Finding Nutrition

Adi was suffering.  The chemotherapy inflicted heavy damage on her body, and looming, unspoken, was the threat of recurrence.  I had no way to help.  Seeking answers, I dove into the Sea of Nutrition Science.  The sea was murky and its treasures were hard to find.  I emerged after four months, not with shiny pearls, but with nutritious oysters, rich with food for thought.  The sea is murky because nutrition science is vague.  Experiments are mostly conducted on animals, and human studies are largely observational.  They can demonstrate correlation but do not prove causation.  The few randomized, controlled experiments are small, and leave a lot of room for doubt.  Despite, and perhaps because of, this vagueness, there are many nutrition philosophies patrolling these depths, all claiming to be king of the sea.  Hence this oyster, which took me a long time to find and gather.

• Be a skeptic.  A nutritional philosophy is an opinion, not science.

In Oncology Bay, I learned that cancer cells can utilize only glucose for their energy and growth.  In contrast, normal cells have many metabolic alternatives.  This weakness can be exploited to combat the disease.  To do so, Dr. Valter Longo, recommends periodic five-day fasts.  To ease the long fast, he designed a Fast Mimicking Diet (FMD), and founded Prolon, which sells the appropriate meals.  The FMD, when taken prior to a chemo cycle, alleviates the side-effects.  Unfortunately for Adi, this information came too late to be useful.  If fasting works by temporarily lowering glucose, then a short swim away, I found the Ketogenic Diet (KD), which lowers it continuously.  This diet, taken up by ultra-distance athletes and bodybuilders, offers to improve athletic performance and enhance clarity of mind.  KD strictly limits carbohydrates (the glucose-producing nutrient) to less than 10% of total calories,   The majority of the needed calories come from eating fat, which metabolizes into ketones rather than glucose.  A snack on this diet, could be butter wrapped in bacon.  Sounds horrible?   I felt the same way until I read Dr.  Peter Attia's blog. There, I learned all about cholesterol, and after being convinced that fat is not harmful, I converted to the KD, which I followed... for a while.  Although both Adi and I realized that such a drastic diet may not be right for us, we noticed that fasting was a weapon utilized by both KD and FMD.  Conveniently floating by, was the Time Restricted Diet (TRD), which formalized various fasting schedules.  The most popular scheme seemed to be a sixteen-hour fast (skip breakfast).  Another denizen of the deep, pointed to the fact that eating at night violates the body's Circadian Clock and disrupts metabolism.  We decided that although we will attempt the longer fast, we are committed to the less-demanding oyster

• Do not eat between sunset and sunrise (12 hours)

While roaming the seas, I kept in mind that diabetes could be lurking in my genes.  Diabetes is usually lumped with  other chronic diseases such as obesity, high blood pressure, cardio-vascular disease, cancer and more.  Often, a precursor to these nasties is Insulin Resistance, a condition in which both glucose and insulin levels are elevated.  If I wish to reduce my risk of diabetes, I will need to remain insulin-sensitive.  One way to do so, is to avoid  excess glucose, or in nutrition terms

• Control carbohydrate consumption

BTW, fasting also, serves this purpose.  'Control' means that the calories derived from carbohydrates should fall somewhere between 15% to 30% of the total.  This is a wide range, which I will eventually narrow.  I learned not to worry about protein, since it is regulated by our body (probably at 10% to 20%).  Fat will fill the rest of my caloric needs.  If this sounds too vague or too complicated, I have good news.  The nutritional sea is subject to changing fashions (like any science). High carb, low carb, Atkins, Paleo, and so on.  The latest fashion is that there is not one solution that fits all.  You should choose a nutrition regime that fits your genes, condition, and goals.  This is what Ofer has been trying to tell me all along, and I now accept as truth.  Not surprisingly,  there is an Israeli research group that is building a computer model to provide your individualized menu.

• Correct nutrition is a personalized nutrition.

Out of curiosity, rather than necessity, I wanted to learn about the causes of the "Obesity Epidemic"

Among the more notorious villains I found Fructose, Insulin, and Food addiction.  Heated debates are raging between the proponents of the different theories.  Stephan Guyenet's calmer blog, helped me navigate the issues.  Out of the churning waters I plucked two oysters that were not a large departure from my previous habits, and conform with my new understanding

• Do not drink any sweetened beverages
• Do not eat any processed products

We all want to optimize our nutrition, and we tend to exaggerate its impact on health.  I observed, that good nutritional habits, reduce the risk of chronic illness by only ten, or twenty, percent.  Yet exercise, appears to be as beneficial as correct nutrition, if not more so.  Across many studies, exercise erases the effect of other high risk factors.  For example, obese people who exercise, have the same risk of heart disease as normal-weight persons.  Vigorous exercise also improves insulin sensitivity by depleting the muscle's energy stores.  For the "vigorous" portion, I augmented swimming with high intensity resistance workout, described by Dr. Doug McGuff's.

• Exercise regularly and vigorously

In homage to Pareto,  I will present the last oyster

• Don't stress.  Follow the rules 80% of the time.

