Tuesday, December 4, 2018

Vegetable Oils are Bad: Tucker Goodrich, Peak Human listening companion (Part 3)

Part 1 of this post (overview)

The Peak Human podcast with host Brian Sanders and guest Tucker Goodrich is my favorite health podcast episode of 2018. This podcast is about the idea that vegetable (seed) oils are at the root of the diseases of civilization (diabetes, heart disease, autoimmune disease, cancer).

Here are some notes and citations you may find helpful as you listen to the podcast.

[1:55] Tucker’s technical background as a problem solver

[2:45] Tucker had a stroke-like event at 38 (went partially blind, couldn’t talk for hours)

[3:15] Tucker had acute diverticulitis

[3:45] Despite trying to eat healthy, exercise, Tucker was progressively getting a little less healthy. Despite trying to eat healthy and even giving himself the nickname “Mr. Whole Wheat”. (This tells me that the current guidelines do matter, are harmful.) Exercise didn’t help him lose weight. Despite lots of exercise, he was still putting on about a pound a year (common thing that happens to many Americans)

[4:25] Tucker found Stephan Guyenet’s blog

[4:50] Despite being sick with it for 16 years, he cured his own chronic diarrhea in two days via diet. He had had surgery for diverticulitis. At the time of surgery, doctors didn’t even know if the surgery would help with his diarrhea. Now he feels that surgery was unnecessary.

[6:30] Tucker made connections through his own research (and in large part thanks to Guyenet’s work) that wheat intolerance is tied to chronic diarrhea.

[7:30] Diseases of civilization can’t be genetic because they set in within a single generation, and because they traveled all around the world.

[8:15] Tucker helped with book Story of the Human Body to help author Daniel Lieberman get feedback from the “ancestral health”/”paleo” community. Lieberman and other anthropologists’ research gets used to form basis of Paleo diets, but many of them do not want it to be used in that way. Goodrich unsure why. Sanders mentions that Lieberman buys into needing lots of fiber, whole grains, etc. Anyway, ancient genes don’t match current environment

[11:00] Humans evolve based on food shortages

[12:05] Diseases of civilization - started with agriculture

[12:45] Agriculture led to cavities, malocclusions, lower health, stunted height, worse bone structure, but higher population (reminds me of idea from Sapiens: agriculture great for growth/spreading of our species, horrible for individual members of our species. Harari may even have gotten the idea from reading Jared Diamond’s work.)

Dutch, just in 20th century, the tallest population on the planet, finally got back to height of Paleolithic ancestors.

Paleolithic people were probably more physically fit than our elite athletes, bigger brains, stronger bones, longer femurs.

References for bone strength, height, comparisons between Paleolithic ancestors and modern humans:
http://time.com/3869712/bone-strength-modern-man/
https://news.nationalgeographic.com/2017/11/prehistoric-women-manual-labor-stronger-athletes-science/
https://www.marksdailyapple.com/the-connection-between-height-and-health/

Jared Diamond article on agriculture: The Worst Mistake in the History of the Human Race

[14:45] Agricultural people also began to get diseases of civilization (but very rarely)

[15:00] Cancer, heart disease, diabetes used to be very rare until the 19th and 20th centuries.
These are all new diseases as new eating pattern has traveled around the world.
Goodrich mentions the Joslin Diabetes Center. At the start of Joslin’s career, diabetes was rare, and it was a certain death sentence. Dr. Elliott P. Joslin started to treat it in late 1800s but it was very rare. He treated it with prescriptions of strict calorie-restricted diet (borderline starvation) and exercise. Then after discovery of insulin, he incorporated that too. See more here

Side note: from the CDC’s numbers, diabetes went from being diagnosed in less than 1% of the U.S. population in 1958, to 7.4% in 2015).

Joslin found 172 cases of diabetes over 60 years in the Massachusetts Hospital (as found in the Boston Medical and Surgical Journal, Volume 139, page 179, it is actually 172 over an even longer timeframe: 74 years). That shows that diabetes was very rare.

[16:00] Tucker references Otto Warburg’s work on cancer (I’ve briefly written about this in a review of the book Tripping Over the Truth). Warburg found that cancer is primarily a metabolic disease. Hitler let Otto Warburg, a Jewish person, stay in Germany because he was so concerned about cancer.

[16:45] From 1920 to 1955, heart disease in England went up by 70-fold. Tucker has discussed this on Twitter here and here. The validity of the increase being “seventy-fold” is debated, but it is clear that, regardless, there is a major increase in heart disease during this timeframe.

[17:00] Tucker applies his RTFM (Read the Flipping Manual) problem solving approach to the cause of the diseases of civilization:
  • Diseases of civilization are not genetic because they set in within a single generation, and because they traveled all around the world.
  • Diseases of civilization are not primarily caused by pollution because even people on islands get very obese, and they get these diseases.
  • Diseases of civilization are not caused by lack of exercise because many industrialized people exercise just as much as hunter gatherers (There is conflicting data on this. But there is some data to indicate that industrial peoples expend the same amount of energy per day as hunter gatherers. Found here and here. For counter-balance, here is an article indicating that hunter gatherers expended 800-1200 more calories per day than modern sedentary folks. Regardless of whether hunter-gatherers exercised more or not, whether their bodies adapt and expend the same amount of energy or not, I agree with Goodrich’s point that it is not exercise. I think Weston A. Price’s work (which I’ve discussed here and here) showing the changes within a single generation show this. Goodrich and Sanders go on to discuss Price’s work at the 18:55 mark.)
So if it’s not genes, exercise, pollution, environment. . . what’s new? Diet. Something new in food in last 150 years. Diseases of civilization become prevalent when Western food spreads to new groups (including in other species: dogs, cats, monkeys, rats, racoons we feed, etc. If humans feed them, they start getting diabetes, obesity, heart disease. Ahem. There is a website named https://usa.petdiabetesmonth.com/)

[18:55] Brian and Tucker bring up Weston A Price’s work. All over the world, when Western foods were adopted, diseases of civilization came with them. It happened in a single generation. Parents had perfect teeth, children had cavities and malocclusions, bad teeth (among many other new health problems). This even happened sometimes between older and younger siblings. (Seriously, Weston A Price’s work is the most impactful reading I’ve ever done; I can’t recommend anyone’s work more. Read his work online here and/or buy his book here.)

[19:45] The Western foods Price identified are highly processed wheat flour, refined sugar, and refined vegetable fats (AKA vegetable oils or seed oils). Price also mentions canned vegetables and preserved meats.

