gradual progression toward a goal of 175 minutes of moderate intensity physical activity per week by the end of the first six months. Exercise bouts of ten minutes and longer are counted toward this goal. Exercise is recommended to occur five days per week.

Moderate-intensity walking is encouraged as the primary type of physical activity.

I think this is reasonable advice. It translates to 35 minutes per day for 5 days. The intensity is quite low. This level of exercise is hardly likely to be excessive; indeed, it’s probably grossly insufficient for optimal health. It represents about a mile and a half of walking per day, five days per week. This may have been a homeopathic level of activity.

There is another reason the exercise may have produced no observable benefit. Since I believe the health benefits of exercise occur primarily through circadian rhythm entrainment, it’s likely that daytime exercise is much more beneficial than night-time exercise. Night-time exercise might be ineffective or even harmful to health if it disrupts circadian rhythms.

Unfortunately many people find it difficult to find time during the day for exercise. If the walking was performed at night, even the modest benefits of the activity may have been lost.

Weight and Health: What’s the Direction of Causation?

The one “success” of Look AHEAD was that it brought about some weight loss: the intervention group lost 5% of their original weight.

We know that obesity is associated with poor health. Since causation implies correlation, the existence of this correlation suggests that either (1) obesity causes poor health, (2) poor health causes obesity, or (3) some third factors cause both obesity and poor health.

The Look AHEAD study presumed (1) – that obesity causes poor health. The “eat less, move more” intervention was wholly directed at weight loss. If obesity is the cause of poor health, Look AHEAD should have improved health. It didn’t. This tells us that the direction of causality is either (2) or (3). Obesity doesn’t impair health; other factors that impair health cause obesity.

It’s easy to make faulty inferences about the direction of causation. The Look AHEAD scientists made the same mistake this woman did:

Conclusion

The basic flaw in the Look AHEAD study was that it was designed to bring about weight loss, and hoped that weight loss would improve health.

A better intervention would seek to improve health through a more PHD-like diet and through circadian rhythm therapies. Successful health improvement would, more than likely, lead to weight loss.

For the overweight and for diabetics, the focus should not be on weight, but on health. Improve health, and weight loss will follow. Focus on weight with a simple-minded “eat less, move more” intervention without tending to the quality of your diet and lifestyle, and you might be doing yourself more harm than good.

Very Low-Carb Dieting: Are the Hormonal Changes Risk-free?

Posted by on October 19, 2012 60 comments

I was in Chicago earlier this week to record a video discussion with Dr Ron Rosedale hosted by Dr Mercola. Ron and I have taken opposite sides in several “safe starch debates” (First installment here; reply to Ron here; Ancestral Health Symposium panel discussed here.) This new discussion was intended to be more cordial and uncover common ground as well as differences.

I was intrigued to see that Ron’s lunch consisted mostly of plant foods which he ate avidly; he said he believes that most people on his diet eat a significant amount of plant foods. I came away with the impression that the Rosedale Diet resembles the ketogenic version of PHD, only with less starch and MCT oil.

One of my objections to Ron’s recommendations has been that very low carb and protein consumption can be stressful to the body. Scarcity of carbs and protein invokes certain starvation-associated pathways – for instance, lower T3 thyroid hormone. We discussed this in “Carbohydrates and the Thyroid,” August 24, 2011.

Ron believes that low T3 on low-carb diets is healthy, and other low-carb advocates, such as Sam Knox, have made similar arguments.

I believe that intermittent fasting, which invokes starvation-associated pathways transiently, is usually health-improving – but that you can overdo it. What happens if you invoke these pathways chronically and continuously?

Prof Dr Andro on the “Athlete Triad”

Some light was shed on this question recently by Adel Moussa, aka Prof Dr Andro, who discussed the “athlete triad” in three posts (Part I, Part II, Part III) at his blog Suppversity.

The athlete triad appears most commonly in athletes who undereat and overtrain. Symptoms include low energy, amenorrhea in women and low testosterone in men, osteoporosis, reduced cognitive ability, and impaired immune function. The syndrome is surprisingly common, especially in female athletes:

Although the exact prevalence of the female athlete triad is unknown, studies have reported disordered eating behavior in 15 to 62 percent of female college athletes. Amenorrhea occurs in 3.4 to 66 percent of female athletes, compared with only 2 to 5 percent of women in the general population. [1]

As Adel discusses in Part II, the athlete triad is characterized by the following hormonal pattern:

  • low estrogen and testosterone levels
  • low T4 and low T3 thyroid hormone levels, often with low TSH and high reverse T3
  • a disturbed circadian cortisol rhythm lacking an appropriate cortisol spike in the morning and a normal decline in cortisol levels in the course of the day
  • low leptin, low insulin, and low IGF-1

Precisely the same hormonal patterns, including lower thyroid hormone levels, higher cortisol, and a suppressed circadian cortisol rhythm, are observed in total fasting and starvation. [2] [3]

These hormonal changes conserve glucose and protein, an appropriate step during starvation. The energy-intensive tasks of immune function and reproduction are temporarily suppressed until energy is more readily available.