 Adhering to the rules for 80% of the time, will require only 20% of the will power, and leave the rest for more important tasks.  If you sin, it's OK.  Our body is anti-fragile, it can take it, and thrive.  I eat a small mountain of ice cream every Saturday.

Non-scientific References

A talk against fructose here.  A classic.

The case against insulin here

I like the way he talks, and he is also an ultra-distance swimmer.  Peter Attia on TED

Somewhat wonkish, yet interesting interviews by Dr. Rhonda Patrick 

Nutrition Science or Fiction?

Recently, I experienced a vivid flashback to a warm winter afternoon in Israel, fifty-or-so years ago.  I, a brash engineering student, in my mother-in-law's spacious kitchen, hotly debating her assertion that sugar is a poison.  As we talked, she leisurely spread a thick layer of shmaltz (clarified chicken fat) on a slice of bread.  When done with the bread, she snuck a few more bites out of the schmaltz dish, then lit a cigarette.  Along with the rest of the family, I abandoned the effort to admonish Savta (grandma) Hanka for her dangerous habits of fat consumption or smoking.  We knew the usual retort, "I will not die young!"  She was about fifty, at the time.

In the following decades, the topic of nutrition seldom rose to the forefront of my attention.  My health and weight were under control, and I had no reason to question the guidelines provided by the nutrition authorities: "Eat mainly carbohydrates, minimize fats, and avoid saturated fats"

Fast-forward to a cold winter in Seoul, 2017.  I am furiously reading all I can about nutrition.  It was Adi's illness that radically changed my interest.  I considered chemotherapy to be the medical equivalent of the US carpet-bombing in Vietnam.  I wanted to find a better way.  First, for Adi to tolerate the "treatment", and then maybe, to replace it.  When I realized that targeted cancer cures are still immature, I shifted my focus to nutrition.  I examined (or skimmed) numerous diet philosophies, ranging the alphabet from the Atkins diet, through Erkin, Ketogenic, Mediterranean, Paleolithic, and more.  Each philosophy promised to burn fat, cure diabetes, reduce the risk of cardiovascular disease, and prolong the onset of Alzheimer's.  They all had a charismatic spokesperson, an impressive research validation, and an enthusiastic group of followers.  Not surprisingly, the Internet is full of long-running squabbles between the groups, each claiming to provide the best results.  So how could they all be right?  Diversity of opinion is common in science.  Yet in this field, it seemed to be more pronounced.  However, after I understood the difficulty of conducting conclusive nutrition experiments, I was no longer surprised by the rivalry.

Warning:  The next paragraph is a somewhat technical description of research methods.  Anyone not interested, or already familiar with the topic, feel free to skip it.

Two types of research procedures are typically employed in the Life Sciences.  The more robust method is the Randomized Controlled Trial, the other is an Observational Study.  In the controlled trial, groups are randomly selected from a large population.  The random assignment ensures that they are statistically identical.  One group may receive a new drug, while the other, the "Control" receives a similar-looking pill.  Any difference between the results can be attributed to the effects of the drug.  These studies are very expensive, and in the case of nutrition, often impossible.  Instead, most nutritional research is based on observational studies of some segment of the population.  To compensate for the lack of a control group, the researchers collect all the parameters that they deem relevant.  The data is subjected to statistical analysis, searching for correlations.  However,  the fact that two parameters move together, let's say, people that consume more coffee, suffer more heart attacks, does not prove that coffee causes heart disease.   It may be that a third, unmeasured parameter, is causing both effects.  i.e.  the heavy coffee drinkers, as a group, hold the more stressful jobs.   (This point of logic, is often lost on newspaper reporters.)  Observational studies are prone to several other errors, yet the causes of most infectious diseases, as well as the link between smoking and lung cancer, were discovered that way.  In other cases, results were not so good.  Hormone replacement therapy, which was recommended based on observational studies, caused the death of many women.  The difference is that in the first examples, the effects were very large.  When the effects are small, as is the case in nutritional changes, observational studies do not provide clear conclusions.

To summarize the previous paragraph:  The majority of research papers in this field provide, at best, circumstantial evidence, not a "smoking gun".  I reviewed the claims of the various plans.  I studied the supporting research they presented, which as I read it, seemed very convincing, and then found out, with the help of the competing groups, why that research is not valid.  Eventually, I came to my first observation.

• A nutritional philosophy or plan, no matter how strongly presented, is an opinion, not a scientific finding.

Which left me wondering why, with only weak evidence, do the diet gurus speak with such enormous   certainty?   Nonetheless, I found sufficient evidence to form my own opinions, which led to the flashback I described at the beginning of this post.  I came to believe that Savta Hanka was right in two assertions,

•   Sugar is a poison (I would say "Toxic")
•   Fat will not kill you, nor will it make you fat.  (Except for synthetic trans-fats, which are bad)

She was wrong in her third assertion.

• Fifty-years-old is still young.

Savta Hanka, my apologies.

P.S.  She died after reaching ninety, and not from lung disease.