[20:30] Guyenet, checking to see if Price’s work had scientific backing (largely, it does), wrote a lot about cancer incidence and seed oils. Upon reading about this, Tucker finally cut seed oils out of his diet and cured his 16-year irritable bowel disease in two days. It had not been cured previously by a low-carb diet.

[22:00] Tucker mentions that cutting seed oils eliminated his carb cravings. Also, he found out he had a wheat problem. Seed oils caused his irritable bowel disease; wheat caused his diverticulitis. Removing them led to quick cures.

[23:30] Vegetable oils are in basically every processed food.

[24:00] Exercise didn’t help him lose weight; diet did.

[25:00] Amazed at Guyenet’s work and the dramatic effects in his own life, Tucker began researching health and nutrition very seriously. On top of Guyenet, he read a lot from Mark Sisson

[25:45] What’s the mechanism behind seed oils being bad?

[26:15] SL Malhotra giant epidemiological study:
Northern (lots of dairy fat, meat) vs. Southern India (seed oils, low saturated fat, essentially following our modern food pyramid)
7-15x heart disease for the Southern Indians.
This is at about the same time as the aforementioned huge coronary heart disease increase in England.
What’s the biggest change during this time? Goodrich says it’s seed oils, and references that intake of soybean oil went up 1000-fold.
Still, there are always confounders. Epidemiology is still not trustworthy without mechanism.

[28:15] Okinawans are the poster child for Blue Zones
Longest-lived society in the world in latter half of 20th century
American people popularized “Blue zone” stuff (and said Okinawans were plant-based), but when you read Japanese sources, you get a very different perspective on what happened in Okinawa. After WW2, Okinawa had highest meat intake of anywhere in Japan (one of only places in Japan that did not become Buddhist, vegetarian. They believed pork to be longevity food.)
Still, they ate a lot of carbs. Tucker says 74% carbs. Diet mainly rice and yams, some pork. (This source concurs that 1949 Okinawans ate high carb. It says 85% carb.)

First American fast food in Japan was in Okinawa, 9 years before any opened in Tokyo
Lifespan in Okinawa went from longest-in-Japan to shortest-in-Japan in one generation (their environment did not change, their genes didn’t change, pollution didn’t change-- they were already industrialized, it wasn’t carbs-- they already ate high carb) after American junk food introduced.

So Harumi Okuyama studied this and published the paper titled Excess Linoleic Acid. This paper strongly calls out excess linoleic acid from vegetable oils as a driver of cancer, allergies, autoimmune disease, ADHD, behavioral issues, and heart disease.

America was recommending people eat vegetable oils. Saturated fat was demonized. This spread to Okinawa.

In Okinawa, parents were burying children. Diabetes, cancer, heart disease went way up in their population.

So. . . now that linoleic acid has been postulated by Okuyama as the problem, is it plausible? Is there a mechanism?

[32:15] Harvard recommends seed oils, saying industrialized countries eating seed oils have slightly lower rates of heart disease (but are they only looking at industrialized countries that are already eating too many seed oils, where seed oil consumption has already gone above the threshold needed to do damage?). And if seed oils lower heart disease, why do we see rising rates of heart disease in England, in India, in Japan, and in U.S. throughout the 20th century alongside increased seed oils?

[34:15] Weston Price was able to go around and look at people’s mouths and determine what was wrong. Westernized foods.

[34:30] “As an engineer, if you have a complicated system, and it stops working, your first question is ‘What changed?’ It worked yesterday, it’s not working today. What changed?”

In Computer Science, either the code changed, or there’s bad data that got put into the system. In this case, we know the code didn’t change. It’s not genetic, it happened too fast. It has to be a change in the input. It happened across species so it’s not a bacteria or virus. (And no one has ever found such a virus)

[35:45] High-carb societies: Japan, Okinawa, United States. . . all ate high-carb. And were healthy. Before seed oils.

[36:30] Japan still skinny, probably the skinniest industrialized population. Approximately 3.5% obesity rate. (3.5% in 2009 OECD data, 3.7% in 2015 OECD data)

[37:00] India’s diabetes and obesity rates are skyrocketing. Indian diet is low fat, high carb, their main fat source is seed oils.

Japan and China have decreasing carb consumption but increasing disease rate. (For this, the best references I found were discussions Tucker has had on Twitter in relation to this:

https://twitter.com/TuckerGoodrich/status/922551707908935686
https://twitter.com/TuckerGoodrich/status/940561701149331456
https://twitter.com/TuckerGoodrich/status/922887877482205187
https://twitter.com/TuckerGoodrich/status/817021632032178177
https://twitter.com/TuckerGoodrich/status/1023644536927662080
)

Tsimane and Kitavans ate high-carb, healthy, no diabetes.
Tsimane and Kitavans and other high-carb societies avoided diabetes, so carbs must not be the cause. So what is the cause?

[38:00] Carbohydrates still “Plan B” diet. Feed Japanese/Chinese cultures more meat, they get taller

[39:30] “Eat like a human should. . . “ That doesn’t mean you need to be a carnivore, although that works. . . ”

[40:00] Indians switched from ghee to seed oils -> diabetes explodes

[40:15] Warburg -> metabolic disease. No interventional studies in humans on diet and cancer interaction. But there is interventional study for heart disease: the 1994 Diet Heart Trial (Lyon).

In this trial, one diet reduced secondary heart attacks (study conducted on people who had heart attacks previously) by 70%. The diet that achieved this lowered omega-6 fats to 3.6% (Americans eat 7-8% of their calories from omega-6 fats) and raised omega-3 fats.

[42:00] Epidemiology very flawed. Harvard School of Public Health relies on it a lot, despite epidemiology’s flaws. For a look at how foolish epidemiology can be, see this article from Dr. Georgia Ede

William Lands, a researcher who studied fatty acid metabolism for 50 years, found no mechanism by which saturated fats can kill somebody

Lands: “Fifty years later, I still cannot cite a definite mechanism or mediator by which saturated
fat is shown to kill people.”

[42:30] Goodrich: “Theory’s got to work with all the facts. . . we’ve been eating saturated animal fats for millions of years; it’s been a primary food of ours. They didn’t overnight start causing heart disease. It’s just not plausible.”

[43:00] The lower-omega-6 diet had a relative risk reduction of 70% in that trial.

