health – Pål Jåbekk

Death by mediocrity

«Moderation is a fatal thing. Nothing succeeds like excess.«

Oscar Wilde

One of the truly great obstacles on our path to optimal health is the solid belief in the golden mean or everything in moderation. Rarely have such an inadequate and useless thought been given so much undeserving acceptance.

The belief in a dietary golden mean seems based on a lack of knowledge. But it is understandable that, when faced with the choice of two seemingly extremes, we choose a desirable mean. This thinking has probably saved many lives throughout history. But when it comes to diet in a modern world, it is poor guidance.

«I hear both carbs and fat are fattening, so I try to eat a little of both. Everything in moderation you know.»

Yes, I know, but you are not making sense. A desperate attempt at reducing cognitive dissonance is making you choose a bloody poor strategy.

Because the truth is that a strategy that seems like an extreme, might be your best choice, thus making all other choices poorer. Your notion of what is extreme is likely not based on knowledge of the field.

This is of course all a matter of perspective. I consider a diet based on whole grains, with 60% of energy from carbs, fruit five times a day and negligeble amounts of saturated fat, cholesterol and red meat, to be very extreme indeed. By others it is considered a safe choice or even an optimal choice.

But if grains affect youever so slightly in a negative way, the belief that everything can be eaten in moderation, will lead to greater negative health effects than that seemingly extreme no grain diet.

Disagreeing professionals confuse us. Who should we trust? In our despair we opt for a mean. Yet the desire for optimal is just as strong. Often, the golden mean is so far from the optimal, that the positive health effects honor us with their absence.

So if disagreeing «experts» make you choose a middle way, know that you have not chosen the optimal way. And when the nutritionist or doctor advice you to eat everything in moderation, cover your ears and walk away.

Following general principles is a dangerous sport. General principles are just that, general. They don’t always apply. When it comes to diet, «everything in moderation» is not a good guiding rule. Optimal diet is optimal diet, regardless of our preferences or feelings.

The fittest person in the morgue

I have to admit that the title is stolen from an article by Mary Sheppard. The article is about the strange phenomenon of athletes keeling over and dying during strenuous exercise. The irony is that a marathoner will probably be the most worn out specimen at the morgue despite having a high VO2max before death.

The Hormesis

“If we accept the validity of the general concept of physiological hormesis as being the phenomenon of achieving health beneficial effects by exposure to mild stress, then hormesis is being applied already and successfully to humans. The evidence for this is the well-demonstrated health benefits of regular and moderate exercise.”[1]

Running is good for us. It has to be, we’ve been told so for years and years. There’s just no doubt about it. There usually isn’t much need for running in a modern society, except for perhaps trying to catch a bus or escaping the occasional bully or mugger. But despite the lack of need to run, many of us still prefer to run, and some run a lot. We even learn to enjoy the burning lungs, the taste of blood and a heart rate that would otherwise have us seriously worried. We are mimicking the thrill of the hunt. Humans are truly made to run. But, contrary to our hunting forefathers there is no reward following the hunt. No big mammoth to cut up and bring home. No great mammal that feeds your family for a week and that makes running unnecessary until the meat is gone.

Modern humans do things differently. Instead of following the natural evolutionary approach and wait with exerting ourselves until more food is needed, we run again the very next day, and the day after that, and the day after that. The total amount of physical activity is staggering. There is nothing natural about it. Recreational joggers and marathon runners burn through an extreme amount of energy, usually supported by a high carbohydrate diet. Many also claim they do it for their health. But is it really that healthy?

Exercise is the perfect example of the principle of hormesis. The term is usually used to describe favorable effects of small amounts of something that is unfavorable in larger amounts, like a toxin or a stressor. Exercise is a stressor. If you want to test it, you can start exercising and don’t stop. You will get weaker and weaker until you fall and your body will be in a far worse shape than when you started. Exercise is really and truly bad for us, but only acutely and only if we forget to rest after.

“…the occurrence of SCD [Sudden Cardiac Death] associated to training and competitions for athletes is increased by 2.8 times compared to the average relative risk of non-competitive practitioners, hence giving rise to the following question: Does sports activity causes sudden death in young people?”[2]

It is important to remember that it is the physiological response to exercise, the repairing of damaged tissues, and increasing of tolerability that causes exercise to make us stronger. It is the rest, the restitution that increases our potential, our endurance and our strength. Exercise makes us weak, rest makes us stronger.

