Sometimes I'm just tired of fighting the fight

Today was one of those days. A day where I didn't want to exercise, but I did anyway. A day where I was hungry all day, and I felt like a bottomless pit. I just wanted to eat all day, but I didn't.

Today was one of those days where I wanted to lay down my sword and give up the good fight.

I don't get these days too often anymore, but they still happen. When they happen I have to remind myself why I'm doing this, why I'm in a constant state of being on guard, why I've accepted it's okay to be hungry sometimes. I have to remind myself why I can't always give in to my desires to eat until I feel full, and that I have to exercise. It's not optional. This is now my life.

There are many reasons I don't give up on myself. Number one is my self-confidence and self-esteem issues. I remember the sad 51-year old woman that weighed 240 pounds in February of 2008.  I remember how much I hated myself for letting my body get in such bad shape. I've never felt uglier or sicker than I did at 240 pounds. Considering I've always had a very bad self-image, that's saying a lot.

I remember the one pair of size 20 black slacks I owned, that I wore every single day. I remember the ugly size 3X tops, designed for someone much older than I felt in my heart. My body felt every day of 51 years, but in my heart, I still felt like I was in my twenties. During that time I couldn't imagine going on in life and reaching old age, not feeling and looking like I did.

My health was a wreck in Feburary 2008. Everything hurt. My blood pressure was 180/110. I was a heart attack or stroke waiting to happen. My knees and ankles were in agony. Just walking at a slow pace on a level surface caused intense pain in my chest, knees and ankles.

I had difficulty breathing. I didn't exercise. I thought I couldn't exercise without killing myself. Just walking from the parking lot at work in to my office, I often thought I was going to have a heart attack.

My marriage was in serious trouble, mainly because of my low self-esteem. If you hate yourself how can you believe anyone else can love you? You can't, it's simply not possible. I assumed my husband was as disgusted and disappointed in me as I was in myself. It was a recipe for a very toxic relationship.

In a word, I was MISERABLE on every level.

When days like today happen, when I'm really not feeling it, when the desire to track my Points and stay within my limit doesn't feel within my grasp, and when I don't feel like exercising, I have to remind myself how far I've come in the last 2 1/2 years. Even though I'm not at goal yet, I've come a long way.

Seventy-five pounds off my body has made a world of difference in how I view myself, my marriage, and my world. I don't hate myself anymore. I'm not disgusted by myself. I expect my husband to be proud of me. Yes, me. Just as I am now. I'm in the best physical condition of my entire life. My resting pulse is 49, my blood pressure is 120/60 (no medicines), and my cholesterol and triglycerides are below normal (137 and 68). I wear a size 10.

I've worked hard to get here. I refuse to let a bad day screw with me. I'll never go back to the person I was when I started this process. I simply can't imagine that will ever happen, regardless of how much I like food, I like myself better.

Anyone who has followed me for any length of time knows I've had slip-ups with my food. I even re-gained 25 pounds last fall. I was sure I was on my way back to 240 pounds plus the obligatory regain of an additional ten pounds. Somehow this time I found the strength within myself to fight back. I picked up my sword and went back to battle, losing 17 of the 25 pounds (so far). I'm going to keep waging the battle until I get to goal and maintenance for life.

I'm not giving up the fight. Not today. Not tomorrow. Not ever.

Book Review: Dangerous Grains

Dangerous Grains is about the health hazards of gluten grains. It's co-written by James Braly, an M.D. who specializes in food allergies, and Ron Hoggan, a celiac patient who has written widely on the subject.

Celiac disease is a degeneration of the intestinal lining caused by exposure to gluten. Gluten sensitivity is a broader term that encompasses any of the numerous symptoms that can occur throughout the body when susceptible people eat gluten. The term gluten sensitivity includes celiac disease. Gluten is a protein found in wheat, its close relatives (kamut, spelt, triticale), barley and rye. Wheat is the most concentrated source.

Dangerous Grains is a good overview of the mountain of data on celiac disease and gluten sensitivity that few people outside the field are familiar with. For example, did you know:

• An estimated one percent of the U.S. population suffers from celiac disease.
• Approximately 12 percent of the US population suffers from gluten sensitivity.
• Gluten can damage nearly any part of the body, including the brain, the digestive tract, the skin and the pancreas. Sometimes gastrointestinal symptoms are absent.
  