[43:15] “They sell billions of dollars worth of statins based off of a 20-30% relative risk reduction.” (and for a look at why that “20-30%” sounds way more impressive than it is, check out this terrific presentation from Dr. David Diamond)

[43:40] The American Heart Association had to change their recommendation from the prudent diet, which had just been demonstrated to be outright harmful. But no one seems to recognize the mechanism by which the Mediterranean diet (the one that lowered omega-6 and increased omega-3 fats) worked in Lyon

[44:00] Brown and Goldstein got a Nobel Prize for discovering the LDL receptor. Here is their paper

They initially thought that if you feed LDL to a macrophage, it becomes a foam cell, and atherosclerosis would follow. But it turned out LDL on its own doesn’t do it, it takes a modification (“...native LDL is not taken up by macrophages in vitro but has to be modified to promote foam cell formation. Oxidative modification converts LDL into atherogenic particles that initiate inflammatory responses. Uptake and accumulation of oxidatively modified LDL (oxLDL) by macrophages initiates a wide range of bioactivities that may drive development of atherosclerotic lesions.” Of course, this same paper immediately goes on to say that statins reduce risk for cardiovascular events, which would likely be a point of contention for Goodrich (and me))

Tucker references the work of Steinberg and Witztum, who did the rabbit study referenced below. Also, more recently, they published this about the role of LDL in atherogenesis.

[46:00] Polyunsaturated fats (PUFAs) are easily oxidized. If you oxidize LDL, the omega-6 fats are altered, and if you put that in vat with macrophages, they will get hoovered up and turned to foam cells. (But the non-oxidized LDL do not get hoovered up and turned to foam cells.)

[46:30] Rabbit study finding from Steinberg and Witztum that olive oil (a monounsaturated fat (MUFA), not a PUFA) did not oxidize LDL but PUFAs did oxidize it:

And another similar rabbit study here

A Witztum and Steinberg paper saying: “These data strongly support the conclusion that at least a portion of the LDL found in atherosclerotic lesions has undergone oxidative modification. That conclusion is further supported by the previously reported occurrence, both in rabbits and in man, of autoantibodies that bind to MDA-LDL and 4-HNE-LDL (18). Finally, that antioxidant therapy inhibits lesion formation in the WHHL rabbit (15, 16) strongly attests to the importance of oxidized LDL to the atherogenic process.”

Witztum and Steinberg, human LDL study: “The extent of LDL oxidation, regardless of whether the LDL was isolated from normo- or hypercholesterolemic subjects, was strongly influenced by the percent of 18:2 (linoleic acid, an omega-6 PUFA) in LDL.”

[48:30] To give rats cancer, they must be given a carcinogen and an omega-6 fat

In this study, control diet (including safflower oil) = no cancer. High heme + safflower oil = cancer. High heme + olive oil instead of safflower oil = no cancer. Mark Sisson comments here: “feeding heme iron to rats promoted colon cancer only when fed alongside high-PUFA safflower oil.”)

Another study: replacement of linoleic acid safflower acid with oleic acid safflower oil reduced promotion of colon carcinogenesis

[49:00] 4.4% omega-6 fat as amount of energy intake for rats = threshold to give them cancer. Above that, it doesn’t seem to make any difference

[49:30] Common mutation = p53 gene mutation. p53 = cancer suppression gene (“The p53 gene... is a tumor suppressor gene, i.e., its activity stops the formation of tumors.”). This is common in colon cancer, lung cancer, breast cancer

Asian women. Moved to United States, their rate of breast cancer increased sevenfold So this isn’t genetic; something about the input from the American environment must cause this.

[50:30] Random genetic damage (8-OHdG) present in all diseases of civilization

Goodrich: “Why is DNA damage happening in atherosclerosis? Why is it happening in obesity? . . . Mitochondrial dysfunction is a hallmark of every disease in the diseases of civilization. . . so what causes that? ”

[52:15] In 2004 rat study, it is shown that avoiding cooked seed oils isn’t enough. Just eating a high-PUFA diet made rats diabetic, and it made them susceptible to cardiolipin oxidation (in the mitochondria). Tucker breaks this study down here

Tucker says this means avoiding cooked seed oils is not good enough. The same thing happens inside the cardiolipin in your cells.

Another study related to cardiolipin and fatty acids, and Tucker’s selected quotes from the study

[53:15] Tucker references Thomas Seyfried’s work finding that there are no brain cancer cells without damaged cardiolipin and damaged mitochondria

[54:00] We know how to damage cardiolipin and therefore we know how to induce diseases of civilization: high-omega-6 diet plus high-carbohydrate diet.

[54:15] Tucker’s hypothesis is that seed oils are the main culprit behind the diseases of civilization.

[54:30] “...you can practically cure diabetes by going on a low-carbohydrate diet.

Primary symptom of diabetes: insulin resistance

But places like India cannot switch to low-carb diet: not enough food. So we need to know if carbs are true cause. This study shows that moving people along the spectrum from high-omega-6 to low-omega-6 led to improvements in insulin resistance, even while eating a high-carb diet.

[56:00] Tucker explains that omega-6 PUFAs (omega-6 PUFAs are highly concentrated in seed oils) break down into toxins. p53 = aforementioned cancer suppression gene. The damage to p53 is caused by HNE, an omega-6 breakdown product.

[56:45] Non-Alcholic Fatty Liver Disease (NAFLD) being cleared in high-carb diet (with lowered omega-6 PUFAs) in 100% (12 patients)

Of course, insulin resistance improved in these patients as well, and their measured eicosanoids (PUFA breakdown products) decreased (referenced by Tucker on Twitter here)

Despite the possibility of fixing NAFLD while high-carb, Goodrich states that a ketogenic diet is the fastest way to get rid of NAFLD.

Cannot induce alchoholic fatty liver disease without omega-6 (might seem far-fetched until you click the link and see the paper’s title is Dietary linoleic acid is required for development of experimentally induced alcoholic liver injury.)

More on the different effects between saturated fat (protective) and unsaturated fat (harmful) for alcoholic liver disease found in this review

[58:00] Some populations have thrived on high-carb. Even high refined carbs (white rice, Japan). They got malnutrition and stunting, but largely avoided the diseases of civilization (heart disease, cancer, etc).

[1:00:15] Asian flush / Asian glow = common genetic mutation that causes faces to turn red upon drinking alcohol. Most common genetic mutation in the world (ALDH2*2). Controls the production of enzyme ALDH2. ALDH2 detoxifies alcohol and it detoxifies seed oils. Knockout model = people with ALDH2 mutation are more likely to get diseases of civilization.

Stated in this paper: “a higher susceptibility to various diseases such as Alzheimer’s, osteoporosis, and acute coronary syndrome has been associated with ALDH2*2 carriers.”

So, basically, when the seed oil detoxifier (ALDH) is impaired, chronic disease rates go up.

[1:01:45] Glutathione is a very important antioxidant. Primary antioxidant for seed oils.