Energy and glucose restriction has been shown to increase the lifespan of several species. It also increases formation of reactive oxygen species (ROS) in the mitochondria. The organism however, seem to adapt and acquire an increased resistance to oxidative stress. Antioxidants, which decrease ROS levels, limit the life extending effects of glucose restriction and exercise [3]. It has also been suggested that high antioxidant intakes lessens the adaptive response to exercise. But not all data show this [4].

The bottom line is that if you want exercise to be healthy, you better learn to rest.

The Metabolism
Everybody is free to do what they want and to exercise as they please. But the marathon runner lies, consciously or not, if he says he runs for his physical health. Although top athletes are marvelous examples of how far we can push the boundaries of the human body, they are not in it for the health. Injuries, wear and tear, infections and long term side effects are all part of the deal. This deal also needs to be remembered by recreational runners.

If you run for hours a day, you do it for the joy of exercising. You do it for the brake it gives you from the everyday hassle. You do it for shear competitiveness. But you do not do it for your physical health. That is bollocks.

From a metabolic standpoint is makes little sense to participate in long duration exercise of an intensity that is way over in the carbohydrate burning zone. Our carbohydrate fuel stores are quickly depleted. From en evolutionary standpoint these stores are there for short and intense bouts of exercise. As a hunter or gatherer we would spend most of our time in a fat burning low intensity zone and only occasionally do shorter high intensity work. Imagine foraging or tracking prey or working around the camp – all low intensity physical activities. Or you can watch Robb Wolf and his “caveman” friends hunting big game with atlatls. There is little sprinting involved.

Many runners (or other endurance athletes) however, spend much of their time in a carbohydrate burning zone. I was taught in school that intensities around the anaerobic threshold, where much of the energy (ATP) is produced outside of the mitochondria, are ideal for improving endurance performance. But the long time spent exercising at these intensities, may cause serious problems.

One obvious aspect is that the high intensity exercise many do requires them to stuff themselves with carbohydrates. Stuffing yourself with carbs is probably more of a problem if you don’t exercise much, but it might still be problematic. High carbohydrate for an endurance performer is usually synonymous with high sugar high starch which will in itself have a negative impact on the body. What’s worse is that high starch usually means high grain low fat. The stage is set for gut problems, infections, allergies and asthmas, muscle cramping and soreness, slow wound healing and general poor health. Remember, the apparent absence of disease does not equal good health. Poor diet might be the reason why the 50 year old marathon runner often does not look anything like a healthy human specimen.

The Body
But there are other problems, directly related to the exercising itself. One obvious aspect is the amount of wear and tear. The higher intensity exercise you perform the longer restitution needed to fully repair the body. Injuries and frailty is part of the deal. Endurance athletes are more osteoporotic than the rest of us [5-8].

Too little rest and too much exercise results in increased cortisol and other stress parameters. Marathon running is a huge stress to the body. One group of researchers from Canada used data from magnetic resonance imaging (MRI) to find out how marathon running affects the heart over time. Headed by Dr. Eric Larose, the group found that the magnitude of abnormal heart segments was more widespread and significant in a group of less fit runners. Runners with lower VO2max showed more signs of heart injury than more fit runners.

Wu et al [9] found that a 24hour ultra marathon damaged about every part of the body measured, including the liver and gallbladder. They also found that HDL decreased, LDL increased, red and white blood cell count decreased as well as testosterone. Their conclusion: “Ultra-marathon running is associated with a wide range of significant changes in hematological parameters, several of which are injury related.”

Lippi et al noticed that enzyme biomarkers indicating liver damage are increased after a half marathon run to such a degree that there is no point testing for liver damage close to a race [10].

Skenderi et al [11] examined thirty-nine runners competing in the Spartathlon race (a 246km continuous race from Athens to Sparta) who managed to complete the race within a 36h time limit. They found that “Muscle and liver damage indicators were elevated at the highest level ever reported as a result of prolonged exercise…”

There is more data showing muscle damage from this kind of exercising. Warhol et al [12] found that the muscles of veteran runners had intercellular collagen deposition suggesting repeated injury. Tissue from non runner controls did not show this.

“Since oxidative modifications of DNA can lead to mutations and exceptionally high volumes of exercise are also associated with a substantial oxidative stress, concerns have arisen about the health effects of competing in endurance and ultraendurance exercise events, particularly when participants are not optimally trained.”[13]

As if damaging your muscles and organs weren’t enough, both ultra endurance exercise and half marathon results in DNA damage [13,14]. There is however need for follow up studies of DNA damage and instability. So far the effects are only proven acutely. Rae et al fount that telomere length in the vastus lateralis muscle in experienced endurance runners was inversely related to years spent running and hours spent training [15]. Shortening of telomere length is a sure sign of aging. Collins et al [16] found that Athletes with exercise-associated fatigue (fatigued athlete myopathic syndrome) had significantly shorter telomere length in their vastus lateralis compared to matched controls. Results from Ludlow et al suggest that hormesis is in fact a factor and that when it comes to telomere length moderate physical activity is better than both low and high levels [17].