• Both celiac and other forms of gluten sensitivity increase the risk of a large number of diseases, such as type 1 diabetes and cancer, often dramatically.
• The majority of people with gluten sensitivity are not diagnosed.
• Most doctors don't realize how common gluten sensitivity is, so they rarely test for it.
  
• Celiac disease and other symptoms of gluten sensitivity are easily reversed by avoiding gluten.

Twelve percent of Americans have gluten sensitivity! That's an enormous disease burden coming from a single type of food. I suspect the true incidence may actually be higher. There are preliminary data suggesting that most people may mount an immune response to gluten that does not require antibodies (through the innate immune system). This type of gluten sensitivity would be overlooked by the typical antibody tests, but could still result in damage.

Dangerous Grains also discusses the opioid-like peptides released from gluten during digestion. Opioids are powerful drugs, such as heroin and morphine, that were originally derived from the poppy seed pod. They are strong suppressors of the immune system and quite addictive. There are no data that conclusively prove the opioid-like peptides in gluten cause immune suppression or addiction to wheat, but there are some interesting coincidences and anecdotes. Celiac patients are at an increased risk of cancer, particularly digestive tract cancer, which suggests that the immune system is compromised. Heroin addicts are also at increased risk of cancer. Furthermore, celiac patients often suffer from abnormal food cravings. From my reading, I believe that wheat causes excessive eating, perhaps through a drug-like mechanism, and many people report withdrawal-like symptoms and cravings after eliminating wheat.

I know several people who have benefited greatly from removing gluten from their diets. Anyone who has digestive problems, from gas to acid reflux, or any other mysterious health problem, owes it to themselves to try a gluten-free diet for a month. Gluten consumption has increased quite a bit in the U.S. in the last 30 years, mostly due to an increase in the consumption of processed wheat snacks. I believe it's partly to blame for our declining health. Wheat has more gluten than any other grain. Avoiding wheat and all its derivatives is a keystone of my health philosophy.

Another notable change that Sally Fallon and others have pointed out is that today's bread isn't made the same way our grandparents made it. Quick-rise yeast allows bread to be fermented for as little as 3 hours, whereas it was formerly fermented for 8 hours or more. This allowed the gluten to be partially broken down by the microorganisms in the dough. Some gluten-sensitive people report that they can eat well-fermented sourdough wheat bread without symptoms. I think these ideas are plausible, but they remain anecdotes to me at this point. Until research shows that gluten-sensitive people can do well eating sourdough wheat bread in the long term, I'll be avoiding it. I have no reason to believe I'm gluten sensitive myself, but through my reading I've been convinced that wheat, at least how we eat it today, is probably not healthy for anyone.

I'm not aware of any truly healthy traditional culture that eats wheat as a staple. As a matter of fact, white wheat flour has left a trail of destruction around the globe wherever it has gone. Polished rice does not have such a destructive effect, so it's not simply the fact that it's a refined carbohydrate. Hundreds, if not thousands of cultures throughout the world have lost their robust good health upon abandoning their traditional foods in favor of white flour and sugar. The medical and anthropological literature are peppered with these stories. I'm aware of one healthy culture that traditionally ate sourdough-fermented whole grain rye bread, the Swiss villagers of the Loetschental valley described in Nutrition and Physical Degeneration.

Overall, the book is well written and accessible to a broad audience. I recommend it to anyone who has health problems or who is healthy and wants to stay that way!

Water And Weight Loss

Water helps to lose weight.
The liver's job is to convert the stored fat into energy, this metabolism of fat is directly influenced by the amount of water you drink. It directly affects your body fat and weight loss.

The liver also acts as a backup for the kidney, which needs plenty of water to work properly.The kidneys cannot function properly without enough water. When kidneys do not work to full capacity, some of their load is shifted on the liver. But if the liver has to do some of the kidney's work, it cannot do its job. It then can't metabolize fat quickly or efficiently so weight loss slows down.

So drinking water is important for losing weight. Water suppresses the appetite naturally and helps the body metabolize stored fat. Decrease in water intake will cause fat deposits to increase and an increase in water intake can actually reduce fat deposits.