Diseases often signified by lower levels of glutathione because body cannot produce it fast enough to deal with the omega-6-derived toxins.

Selenium is a precursor to glutathione. Where there is no selenium in soil, like in China, the body cannot produce glutathione. So places with low selenium have low antioxidant capability and increased disease.

Two sources discussing China having increased disease from low selenium

[1:03:30] If you put glucose and linoleic acid into a beaker, it causes the linoleic acid to oxidize. Same thing happens in your body when you have linoleic acid (the omega-6 PUFA) intake and you have hyperglycemia (which, essentially, is the modern American diet). The toxins produced by the oxidation of these omega-6 PUFAs cause health problems.

[1:04:15] Omega-6 fats are the driver of disease, but to fix it, go low carb and low omega-6 to hit both sides of the hyperglycemia/high-omega-6 coin. Sanders points out that America does the opposite by eating high carb and high omega-6.

[1:04:45] Oxidized omega-6 fats are problematic. Saturated fat is not. William Lands studied fatty acid metabolism for 50 years. He found no mechanism by which saturated fats can kill somebody.

(William Lands: “Fifty years later, I still cannot cite a definite mechanism or mediator by which saturated fat is shown to kill people.”)

[1:05:00] Scary Wikipedia pages for omega-6 PUFA breakdown products (oxidized metabolites):

Acrolein: https://en.wikipedia.org/wiki/Acrolein
HNE: https://en.wikipedia.org/wiki/4-Hydroxynonenal
MDA: https://en.wikipedia.org/wiki/Malondialdehyde

[1:05:30] The same toxins in cigarette smoke are the ones that omega-6 fats turn into inside your body

[1:05:45] Cooking oils leading cause of lung cancer among Chinese non-smoking women

[1:06:15] Not a conspiracy! Although cottonseed oil was originally a toxic waste product, the producers initially thought it was healthy-- thought it had been detoxified.

The mitochondrial damage mechanism was not discovered until 2012 (upon Twitter clarification here it was actually a 2010/2011 paper)

[1:06:45] Crisco introduced in 1911. Cottonseed oil was being mixed with lard for 50 years before that. The problem is that it is not acutely toxic, so no one knows right away. Think about it... it took hundreds of years to determine cigarettes were toxic!

[1:07:30] Industry journals show that these seed oils become toxic. Linseed oil can burst into flames outside. Fast food uniforms become flammable

[1:08:15] Coconut oil vs. soybean oil: soybean oil caused obesity, coconut oil harmless

For reference, here is the information Goodrich and Sanders laugh at about coconut oil being harmful (“expert” assertion based on misguided epidemiology and assumption that saturated fat is harmful and that it is meaningful to have high LDL cholesterol. . . as opposed to having high oxidized LDL as discussed above)

[1:08:45] All nutrients (even water!) have a U-shaped curve. Basically, too little intake = high-risk. Too high intake = high-risk. Dose makes the poison. Example image of U-shaped curve

[1:09:15] You can’t completely eliminate omega-6 fats from your diet. Get it from whole food. And even be careful with grain-fed meat (note: This applies more to pork and chicken than to beef (thanks to cows being ruminants and having multiple stomachs). Grain-finished beef still has low absolute levels of omega-6, despite it not having as much omega-3 content as grass-finished beef.)

[1:10:00] Lower-omega-6 Plenish causing “less obesity” than regular soybean oil

[1:10:30] So, if not seed oils, what should we eat? Probably fats from meat and dairy.

Tucker speculates that there may be other essential fatty acids. For example, lack of heptadecanoic acid (a saturated fat) was found to lead to metabolic syndrome in dolphins (who do not eat carbs):

[1:12:00] Sanders and Goodrich agree that vegan diet is not recommendable, but you can make improvements on it, especially by virtue of eliminating “crap”. If you are so inclined to eat a vegan diet, Goodrich recommends checking out the work of Scott Jurek (plant-based ultra-marathoner: http://www.scottjurek.com/, book: Eat and Run)

Not recommended, but if you do it, make sure to supplement B12 and omega-3!

[1:13:30] Tucker not a low-carb zealot. References how healthy the Kitavans are, despite eating 75% carbs.

[1:14:00] Goodrich stopped eating sugar to avoid dental problems since he was 19 years old.

Goodrich cites Chinese and Indian populations eating low sugar but high diabetes and obesity. (References to China and India eating low sugar. Goodrich: two lowest sugar consumptions in the world. Chinese eat 1/10th of Americans’ sugar, Indians even less.)

Chinese and India getting diabetes now, not 50 years ago.

[1:15:00] Good overview from Sanders: Seed oils new in human history within about last 150 years. Evolutionarily, it doesn’t make sense. Not natural.

[1:15:45] Goodrich thinks seed oils driving disease makes the most sense to fit what we see throughout the world (and in his own personal experience).

[1:16:15] Tucker references thinking people at Mark’s Daily Apple were nutjobs for saying they had increased sun tolerance. Of course I have no idea what he was looking at specifically, but I thought I should link to a couple things sunburn-related from Mark’s Daily Apple:

https://www.marksdailyapple.com/primal-sun-protection-and-stigmasterol-stability/
https://www.marksdailyapple.com/why-some-sun-exposure-will-protect-you-from-deadly-skin-cancer/
http://forum.marksdailyapple.com/forum/the-primal-blueprint-forum-discussion/primal-blueprint-odds-and-ends/53459-so-why-exactly-is-sunburn-no-longer-an-issue-for-me
https://www.marksdailyapple.com/how-to-engineer-a-successful-day-of-sunbathing/

[1:16:45] Tucker references Chris Kresser and his respect for Kresser but how he is very skeptical of Kresser’s background in Eastern medicine. Speaks to how much information is floating around out there and how difficult it can be to separate the wheat from the chaff

[1:17:30] March 2009 is when Tucker fixed his diet. Went skiing a few weeks later on a sunny day. Sun above and sun reflecting off the snow. That combo usually equals sunburn. This day he skied all day and didn’t get a sunburn. A few weeks later, he was standing in the sun for hours with his dark-complected wife. She loved going to the beach and he (fair complexion) hated it. But on this day, she burnt and he did not! After this experience, she changed her diet (and their whole family’s). Now, instead of burning in 45 minutes in the sun, it takes 5-6 hours for Tucker to burn. It’s not magic, but his tolerance has increased dramatically.