As heart-healthy as running is supposed to be the heart is still one of the body parts placed under the most pressure and cardiac damage is easily measured [18,19]. I was taught in school that endurance exercise increases left ventricular volume and thus produces a greater cardiac output. Strength exercise on the other hand was supposed to increase heart wall thickness because of the high blood pressure, and thus increase the risk of cardiac arrhythmias. I think this is what is called the “Morganroth hypothesis.” Trouble is that much data refute the hypothesis. The most recent comes from Australia, showing increased left ventricular wall thickness after endurance exercise, but not after strength exercise.

Cardiac troponin (part of contraction process in skeletal and cardiac muscle) increases greatly after a half marathon in young runners, and “…reach levels typically diagnostic for acute myocardial infarction…”[20]. The level is higher in less trained athletes [21]. Whether cardiac injury markers are indicative of real damage is uncertain. Jassal et al puts it this way “Elevations of cardiac injury markers in non-elite athletes are extremely common following the completion of endurance events and correlate with the increased endurance time. Whether the increase in the levels of these enzymes represents true myocardial injury or a result of the release of cTnT from the myocytes requires further investigation.”[21].

“The clinical significance of chronic exposure to endurance exercise is unknown. The development of myocardial fibrosis has been suggested as a long-term outcome to chronic exposure to repetitive bouts of endurance exercise and has been linked to an exercise-induced inflammatory process observed in an animal model. This hypothesis is supported by a limited number of studies reporting postmortem studies in athletes and an increased prevalence of complex arrhythmia in veteran athletes.”[22]

There are other parts of the cardiovascular system negatively affected by extreme exercise. A 96 fold increased serum level of calprotectin after both half and full marathon is indicative of damage to the vascular endothelium and microthrombi [23].

Marathon running has also been shown to induce kidney damage/renal abnormalities [24], and especially if you get dehydrated.

It has been suggested that marathon running also induce brain damage, as measured by increase levels of S100beta, a common marker of brain damage. A study from 2004 however, indicates that the increased S100beta levels come from extracranial sources [25]. But it’s still tissue damage. By the way, S100beta is also a marker of cancer.

The Conclusion
Exercise breaks us down. Rest is what makes us stronger. There is little indication that marathon running is worth participating in for health reasons. Running is in itself fine, but too much and too high intensity combined with an unnatural diet makes it very unhealthy. If I was to give an advice based on the best of my knowledge for optimal health I would recommend short high intensity exercise such as interval or strength training. Do this 2-4 times a week and keep any other exercise you partake in in a fat burning, moderate intensity zone. This is also an exercise advice that can be easily coupled with low carbohydrate dieting.

References

1. Rattan SI, Demirovic D: Hormesis can and does work in humans. Dose Response 2009, 8: 58-63.

2. Ferreira M, Santos-Silva PR, de Abreu LC, Valenti VE, Crispim V, Imaizumi C, Filho CF, Murad N, Meneghini A, Riera AR, de Carvalho TD, Vanderlei LC, Valenti EE, Cisternas JR, Moura Filho OF, Ferreira C: Sudden cardiac death athletes: a systematic review. Sports Med Arthrosc Rehabil Ther Technol 2010, 2: 19.

3. Ristow M, Zarse K: How increased oxidative stress promotes longevity and metabolic health: The concept of mitochondrial hormesis (mitohormesis). Exp Gerontol 2010, 45: 410-418.

4. Higashida K, Kim SH, Higuchi M, Holloszy JO, Han DH: Normal Adaptations to Exercise Despite Protection Against Oxidative Stress. Am J Physiol Endocrinol Metab 2011.

5. Campion F, Nevill AM, Karlsson MK, Lounana J, Shabani M, Fardellone P, Medelli J: Bone status in professional cyclists. Int J Sports Med 2010, 31: 511-515.

6. Smathers AM, Bemben MG, Bemben DA: Bone density comparisons in male competitive road cyclists and untrained controls. Med Sci Sports Exerc 2009, 41: 290-296.

7. Burrows M, Nevill AM, Bird S, Simpson D: Physiological factors associated with low bone mineral density in female endurance runners. Br J Sports Med 2003, 37: 67-71.