Similar patterns of reduced T3 and elevated cortisol excretion were recently seen in a clinical trial of a 10% carb weight maintainance diet. [4] This trial shows that even in the absence of calorie restriction, carb restriction is sufficient to reproduce much of the “athlete triad”/starvation hormonal pattern.

This pattern reaches its most extreme form in anorexia:

[H]ypocaloric diets causes changes in thyroid function that resemble sick euthyroid syndrome. Changes consist of a decrease in total T4 and total and free T3 with a corresponding increase in rT3….

States of chronic starvation such as seen in anorexia nervosa are also associated with changes in thyroid hormone, GH, and cortisol secretion. There is a decrease in total and free T4 and T3, and an increase in rT3 similar to findings in sick euthyroid syndrome…. [T]here is an increase in GH secretion with a decrease in IGF-1 levels…. The changes in cortisol secretion in patients with anorexia nervosa resemble depression. They present with increased urinary free cortisol and serum cortisol levels. [5]

In chronic starvation, hunger is replaced by anxiety and a desire to move. In evolutionary context this urge to be active may have stimulated food-seeking, but in modern life it can exacerbate conditions like the athlete’s triad.

In Part II of his series, Adel made an interesting observation. Chris Kresser often mentions a patient who cured his health problems with pizza and beer. Here’s Chris recounting the story to Kurt Harris:

Chris Kresser: Back around 2000, I was interning for a holistic doctor down in San Diego, and this was before I got into Paleo or anything, and I was, I think, a vegan macrobiotic, for crying out loud, at that point!  So, we had a patient who was just really, really sick, and he was just getting sicker and sicker.  He weighed about 90 pounds.  I think he was about 6 feet tall.  And the doctor had him on a restricted diet, you know, one of those food allergy type of diets where all you’re eating is, like, broccoli, venison, and quinoa.

Kurt Harris:  The Specific Carbohydrate Diet?

Chris Kresser:  No, no, just like a really, you know, they do the IgG food testing, which is kinda bunk anyways.

Kurt Harris:  Yeah, that’s pretty bunk.

Chris Kresser:  And then they find out you can only eat strawberries, broccoli, quinoa, and ostrich!  You know?  And so, he was doing that, and he kept removing foods until he was literally down to, like, broccoli and steamed whitefish or something.  That was all he was eating.  And he just kept getting sicker and sicker.  So, he disappears for about six months, comes back a completely different person.  He’s back up to 160 or 170, which was his normal weight, you know, completely normal complexion.  Literally, we didn’t even recognize him, and the doctor was saying:  What happened?  Was it diet?  And the guy was like:  Yep, it was diet.  And he said:  Was it the candida diet?  Was it the Specific Carbohydrate?  What was it?  And he said:  It was the beer and pizza diet!  [laughter]  And this guy literally, I mean, the guy got to this point where he was like:  OK, if this is my life, I’m fine with just flaring out.  You know, this isn’t worth it.  And if I’m gonna go out, I’m gonna have fun.  And so, he started going out.  You know, he wasn’t ever hanging out with his friends anymore because he was on such a restricted diet, he had no social life, so he just said: Forget it.  I’m gonna drink beer and eat pizza at least three times a week, and then the other times I’m gonna do whatever I want.  And that completely restored his health.

Adel speculates (very plausibly in light of the man’s weight of 90 pounds!) that the patient was suffering from the starvation pattern which is replicated in very low-carb “euthyroid sick syndrome” and the athlete triad. What he needed was more calories, especially carb and protein calories. Pizza and beer are great sources!

Conclusion

It was a pleasure to chat with Ron and Dr Mercola in Chicago. We recorded a four hour discussion, which is going to be edited down to an hour or hour and a half.

We found plenty of common ground. We agreed that there are very real health benefits to low-carbohydrate diets. Low-carb diets are helpful against diabetes and metabolic syndrome, and quickly improve cardiovascular risk markers such as blood pressure, triglycerides, and HDL.

But in biology, good things can always be taken too far. One can restrict carbohydrates (and protein) too much. Extremism in carb restriction may, indeed, be a vice.

References

[1] Hobart J, Smucker D. The female athlete triad. Am Fam Physician. 2000 Jun 1;61(11):3357-64, 3367. http://pmid.us/10865930.

[2] Shimizu H et al. Altered hormonal status in a female deprived of food for 18 days. J Med. 1991;22(3):201-10. http://pmid.us/1770328.

[3] Palmblad J et al. Effects of total energy withdrawal (fasting) on the levels of growth hormone, thyrotropin, cortisol, adrenaline, noradrenaline, T4, T3, and rT3 in healthy males. Acta Med Scand. 1977 Jan;201(1-2):15-22. http://pmid.us/835366.

[4] Ebbeling CB et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA. 2012 Jun 27;307(24):2627-34. http://pmid.us/22735432.

[5] Douyon L, Schteingart DE. Effect of obesity and starvation on thyroid hormone, growth hormone, and cortisol secretion. Endocrinol Metab Clin North Am. 2002 Mar;31(1):173-89. http://pmid.us/12055988.