(My personal note: Earlier this year, I was inspired to learn about the potential for increased sun tolerance after removing seed oils from my diet. So when my wife and I honeymooned in Hawaii for a week in July 2018, I spent a lot of time outside in the mid-day sun and did not apply any sunscreen (except for one instance when I let my wife put a tiny bit on my face). I did not get any bad burns. My experience jibes with Tucker's; I wasn't magically able to completely not burn. But for the length of time I was outside in the July Hawaii sun without sunscreen, I think most people would have expected me to be a complete lobster. And I was not. I did not get many sunburns at all, and the very minor sunburns I got did not last long.)

[1:20:15] Tucker has collected dietary sunburn improvement anecdotes
Also, here is a blog post from Tucker on sunburn

[1:20:30] Tucker talks about man who tested X-ray safe exposure limits on himself, lived to be 102:

[1:21:30] Tucker talks about paper from 1950s that shows mechanism of why radiation causes radiation poisoning, and how the omega-6 breakdown products are involved:

[I read the paper, not understanding all of it. But the paper makes it very clear that autoxidized linoleic acid is toxic and is a necessary part of radiation toxicity.

Conclusion #4 from the paper: “4. On a basis of total peroxide content, autoxidized linoleic acid, unlike autoxidized squalene, was more toxic by intraperitoneal injection than any of the simple peroxides with which it was compared. Autoxidized methyl linoleate was less toxic than most of the simple peroxides.”

Conclusion #7 from the paper: “The evidence is consistent with the view that radiation toxicity is due to initiation of chain autoxidation of essential fatty acids producing lethal doses of peroxides in sites not reached by vitamin E.”]

Radiation causes omega-6 fats to break down and that is what poisons you. The oxidized linoleic acid killed the mice quickly.

Mouse study showing benefits of higher Omega-3 diet (compared to higher Omega-6 fat diet) for skin cancer

Another hairless mouse study showing the dangers of polyunsaturated fats (sunflower oil in this study): “The photocarcinogenic response was of increasing severity as the polyunsaturated content of the mixed dietary fat was increased, whether measured as tumour incidence, tumour multiplicity, progression of benign tumours to squamous cell carcinoma, or reduced survival.”

Another study: “When mice were given injections of 10(6) melanoma cells, the initiation time required for visible tumor growth in mice receiving the polyunsaturated fat (PUF) diet was significantly less than that in mice receiving the saturated fat (SF) diet.”

[1:23:15] After discussing mechanism, they bring it back to the common sense “evolutionary appropriateness” point: Essentially: Evolutionarily, the sun should not be dangerous; we evolved in it. We didn’t evolve to spend all day in caves.

[1:23:45] Omega 3: Omega 6 ratio = these things compete with one another. When high omega-6, it evaporates the omega-3 fats. Omega-3 fats depleted in grain-finished beef.

[1:24:15] Susan Allport, working with Jeff Volek, documents what happens in one month from high Omega-6: Omega-6 blood content immediately increased significantly, omega-3 dropped right away, resting metabolic rate dropped, fat increased, arteries stiffened. Other more subjective negative effects too.

Christopher Ramsden study: The title says it all: Dietary omega-6 fatty acid lowering increases bioavailability of omega-3 polyunsaturated fatty acids in human plasma lipid pools.
You can’t just add Omega-3s. You need to decrease Omega-6.

[1:25:00] Japan: don’t get obesity like we do (Goodrich implies that this may be because of omega-3s; animal model shows this). They are getting diabetes, heart disease, increased cancer rates.

[1:25:30] Ratios of omega-6 to omega-3 in human tissue. Traditionally, these have been in the range of 1:1 - 4:1. Today, thanks (but no thanks) to widespread seed oils, they are way, way more tilted towards omega-6. Tucker says that today it is like “15:1 is good”

[1:25:45] Study of increasing Omega-3 fats lessening aggressive behavior in prisoners
Study on Omega-3, Omega-6, hostility
Article on Omega-3, Omega-6, hostility
Stephan Guyenet on similar Omega ratio and behavorial consequences

Sanders talks about Weston A. Price and how he ascribed a lot of behavioral and moral troubles to malnourishment/changes in diet. Tucker agreed that anecdotally, changing his diet actually made him better to be around, slower to anger (he was cranky before, he was embarrassed to learn)

[1:27:15] High-level overview:
Wheat and seed oils cause autoimmune disease.
If overweight and have heart disease, definitely go on a low-carb diet. High-carb is a co-factor. Cutting carbs will accelerate recovery. If a lean athlete, probably more wiggle room to include carbs. Though lots of people have success avoiding carbs, not everyone has to. Tucker, after fixing his diet, can outperform people half his age athletically. And no more sunscreen to buy!

[1:29:00] Gabor Erdosi sent Tucker study on ground starch vs. unground starch: ground starch rodents got fat, others did not. Junk food bad.

The thread containing this discussion between Goodrich and Erdosi can be found here

(Before the last notes from the podcast, if you're interested in reading more of Goodrich's work, here are some of his best blog posts on seed oils:
Omega-6 fatty acids: the alternative hypothesis for diseases of civilization
What's Worse—Carbs or Seed Oils? Understanding a High-PUFA Diet.
"Hello, Can We Have Your Liver?": Understanding a High-PUFA Diet.
How To Prevent Oxidative Damage In Your Mitochondria
The Cause of Metabolic Syndrome: Excess Omega-6 Fats (Linoleic Acid) in Your Mitochondria
)

[1:30:15] Avoid seed oils.
His diet does not feel restrictive. He and his ex-wife refer to it as “cheating” diet.
Doesn’t like going to restaurants; can make it better at home (Sanders concurs)
Sanders mentions that it’s like he found a cheat code in life. Tucker says “That’s exactly how to put it” (and I have used the same phrase before!!)
You feel great after you eat it.

Tucker: out with guys, puts butter on his steak. Everyone looks at him like he’s crazy. He’s the skinniest guy at the table. “And it’s because I’m eating this way.”

Vegetable Oils are Bad: Tucker Goodrich, Peak Human podcast takeaways (Part 2)

Part 1 of this post (overview)
Part 3 of this post (podcast listening companion, notes)

The Peak Human podcast with host Brian Sanders and guest Tucker Goodrich is my favorite health podcast episode of 2018.