8. Schmitt H, Friebe C, Schneider S, Sabo D: Bone mineral density and degenerative changes of the lumbar spine in former elite athletes. Int J Sports Med 2005, 26: 457-463.

9. Wu HJ, Chen KT, Shee BW, Chang HC, Huang YJ, Yang RS: Effects of 24 h ultra-marathon on biochemical and hematological parameters. World J Gastroenterol 2004, 10: 2711-2714.

10. Lippi G, Schena F, Montagnana M, Salvagno GL, Banfi G, Guidi GC: Significant variation of traditional markers of liver injury after a half-marathon run. Eur J Intern Med 2011, 22: e36-e38.

11. Skenderi KP, Kavouras SA, Anastasiou CA, Yiannakouris N, Matalas AL: Exertional Rhabdomyolysis during a 246-km continuous running race. Med Sci Sports Exerc 2006, 38: 1054-1057.

12. Warhol MJ, Siegel AJ, Evans WJ, Silverman LM: Skeletal muscle injury and repair in marathon runners after competition. Am J Pathol 1985, 118: 331-339.

13. Wagner KH, Reichhold S, Neubauer O: Impact of endurance and ultraendurance exercise on DNA damage. Ann N Y Acad Sci 2011, 1229: 115-123.

14. Niess AM, Baumann M, Roecker K, Horstmann T, Mayer F, Dickhuth HH: Effects of intensive endurance exercise on DNA damage in leucocytes. J Sports Med Phys Fitness 1998, 38: 111-115.

15. Rae DE, Vignaud A, Butler-Browne GS, Thornell LE, Sinclair-Smith C, Derman EW, Lambert MI, Collins M: Skeletal muscle telomere length in healthy, experienced, endurance runners. Eur J Appl Physiol 2010, 109: 323-330.

16. Collins M, Renault V, Grobler LA, St Clair GA, Lambert MI, Wayne DE, Butler-Browne GS, Noakes TD, Mouly V: Athletes with exercise-associated fatigue have abnormally short muscle DNA telomeres. Med Sci Sports Exerc 2003, 35: 1524-1528.

17. Ludlow AT, Zimmerman JB, Witkowski S, Hearn JW, Hatfield BD, Roth SM: Relationship between physical activity level, telomere length, and telomerase activity. Med Sci Sports Exerc 2008, 40: 1764-1771.

18. Whyte GP, George K, Sharma S, Lumley S, Gates P, Prasad K, McKenna WJ: Cardiac fatigue following prolonged endurance exercise of differing distances. Med Sci Sports Exerc 2000, 32: 1067-1072.

19. Dawson EA, Whyte GP, Black MA, Jones H, Hopkins N, Oxborough D, Gaze D, Shave RE, Wilson M, George KP, Green DJ: Changes in vascular and cardiac function after prolonged strenuous exercise in humans. J Appl Physiol 2008, 105: 1562-1568.

20. Nie J, George KP, Tong TK, Gaze D, Tian Y, Lin H, Shi Q: The influence of a half-marathon race upon cardiac troponin T release in adolescent runners. Curr Med Chem 2011, 18: 3452-3456.

21. Jassal DS, Moffat D, Krahn J, Ahmadie R, Fang T, Eschun G, Sharma S: Cardiac injury markers in non-elite marathon runners. Int J Sports Med 2009, 30: 75-79.

22. Whyte GP: Clinical significance of cardiac damage and changes in function after exercise. Med Sci Sports Exerc 2008, 40: 1416-1423.

23. Fagerhol MK, Nielsen HG, Vetlesen A, Sandvik K, Lyberg T: Increase in plasma calprotectin during long-distance running. Scand J Clin Lab Invest 2005, 65: 211-220.

24. Neviackas JA, Bauer JH: Renal function abnormalities induced by marathon running. South Med J 1981, 74: 1457-1460.

25. Hasselblatt M, Mooren FC, von Ahsen N, Keyvani K, Fromme A, Schwarze-Eicker K, Senner V, Paulus W: Serum S100beta increases in marathon runners reflect extracranial release rather than glial damage. Neurology 2004, 62: 1634-1636.

I see naked people

A little while back I wrote a post entitled “Feet on ground.” It was meant as a reminder, mostly to myself, about not getting caught by the paleo hype, if such a hype exists.

My experience and observations of the people around me, is that many (by this I mean more than one would think, but it’s not a great number) people who live non-paleo lives, who eat lots of grains and low fat products, still seem perfectly fine.