Saturated Fat and Health: a Brief Literature Review, Part II

I'm aware of twelve major controlled trials designed to evaluate the relationship between saturated fat and risk of death, without changing other variables at the same time (e.g., increased vegetable intake, omega-3 fats, exercise, etc.). Here is a summary of the results:

• Two trials found that replacing saturated animal fat with polyunsaturated vegetable fat decreased total mortality.
• Two trials found that replacing saturated animal fat with polyunsaturated vegetable fat increased total mortality.
• Eight trials found that reducing saturated fat had no effect on total mortality.

Of the two trials that found a benefit of saturated fat reduction, neither was properly controlled. The first was conducted in Sweden and published in 1965. The intervention group reduced saturated animal fat and increased polyunsaturated vegetable fat. The control group was significantly older than the intervention group, confounding the results. In addition, physicians regularly monitored the intervention group while the control group went off their radar, thus the intervention group was getting better care. This is the definition of an improperly controlled trial.

The second study to "support" the idea that saturated fat increases total mortality was the Finnish mental hospitals trial. In this trial, two mental hospitals in different towns fed their patients different diets and monitored their health. One diet was low in animal fat and high in polyunsaturated vegetable fat, while the other was higher in saturated fat. Patients eating the polyunsaturated diet had a greatly reduced death rate, mostly due to a reduction in heart attacks. The study design was pitiful. They included all patients in their analysis, even those who stayed at the hospital for only one month or who checked in and out repeatedly. Furthermore, they used a "crossover" design where the hospitals switched diets halfway through the study. This was designed to control for location, but it means we don't know whether the increase in deaths after switching to the control diet was due to the saturated fat or the vegetable oil diet that preceded it for 6 years! The only reason I included this poor study in my list is that it's commonly cited as evidence against saturated fat.

The first study to show an increase in deaths from replacing saturated animal fat with polyunsaturated vegetable fat was the tragically named Anti-Coronary Club study. After four years, despite lowering their cholesterol substantially, the intervention group saw more than twice the number of deaths as the control group. Amazingly, rather than emphasizing the increased mortality, the study authors instead focused on the cholesterol reduction. This study was not properly controlled, but if anything, that should have biased it in favor of the intervention group.

The second study to show an increase in deaths from replacing saturated animal fats with polyunsaturated vegetable fats was the Sydney Diet-Heart study. This was one of the larger, longer, better-conducted trials. After five years, the intervention group saw about 50% more deaths than the control group.

I should also mention that one of the studies in the "no effect" category actually saw more than a four-fold increase in deaths after replacing saturated fat with corn oil, but somehow the result didn't achieve statistical significance (the paper states that p= 0.05-0.1, whatever that means). It may have simply been due to the small size of the study.

Overall, the data from controlled trials are clear: replacing animal fat with vegetable oil does not reduce your risk of dying! The same is true of reducing total fat. The main counterpoint to this conclusion is that the trials may have been too short to pick up the effect of saturated fat. However, two years was enough time to detect the effect of fish oil on death in the DART trial, and the trials I'm writing about lasted up to 8 years (not including the Finnish mental hospital trial or the Swedish one). There's also the fact that the greatest consumers of saturated fat in the world eat it for their entire lives and don't seem to suffer from it. Proponents of the theory that saturated fat is unhealthy have the burden of proof on their shoulders, and the data have failed to deliver.

Most trials of this nature are designed with cardiovascular outcomes in mind. Out of the twelve studies mentioned above, nine measured coronary heart disease mortality.

• Two found it was reduced when saturated fat was replaced with polyunsaturated vegetable fat.
• One found that is was increased when saturated fat was replaced with polyunsaturated vegetable fat.
• Six found no effect.

Of the two that found an effect, the first was the Finnish mental hospital study. See above. The second was the L.A. Veterans Administration study, which was actually a good, eight-year study. However, it's worth noting three things about it: first, there were significantly more heavy smokers in the control group; second, overall mortality was the same in both groups, partly because of an increased cancer risk in the diet group; and third, it's the only well-conducted study of its kind to find such a result.

The study to find an increase in cardiovascular deaths was again the unfortunately-named Anti-Coronary Club trial. The Sydney Diet-Heart trial did not report cardiovascular mortality, which was almost certainly increased. Also, the study mentioned above that saw a "non-significant" four-fold increase in deaths on corn oil also saw a similar increase in cardiovascular deaths. I included it in the "no effect" category.