This episode spurred a million thoughts, but here are my takeaways from this podcast:
  • You are much more likely to heal chronic conditions by self-research than by relying on mainstream medicine
  • You can overcome ridiculous conditions (stroke-like event at age 38, decades of IBS, and diverticulitis, in Tucker’s example) and make yourself healthy again via dietary change
    • You will probably have to learn how on your own
    • For non-acute harms, mainstream medicine generally doesn’t touch root cause
  • Diseases of civilization are not genetic
    • Weston A. Price’s work shows diseases becoming prevalent in a single generation
    • Dramatic lifespan, healthspan decrease in a single generation in Okinawa upon adopting Western foods
  • Diseases of civilization are not environmental
    • People living in tropical (pristine) environments, eating Western foods, are unhealthy
  • Diseases of civilization are not due to lack of exercise
    • We expend about as much energy today as many hunter-gatherers
  • We know of lots of healthy populations that have eaten high-carbohydrate diets
    • Can even reverse NAFLD with high-carb diet
    • It does not work in combination with vegetable (seed) oils
  • We don’t know of any healthy populations with high seed oil consumption
  • Low-carb probably ideal, especially if one already has less than ideal metabolic health
    • Carbohydrates are bad for dental health
    • With seed oils, carbohydrates are a co-factor and an accelerant for causing diseases of civilization
    • Cutting carbs and vegetable oils is the quickest way to improve metabolic health
  • Increased consumption of seed oils corresponds with marked increase in heart disease and other diseases of civilization
  • Seed oils being healthy does not make sense from an evolutionary perspective
  • Saturated fat being unhealthy does not make sense from an evolutionary perspective
  • Eating healthy can be liberating
    • It's a "cheat code"
    • Now Tucker can athletically outperform people much younger than him
  • Epidemiology can be useful, but only within context
  • There are very plausible mechanisms for how seed oils are harmful
  • There are interventional trials showing seed oils to be harmful
  • There are lots of animal models showing seed oils to be harmful
  • You can increase your sun tolerance remarkably by cutting seed oils from your diet

Vegetable Oils are Bad: Tucker Goodrich, Peak Human podcast review (Part 1)

The Peak Human podcast with host Brian Sanders and guest Tucker Goodrich is my favorite health podcast episode of 2018. In the podcast, Goodrich makes a persuasive case as to what he believes is the primary cause of the diseases of civilization (diabetes, coronary heart disease, autoimmune disease, cancer, etc). In this 94 minute podcast, he strongly posits that one type of food is at the root of the health problems of our times.

What is the primary cause of these health issues? Vegetable oils. Or seed oils, as they are more accurately but less commonly known.

These seed oils are industrially-processed oils containing high levels of Omega-6 fatty acids, which break down into toxic products in our bodies. These vegetable oils (corn oil, sunflower oil, canola oil, soybean oil, safflower oil, etc.) are cheap and therefore ubiquitous in our modern food supply. Tucker Goodrich postulates that these oils, even more than refined carbohydrates, are driving the diseases that plague most of the civilized world.

Goodrich makes the case by looking at the effects of consuming vegetable oils from several valid perspectives. In my view, he approaches the modern disease problem from all the correct angles. Some of the perspectives from which he approaches the problem are:
  • Evolutionary perspective
    • Why are we now getting these diseases of civilization at greatly increased rates?
  • The Weston A. Price perspective
    • Did the healthy populations visited by Price eat these vegetable oils?
    • Were the unhealthy populations visited by Price eating these vegetable oils?
  • Epidemiological perspective
    • What happens to disease rates when a population begins eating these oils?
  • Engineering/"IT guy" perspective
    • Populations have not always had high rates of these diseases. What changed?
  • Mechanistic perspective
    • Do we have a legitimate mechanism for why these oils would cause these problems?
    • Have we seen this mechanism show up in animal models?
    • Have we seen this mechanism show up in human interventions?
  • Personal perspective
    • What happens when an individual increases these oils in their diet?
    • What happens when an individual cuts these oils out of their diet?

This podcast episode is intriguing to me because the idea that these oils are harmful unites many diverse dietary strategies. Paleo, Well-Formulated Keto, Whole Foods Plant Based, Carnivore, Ray Peat, Potato Hack, Weston A. Price Foundation: all of these ways of eating shun the consumption of vegetable oils. I think that commonality is a large part of why people can find success with such wildly different approaches.

This podcast (along with following Goodrich’s and dozens of others’ writings, podcasts, and research) helps convince me that seed oils are the worst part of the modern American diet. While I also think there are benefits to limiting carbohydrate intake, cutting down on consumption of linoleic acid (an Omega-6 polyunsaturated fatty acid that is highly concentrated in vegetable oil) is potentially even more critical for health. Wheat products also seem to cause a lot of health issues, so limiting or completely removing them would be wise. This podcast with Goodrich touches on all of these points. It is a valuable listen for anyone who would like to improve their health or gain a better context as to why vegetable oils should be avoided.

In Part 2, I will post my takeaways from the podcast. And in Part 3, I will include a podcast listening companion post in which I provide notes and many of the citations referenced by Tucker in the episode.

Do yourself a favor and check out this podcast. And if you're feeling really generous, do yourself another favor and cut vegetable (seed) oils out of your diet.

Here is an incomplete list of oils you would be wise to avoid: soybean oil, corn oil, canola oil, cottonseed oil, rice brain oil, peanut oil, safflower oil, sunflower oil, rapeseed oil. (Avoiding motor oil consumption is also a good choice.)

If you enjoy this episode, consider checking out all the rest of the episodes of Peak Human. It is a really terrific podcast. And after meeting host Brian at a conference a few months ago, I can vouch for him as a kind, sincere, passionate guy.

Monday, November 12, 2018

My Five-Day Fast

Or, how not eating taught me that I really can not do anything I put my mind to


The Highlights


  • I fasted for five days, consuming nothing but water and salt. It was an amazing experience.
  • I consistently felt more fully present, more energized, and more mentally sharp than I do on typical days. (For what it's worth, I was also engaged in a "Twitter fast" during this time, which I think also helped me be focused/present. But due to the tangible difference in how I felt, I attribute it mostly to the actual fast.)
  • On top of my mind feeling sharp, my body felt terrific. Felt light, fluid. Joints felt looser (in a good way), pain-free. Skin felt very strong (there's even a specific patch of skin on my face where I got shingles a couple years ago that I swear I think the skin got stronger. Hard to articulate, but I think some healing took place there), although the skin on my hands and elbows still got very, very dry. (My hands and elbow skin get very dry every year when it gets cold)
  • I didn't notice negative side effects this time (I had digestive issues on a previous 3-day fast. I didn't even poop once during this fast); I think adding sufficient salt may have been the key.
  • I was able to work out every day of the fast at usual intensity. I might have dropped a bit of strength on the back half of the fast, but the difference was minor.
  • I work as a software developer; I was able to work every day of the fast at (at least) normal capacity.
  • My body was cold. Digestion seems to heat the body up. I even get cold when I fast for 16 hours or so on typical days, so being cold was not a surprise.
  • I got a lot less sleep than normal. The last 3 nights of the fast, I got 6, 5, and 4 hours of sleep, but I still felt very energetic. I just woke up really early and was ready to get after it!
  • With a couple exceptions, hunger was not a major issue.
  • Not eating for a few days made me realize that a lot of time, thought, and bodily processing is tied up in eating.
  • The human body is incredibly adaptive.