As some commenters suggested, this might be just an illusion. The effects of far from optimal diets become increasingly pronounced with increasing age. However, I must still admit that there are several people I know, that surprises me with regards to their health, even old people.

Admittedly, Norway is far from being the worst when it comes to diet and health. We are in general grain based, but we are still far from USA or UK, where things are truly bad.

But, I’m rambling. What I wanted to say, was that I’ve found a very subjective and entertaining way of getting a feel of how deteriorating a modern western lifestyle can be. This thought experiment can be done anywhere, but it might be easiest where people wear little clothes.

When in a place where there are lots of ordinary people (non paleo people) try to remember all those nature shows (best are from BBC and Human Planet is highly recommended, oh and David Attenborough rules) where you’ve seen human tribes living traditional lives.

The slender yet muscular fit looking people – of the type that climbs high trees and goes through much pain just for some honey, or that hunt lions on foot with a wooden spear – that likely come to mind, are likely nude or at least severely underdressed for a tea party, unless you are thinking of Inuit, Lapps or someone similar.

Now, look around, and imagine all the people around you similarly naked and in the bush or on the savannah. If the thought of these people in such a situation seem like some horrible joke of evolution, then we have reason to worry about our general health.

Without seeming like some pervert, I actually think there are things to learn from these thought experiments. Mostly what I keep feeling is not that we are particularly fat (in Norway), but what strikes me, is how little muscular and fit people seem. This is more pronounced from middle age and up. Most of the lean people are either strikingly skinny and unhealthy looking, or lean in the female-westerner-with-high-body-fat-percentage-unable- to-do-a-single-push-up sort of way.

Too much fat, and too little muscle

The lack of visual muscular fitness, often combined with poor body posture, surprises me more than the overweight.

Well, in other news, yet another study finds that overweigh people have higher life expectancy than their lean counterparts, albeit with greater risk of disabilities. Perhaps our focus should be on natural foods and exercise, rather than on the significance of some extra padding. (study here)

Feet on ground

When loading regular non paleo hot dogs, which besides meat were stuffed with nitrates, glucose, starches and all things horrible, I experienced a fleeting moment of guilt. I should be eating some real food. Like some grass fed beef and butter soaked veggies.

But then I started thinking about all the people in the world who continually eat corns, vegetable oils, legumes, sugars, toxic additives and so on who live long lives and who most of the time do not appear very sick.

Reading paleo health literature you might get the impression that everyone who bases their diet on the things we learn should be avoided would simply fall apart, rot from the inside out and become inflamed to the point of combustion.

But they don’t. There are people all around me living on what I would call a crappy diet, and they are fine. Sure some infections and pains could probably be avoided and perhaps they could feel just a little better, but that’s not the point. The point is that they’re fine. Most people around me are grain based. Athletes and sedentary alike on low fat, high fructose, high corn diets, and their doing fine most of the time.

I know we are sick animals, us industrialized humans. Most of us probably do not know what it feels like to be in good health most of the time. But knowing what I do about nutrition and the effects of food on the body I am surprised at how little I or any other paleo(ish) stand out. Where are the superpowers? Why aren’t we more different?

Even considering that most people are sick most of the time or that we are only beginning to see the ill effects of the way we live, I have to admit to myself, that the difference between those living on healthy diets and people living on diets composed of the thing I shun, are not as big as I might be inclined to think.

I am not trying to, nor do I want to downplay the effects of healthy diets. Diet matters and it matters more to those dealt the worst genetic cards.

I just realized that this perspective was missing in my mind and that it should be there to keep me from getting airborne. To keep my feet on the ground, as I am constantly fighting an urge to be carried away and at the same time I’m truly baffled by the results some achieve by lifestyle changes.

Just a thought…

Come on guys, you’re smarter than this

Just because a wording, written or spoken is simplified to better communicate the message at hand, it does not mean we should think simple thoughts.

When I tell my pupils that sugar makes us fat (the word fat can be replaced by sick with no consequences for the argument), they look at their bottle of coke, then down at their skinny teenager body and say, “Oh yeah! I drink a lot of soda, but I’m not fat”

I can excuse and understand the response because I know a 14 year old has too little experience in logic thought. They are on a constant pubertal high and struggles to imagine consequences beyond those of tomorrow. And they are always out to get you and prove you wrong.

Patiently, I can explain to the teenager that “…all that sugar is going to make you fat, but not instantly. Not now, but in time.” “Sugar make us fat,” does not mean “Taste sugar and expand immediately.”

I find it more difficult to excuse the adult population who has a longer track record in being exposed to logic and who are consistently being reminded of the complexities of life.