So not only do the best data not support the idea that saturated fat increases the overall risk of death, they don't even support the idea that it causes heart disease! In fact, the body seems to prefer saturated fat to unsaturated fats in the bloodstream. Guess what your liver does with carbohydrate when you eat a low-fat diet? It turns it into saturated fat (palmitic acid) and then pumps it into your bloodstream. We have the enzymes necessary to desaturate palmitic acid, so why does the liver choose to secrete it into the blood in its saturated form? Kitavan lipoproteins contain a lot of palmitic acid, which is not found in their diet. Are their livers trying to kill them? Apparently they aren't succeeding.

Eat the fat on your steaks folks. Just like your great-grandparents did, and everyone who came before.

Saturated Fat and Health: a Brief Literature Review, Part I

Even years ago, when I watched my saturated fat intake, I always had a certain level of cognitive dissonance about it. I knew that healthy non-industrial cultures often consumed large amounts of saturated fat. For example, the Masai of East Africa, who traditionally subsist on extremely fatty milk, blood and meat, do not appear to experience heart attacks. Their electrocardiogram readings are excellent and they have the lowest level of arterial plaque during the time of their lives when they are restricted (for cultural reasons) to their three traditional foods. They get an estimated 33% of their calories from saturated animal fat.

Then there are the Pacific islanders, who often eat large amounts of highly saturated coconut. Kitavans get 17% of their calories from saturated fat (Americans get about 10% on average), yet show no trace of heart disease, stroke or overweight. The inhabitants of the island of Tokelau, who I learned about recently, eat more saturated fat than any other culture I'm aware of. They get a whopping 55% of their calories from saturated fat! Are they keeling over from heart attacks or any of the other diseases that kill people in modern societies? Apparently not. So from the very beginning, the theory faces the problem that the cultures consuming the most saturated fat on Earth have an undetectable frequency of heart attacks and other modern non-communicable diseases.

Humans have eaten saturated animal fat since our species first evolved, and historical hunter-gatherers subsisted mostly on animal foods. Our closest recent relatives, neanderthals, were practically carnivores. Thus, the burden of proof is on proponents of the theory that saturated fat is unhealthy.

There have been countless studies on the relationship between saturated fat and health. The first studies were epidemiological. Epidemiological studies involve collecting data from one or more populations and seeing if any specific factors associate with the disease in question. For example, the Framingham Heart study collected data on diet, lifestyle and mortality from various diseases and attempted to connect diseases to lifestyle factors. This type of study is useful for creating hypotheses, but it can only determine associations. For example, it can establish that smokers tend to die more often from heart disease than non-smokers, but it can't determine that smoking is actually the cause of heart disease. This is because multiple factors often travel together. For example, maybe smokers also tend to take care of themselves less in other ways, sleeping less, eating more sugar, etc.

Epidemiological data are often incorrectly used to demonstrate causality. This is a big problem, and it irritates me to no end. There's only one way to show conclusively that a diet or lifestyle factor actually causes something else: a controlled trial. In a controlled trial, researchers break participants into two groups: an intervention group and a control group. If they want to know the effect of saturated fat on health, they will advise the participants in each group to eat different amounts of saturated fat, and keep everything else the same. At the end of the trial, they can determine the effect of saturated fat on health because it was the only factor that differed between groups. In practice, reducing saturated fat also involves either increasing unsaturated fat or decreasing total fat intake, so it's not perfect.

I'm not going to review the epidemiological data because they are contradictory and they are "lesser evidence" compared to the controlled trials that have been conducted. However, I will note that Dr. Ancel Keys' major epidemiological study linking saturated fat consumption to heart disease, the "Seven Countries" study, has been thoroughly discredited due to the omission of contradictory data (read: the other 15 countries where data were available). This was the study that sparked the anti-saturated fat movement. Older epidemiological studies and those conducted internationally tend to find nonexistent or weak links between saturated fat and health problems, while more recent American studies, such as the Nurses' Health study, have sometimes found strong associations. I'll address this phenomenon in another post.

In the next post, I'll get into the meaty data: the controlled trails evaluating the effect of saturated fat on health.

Thanks to Rockies for the CC photo.

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