The Details


Two weeks ago, I decided to complete my longest fast to date. My previous longest fast was 78 hours, so just over three days. I began this fast just wanting to hit a new mark, maybe hit 100 hours, and, if I felt good enough, potentially max out at five days (according to the work of Dr. Valter Longo, five-day fasts can have some beneficial regenerative, health-building effects on the body). Did I feel good enough? You better believe it! I did the full five days.

Five days of consuming nothing but water and salt. To many people, that sounds crazy. Maybe it even sounds like torture. I assure you, it was anything but. It was a remarkable experience and overwhelmingly positive. It was truly one of the most memorable five-day stretches that I have experienced; at the risk of sounding grandiose, it truly felt like I was living on a different level.


Sunday, October 28

I woke up early and worked out: farmers walks, kettlebell swings, and burpees. My wife and I went to our favorite Indian buffet for lunch, around noon. That being said, I was done eating by 12:30 PM on Sunday October 28. When I got home, I weighed myself: 210.5 pounds. I didn't eat the rest of the day. After the Indian meal, I had nothing but water the rest of the day (not even salt).

Monday, October 29

Monday, I dropped my wife off at the airport around 5:30 AM (she travels for work), went to the gym at my office and worked out (approximately 17 hours fasted). Solid weight lifting workout. I had nothing but water all day (not even salt). After my workout, I went to work. I weighed myself when I got home: 206.5 pounds. I did 100 burpees at home after work. I went to bed at 10:30 PM, weighing in at 203.5 pounds. I felt good all day. I had a great visit with one of my best friends that evening and felt very mentally clear and energetic all day. My legs were twitchy, though-- that happens to me a decent amount even when not fasting. Normally I treat that with some combination of salt, magnesium, or mustard. I thought I'd give it a little more time, so I didn't have salt, magnesium, or mustard Monday night. (I didn't have magnesium or mustard at all during the fast.)

Tuesday, October 30

I woke up at 2:30 AM with calf cramps. I do get this occasionally anyway, and generally try to mitigate this with salt and/or magnesium. To this point in the fast, I had not consumed any salt. So I walked around, went back to bed, and got up at 5:30 to go work out before work. I weighed in at 201.5 pounds before work. I felt energized but dehydrated.

I initially wanted to get to at least 48 hours without even having salt during the fast, but during my workout I was feeling a little light-headed (and had twitchy/crampy legs). As I learned from The Salt Fix, consuming sodium helps with these symptoms, and that was very true in this case. So at 6:10 AM in the middle of my farmers walk/kettlebell swing workout, I had some salt with water (I was not going to mess with hyponatremia, anyway). I finished the workout (41 or 42 hours fasted), then I went to work and had another good day. I continued feeling sharp and alert. I didn't record whether I did my 100 burpees before or after work that day. Anyway, I did them. I was worried that I was going to have some gastrointestinal issues (read: diarrhea) Tuesday, but I upped my salt intake and no issues came to pass. (On my previous 3-day fast, I did have some GI issues starting around the 48-hour mark.) Throughout the rest of the fast, I made sure to consume salt in plentiful amounts to replenish the sodium lost via exercise.

I experienced very little hunger all day. Occasionally I would get slightly hungry but it quickly passed.

Wednesday, October 31

I woke up at 3 AM Wednesday and felt raring and ready to go (and weighed in at 203 pounds). I did some comedy writing exercises for a couple hours, then I went in to the office gym and worked out. I felt amazing and, 66 hours fasted, set a new personal best for weighted pull-ups. This improvement in pull-ups was very unexpected. The thing I was most worried about with the prolonged fast was breakdown of muscle mass. After my lifting workout of pull-ups, machine rows, rear delt pulls, and barbell upright rows, I went to work. During the work day, I wrote in my phone notes: "10/31 continue to feel terrific, so much mental clarity, elevated mood. It's amazing how much energy the body must use to digest food based on the increased clarity I feel." Seriously, I felt amazing. Even compared to my baseline, which I tend to think is pretty good/energetic.

I talked to my mom on the phone Tuesday evening. And then I talked to my wife on the phone while waiting for trick-or-treaters to come. No trick-or-treaters came, and that's probably just as well (they would have been disappointed coming to the lame house handing out toys instead of candy).

I don't remember if I did 100 burpees after my morning lifting workout or after getting home. Probably after I got home. Anyway, I did them. Also, I weighed myself at 7 PM: 204.5 pounds

Just like the day before, I experienced very little hunger all day. Occasionally I would get slightly hungry but it quickly passed.

I went to bed around 9:00.

Thursday, November 1

Once again, I woke up really early (2:00 AM) and felt energized. More comedy writing exercises. I had a great time doing this. And I was excited-- I was preparing to do open mic stand-up that night (for just the second time in my life).

Then, around 6 or 6:30 AM, it was time to hit the gym. Time for some hex bar deadlifts, 90 hours fasted. Two quick warm-up sets, then one set of trying to pull 365 pounds as many times as I could. I got 12 reps that day, basically in line with where I was when I last did that workout five days earlier. Afterwards, I tried to test out my vertical jump (my legs typically feel springy after hex bar deadlift), and I was an inch or two below my typical jump. That made sense, as my legs did feel a bit fatigued; some combination of no food and low sleep was likely the cause. But I felt terrific overall.

Then, it was time to shower up and head to another day at the office. At the start of the work day, I had my strongest hunger signals of the week. My body was craving food, especially for about the first hour after working out. But. . . even then, it passed. Throughout the work day, I took notes in my phone saying things like "Fasting is the truth" and "Felt chipper as fudge all week" (only I didn't say fudge). So. . . I was feeling goooooood.

After work, 100 hours fasted, I did 100 burpees.

Then, I prepared a little more for doing open mic comedy. . . I went up at about 9:30 PM (105 hours fasted) and did five minutes of stand-up. Compared to my first time doing it about two months earlier, it went really well. I had a great time; I got some decent laughs from a way-too-friendly crowd. Don't worry, I still bombed on some of my punchlines. I'm just glad my fast wasn't broken by crowd members launching tomatoes at me. Anyway, I was really, really excited about how well it went. It capped off a great day. I got home and went to bed around 11 PM.