Life gets more complicated after puberty. Black and white turn into shades of grey. Not because life itself changes, but because we gradually see the complexities. Fortunately, life also gets less confusing with age, but that’s a different matter.

The Twinkie professor is losing weight while eating junk. Does this prove that junk food is not to blame for obesity and lifestyle disease? No, of course not. You are smarter than that.

– Sugar may cause diabetes.
– But many people eat high sugar diets, and do not get diabetic…
– So?

Sugar still causes diabetes. Stop thinking in absolutes. You can be smarter than that. Never mind the fact that I said “may”. We are complex organisms. Our genes differ in type and expression. We live in different environments and we feel different feelings. When too many factors coincide, sugar causes diabetes. I did not say always.

Eating a low carb diet will make most overweight people lose weight. The fact that your friend heard of a person not losing weight on a low carb diet, does not mean carbohydrate restriction is not an effective weight loss tool. Stop for a while and think. You should be smarter than that.

– Overweight may be caused by a too large intake of carbohydrates.
– But what about all those skinny Asians on a high rice diet?
– What about them?

Carbohydrates may still cause overweight and may still be the single most important factor in developing overweight. We are complex beings in a complex world. When too many factors coincide, carbohydrates will make you fat. An insufficient amount of factors have coincided in the people you are referring to. Stop thinking in absolutes. Be smarter than that.

– Grains make us sick.
– But most people here eat lots of grains and many are not sick.
– So?

Most people do not know how great they can feel, how good their heath can be. Just because you don’t consider yourself sick, does not mean your health couldn’t be much better.

Your recurring headaches, your stiff joints in the morning, your inability to concentrate, falling asleep on the couch when you get home from work, your mood swings and all the rest of those small symptoms you notice every day, but never consider to be anything but the normal state, are all signs of something being wrong. It is possible to feel great most of the time. You just haven’t experienced it yet or have forgotten Grains may be to blame for the fact that we no longer know how good we can feel as humans.

The black swan disproves the hypothesis claiming all swans to be white. Or so we are told. But the one fat person eating a low carb diet does not prove that carbohydrate restriction is not a very effective weight loss tool. It proves nothing. Stop thinking in absolutes. You need to be smarter than this.

Poppers swan example is perhaps not the best example for everyday use. If you knew there were no black swans yet encountered one during your walk by the water, you’d look for the punk with the spray can.

If most data indicate easily digestible carbohydrates as the primary cause of overweight and you see people that over time live on diets high in easily digestible carbs, yet remain lean, look for the punk with the spray can. Look for the confounding factors. There are many. The hypothesis remains.

The most horrible examples of a juvenile mind stuck in a body that has been pushed through a scientific education are found in the riders of the thermodynamic approach to weight management – those claiming overweight is caused by a too high energy intake. Those that tell you to count your calories and to calculate your energy expenditure despite the fact that they themselves have never bothered about energy in or out yet still stay perfectly thin.

In these people, the bell that should have gone off in the back of the mind is malfunctioning. Perhaps because of a lack of animal products in the diet. Perhaps because of the grains. No matter the cause, the result is an inability to see the gargantuan crack in their own wall of logic.

Stop thinking like a teenager. You have to be smarter than that.

The Twinkie professor has proven nothing and no headline has ever given you all the information you need to refute a theory.

Smoking causes lung cancer. The observation that your grandmother smoked all her life without getting cancer and dying of old age at 100 years, is not refutation material.

Jumping out of a plane without a parachute will kill you. There might have been people who have survived even this, but jumping out of a plane without a parachute will kill you. Just as grains make you sick and smoking gives you lung cancer.

The troublesome issue at hand is largely rhetoric in nature. Our constant efforts at trying to be skeptic, open minded and to prove others wrong result in alarmingly silly discussions. If each and every utterance should consider all related and relevant factors, our language will no longer be suited for communication.

“Carbohydrates may make you fat” is a better wording than, “carbohydrates may, in time, if ingested in high insulin raising form, and if ingested in the face of full glycogen stores, especially if ingested in a low nutritious form such as corns or in combination with a high omega 6 diet, and if ingested in periods of stress and in an individual whose genes make him or her susceptible to endoplasmatic reticulum stress and insulin resistance, make you fat.”

The first wording is no less correct because of its inferior word count and the sentence does not mean carbohydrates will always and under any circumstance inflate you beyond recognition upon touching your tongue. The second wording elaborates and describes very normal circumstances.

The first wording is not an absolute and if you consider it so, it is because you think in absolutes. Stop doing that. It only makes things worse.

Remember, media wants you to think in absolutes. A story considering all the factors will only appeal to the scientist and will not appear in your newspaper. This will confuse you, as the media will through using absolutes constantly contradict itself. One day carbs are good, the next day they will kill you. Stop and think. For the sake of sound minds everywhere, you must be smarter than this.

Enough is better than too much – the only dietary guidelines you’ll ever need.

Now that I’ve gotten your attention with an overly bold title I will still be so bold as to introduce the draft of my very own dietary guidelines.

The American Dietary Guidelines Advisory Committee (DGAC) has recently produced a draft for the new American dietary guidelines. The Norwegian government has been doing the same here at home. Both in the US as in Norway the guidelines are greatly criticized, most recently and publicly in this article by Hite and colleagues in the journal Nutrition.

I sent a mail with the article to the big chief working on the Norwegian guidelines. I got a «thank you», but I doubt it’ll make a big impact.

The draft for the new Norwegian guidelines is a 370 page document consisting of close to 140000 words. It’s a tome and although it is great fiction I doubt very many will have the stamina to read it in its entirety.

As I feel the new guidelines are not fit to wipe my ever whitening bottom, I decided to make my own guidelines.

They are, I claim, far more likely to reflect the truth and a far better choice if health is your concern. And best of all, my guidelines are only 360 words.

Nutritional guidelines should of course be temporary and modified in accordance with the development of scientifically produced knowledge. I would thus be grateful for any suggestions or additions that might contribute towards improving my guidelines.

It is of course of importance that the dietary guidelines are for the general public. Because of its audience the guidelines must be easily understandable and easy to follow in everyday life. No general guidelines like the official or those presented here should attempt to cover all aspects of health and all eventualities. We still need professionals to address individual health.

The guidelines

1. Relax
Don’t worry. Don’t worry about details, not even those pertaining to diet and lifestyle. If you focus too much on the details, your health will suffer and would indeed be better off with you not worrying about the details.

This is not strictly a dietary advice, but it’s too bloody important to leave out.

2. Eat like humans are built to eat
Science tells us that humans can thrive with good health on quite a lot of different diets, but the diets which accompany good health have a few but important things in common. Here are the main aspects of a healthy diet:

Don’t eat too much grain

Grains or products made of grains should only be a small part of the diet, and wheat should probably be avoided all together.

Eat unprocessed foods

Most of the diet should be unprocessed foods; eat all sorts of animal and vegetable products but try to get most of it in unprocessed form. Now, processed is in itself not bad. Cheese is a processed food, but still a very fine food. While a sausage may be fine a steak is probably better in the long run. Processed foods that should be especially avoided are those with added sugars and starch, deep fried foods and those with added vegetable oils.

Eat fat

Eat plenty of fats but avoid plant oils rich in omega 6. Eat animal fats. Eat butter, not margarines.

Don’t eat sweet

Keep a low intake of added sweeteners in any form, natural and artificial. Sugars should be avoided most of the time.

3. Some of us need a little extra

If your body show symptoms of carbohydrate intolerance usually symptoms like weight gain and blood sugar fluctuations you should probably also reduce the total amount of carbohydrates in the diet.

Dietary supplements can make things even better. Extra vitamin D and long chain omega 3 fatty acids may benefit many of us. If you are an athlete, under lot of stress or in any other way are subject to stress physical or mental, supplements are more important and should be addressed by someone who knows what they’re talking about.

There it is. Nutritional guidelines as three main advises and four distinct and concrete dietary guidelines all adding up to 360 words. Suggestions will be considered and may appear in the final version.

A nutrition paradox

By denying scientific principles, one may maintain any paradox.

Galileo Galilei

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If an overweight person wishes to slim down, the most effective way of doing so is undeniably to live on a diet consisting mainly of fat and protein, even without concern for energy intake. The logic is simple. The two factors mostly in charge of fat cell hypertrophy, glucose and insulin, are mainly influenced by dietary carbohydrates. Scientific data support this.

The very same diet is according to an ever increasing pile of high quality scientific data one of the healthiest diets we know of. This way of eating has been tested repeatedly and the grand total of our knowledge show us that this is in fact the diet which with the greatest probability is the most effective we know of for weight loss and health improvement in general.

This rather unpleasant fact is by some perceived as a paradox; that the very food we have been warned about for half a century because it makes us fat proves best at reducing weight. But is the observation that the main constituent of our diet has to be the most energy dense nutrient, if we wish to reduce our weight and stay slim, really a paradox?

The American paradox describes the current situation in the USA where both average energy intake and fat intake seems to have been declining during the very same time period where weight and waistlines have increased.

There are many similar nutritional paradoxes like the American paradox. The French paradox is the observation that the French suffer a low incidence of coronary heart disease, despite having a diet relatively rich in saturated fats. Hyperlipid muses about these and other paradoxes here.

Professor of philosophy, Mark Sainsbury understands the paradox as,

…an apparently unacceptable conclusion derived by apparently acceptable reasoning from apparently acceptable premises.

One of the best known paradoxes is the liar paradox. One version goes like this:

“What I am now saying is false.”

Is what he’s saying true or false? The problem is that if he is speaking the truth, then what he is saying truly is false, thus he is lying. But if he’s lying then what he is saying is the truth and so we continue going round and round.

Real paradoxes are rare, they are more linguistic peculiarities, and there are no real paradoxes in the natural sciences. Although the famous thought experiment of Schrödinger’s cat is often described as a paradox, it is nothing but a thought experiment. In the real world we would just open the damn box and declare the cat either dead or alive.

A real logical paradox does not exist in natural science because the paradox requires two conflicting statements to both be true at the same time. Fat for example will not make us both fat and lean. Either fat cause overweight or it doesn’t. If the hypothesis claims that eating fat make us fat, yet scientific data show us otherwise, then it means the hypothesis is wrong. There is no need to go crying paradox.

The apparently unacceptable conclusion has not been derived from acceptable reasoning or acceptable premises. The conclusion that fat make us fat is unacceptable.

The scientific data supporting a claim that increasing fat intake cause decreasing weight are many and not easily discarded. Despite of this, the hypothesis claiming fat makes us fat is maintained despite its all too apparent inability to explain the current observations. In order to keep the hypothesis, a paradox is created. By crying paradox we relieve our self from the difficult task of discarding our dear hypothesis and at the same time we gracefully avoid the creation of new knowledge and scientific progress.

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In order for a hypothesis to be viable it has to be able to sufficiently explain the current observations. The hypothesis seeking to explain overweight through excess energy consumption mainly from fat cannot sufficiently explain the current observations and is therefore wrong. It has to be discarded.

Similarly, the hypothesis trying to explain overweight through lack of energy expended during physical activity also does not sufficiently explain the observations and must be discarded. Sainsbury puts it like this:

… generally we have a choice: either the conclusion is not really acceptable, or else the starting point, or the reasoning, has some non-obvious flaw.

What is so great about encountering paradoxes in natural sciences is that they simply do not exist. So when we’re faced with one we know our hypothesis must be modified or discarded. The scientific paradox offers a mental cold shower, but at the same time it gives us the opportunity to take one step closer to the truth.

In the world of health and nutrition science there are many more or less well known paradoxes all based on apparently acceptable reasoning from apparently acceptable premises, but which in reality are nothing but obvious facts concealed by at best poor and at worse completely false hypotheses.

Bad hypothesis example: The dog did it. Image from Istockphoto

Poor people and people with low social status seem to be more overweight than richer people in the same country or region. This means that the people with the least money and more often physical laborious work are the fattest. These findings do not go well with the hypothesis explaining overweight as a disease caused by the abundance of modern society.

In The Journal of the Norwegian Medical Association, Per Ole Iversen writes about the situation in South Africa where paradoxically one often observe undernourished children with overweigh mothers. This seems a common observation in poor and malnourished populations. Benjamin Caballero wrote in “A nutrition Paradox – Underweight and Obesity in Developing Countries”,

A few years ago, I was visiting a primary care clinic in the slums of São Paulo. The waiting room was full of mothers with thin, stunted young children, exhibiting the typical signs of chronic undernutrition. Their appearance, sadly, would surprise few who visit poor urban areas in the developing world.

He continues:

What might come as a surprise is that many of the mothers holding those undernourished infants were themselves overweight.

This is not a new observation although Caballero seems to think so, but he is right in that:

The coexistence of underweight and overweight poses a challenge to public health programs, since the aims of programs to reduce undernutrition are obviously in conflict with those for obesity prevention.

Caballero’s got an important point. Because if you accept the hypothesis claiming overweight is caused by high energy intake you also have to accept the implied notion, that these mothers are willing to watch their children starve for lack of food while they eat themselves fat.

By denying basic scientific principles, one takes part in the upholding of paradoxes. Paradoxes that hinder scientific progress and that in the case of overweight and obesity contribute to feelings of failure and disappointment when what people are told is the right way to loose weight just does not work.