Friday, November 2

Up at 3 AM: 204.5 pounds. More comedy writing exercises. I was still amped from my positive experience the night before. Around 5:30 AM, time for the gym. Farmers walks, kettlebell swings, and burpees. I did fail a few steps early on my final set of farmers walks, so maybe I was losing a bit of physical strength by this point. But anyway, I got the workout in. Then I went to work, had a normal work day until lunch time, at which point it was my turn to help on my company's Meals on Wheels delivery route. We finished the route at about 12:30, basically the exact 5-day mark of the fast. I drove towards my house, grabbed some food from the grocery store, and went home to cook it.

Friday I never got as hungry as I was on Thursday after my morning workout, but I definitely felt hungry from time to time and I was looking forward to eating. I was so excited to chow down that I forgot to weigh myself one final time. Plus, I had to quickly get my lamb chops cooked to avoid cast iron sizzling being a distraction on a 1:30 PM conference call. You know, work responsibilities and stuff.



Yum. The lamb chops (and a couple cans of sardines) were delightful. They tasted great, they didn't interrupt the work call, and the fast was complete.

I ended up eating a lot that night. I didn't think to weigh myself until the next morning (after probably eating about 5000 calories since breaking the fast and after an hour or so of open gym basketball Saturday morning): 205 pounds.

A Few More Notes to Recap

Even compared to baseline, I just felt so alive and in-the-moment that week. My mood was very elevated. It was a very memorable week. To my knowledge, no one I talked to even knew I was even fasting except for a few friends at work who I talked to about it (and my friend who I hung out and talked about it with that Monday). I think my performance at work and my social interactions were at least as good as normal, probably better.

I talk about these types of energy, mental clarity, and body-feel-good benefits from my typical way of eating (largely carnivorous, ketogenic, Paleo-ish, low-carb, low-omega-6, intermittent fasting) a lot and I believe they are real. But I'll be damned if there wasn't a marked difference going from that to how I felt during the fast.

I found the weight changes interesting, as it goes to show how weight on a scale isn't always that meaningful. It fluctuates a lot. Despite eating 0 calories between 10:30 PM Monday and 3 AM Friday, I gained 1.5 pounds. A lot of this likely has to do with hydration, sodium intake, and water retention.

I did my first 24-hour fast about a year prior to this 5-day fast. That experience (and the resulting mood elevation, lessening of joint inflammation, etc.) was one of the key moments that made the power of nutrition feel real to me. It shaped how I thought about food and and it helped get me interested in learning more and more and more about health and nutrition. I now know I have a lot more to learn, but this five-day experience was another incredibly powerful experience for me. All of my experiences fasting: from starting out with 12-hour eating windows, to 1-day, to 3-day, to 5-day fasts. . . have been very good for building self-confidence and self-discipline. Being able to control my intake of food made me feel like I could establish self-control in other areas of my life as well. (Somehow, it helps build self-control despite the fact that the self-discipline didn't feel difficult once I decided to fast because the fasting felt so good.)

Admittedly this experience was better than my previous three-day fasting experience (which I also found overwhelmingly positive). During my three-day fast (about six months prior), I got pretty antsy waiting for the fast to end; I went to bed early the last night so I could fall asleep and then wake up and eat a steak-and-eggs breakfast. Plus I got diarrhea during the 3-day fast but not during this 5-day one. This time, I had no intense desire to rush to break the fast and no diarrhea.

With that, I'm done writing about diarrhea. Anyway, fasting was fun. Do you have comments? Questions? Do you have any experiences with fasting? Let me know in the comments section. Thanks for reading.

Note 1: Despite my positive experience and reflections, I am not encouraging anyone to try any kind of prolonged fasting without proper medical supervision. Especially if taking any medications and/or if one struggles with disordered eating. Not everyone is metabolically ready for fasting; it is not risk-free.

Note 2: I record my weight throughout this week because I found the fluctuations to be interesting, not because I had a goal to lose weight. I did this to see what it would be like, to build up a little self-discipline, and to potentially kick off some healthful regenerative processes in my body; I had no desire to lose weight (although I knew that some weight loss would occur).


Monday, October 15, 2018

Book Review: Tripping Over the Truth

Summary


Tripping Over the Truth is a book about one of the most dreaded words in the world. Cancer. Because we have all known and loved people affected by cancer, it’s not a topic to be brought up in polite conversation. And because we have all known and loved people affected by cancer, it is a critically important topic. Throughout his book, author Travis Christofferson weaves together history, science, personal drama, and level-headed criticisms of the status quo in cancer research. This attention-demanding book is likely to make any reader take a step back and consider viewing the disease differently.



Christofferson suggests that the last several decades of cancer research have approached cancer from the wrong angle. Viewing cancer as a genetic disease has led to billions of dollars (and thousands of research careers) being spent on relatively uninspiring results. Despite many claims of breakthroughs, statistically, cancer rates have barely budged since the 1950s. A gripping anecdote: Senator Ted Kennedy signed the National Cancer Act in 1971, and the nation was optimistic that cancer would soon be overcome. Nearly 40 years later in 2009, despite having access to world-class oncologists, Kennedy died from brain cancer. His treatment induced toxic side effects and provided no life extension.

For the last several decades, cancer research has been conducted under the dominant paradigm of the somatic mutation theory (SMT). The SMT postulates that cancer is caused by DNA mutations. However, in practice, cancer is proving to be more complex than the SMT predicted. Some cancers have no driver gene mutations, whereas the SMT predicted that all tumors require sequential genetic alterations. Beyond that, mutations between different tumors and even within tumors are usually too variable to treat. Targeting specific mutations via pharmaceuticals ends up being like playing “Whac-a-Mole”; as soon as one mutation is targeted and destroyed, another mutation pops up. During this time, toxic side effects accumulate for the patient. With all of these moving pieces and parts, it is no wonder prominent oncologist Bert Vogelstein questioned, “Is it possible to make sense out of this complexity?”

The book is certainly critical of the dominant cancer research paradigm, but it does more than simply criticize the SMT. It provides another view for what causes cancer; in this view, DNA mutations are side effects rather than causes. A small group of scientists have been approaching cancer from this other perspective, based on the research of the late Otto Warburg. Warburg said “the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar.” His theory states that cancer is a problem related to cellular energy production (metabolism). Cancer cells producing energy via sugar fermentation rather than via aerobic respiration is now known as the Warburg Effect.

After Otto Warburg’s 1970 death, Pete Pederson may have been the only researcher still approaching cancer from this metabolic perspective. Pederson made discoveries and published work consistent with Warburg’s theory. He discovered that tumors form when mitochondria (cellular energy producers) become so damaged that they cannot provide enough energy via aerobic respiration, so they send out a distress signal. This distress signal leads to a retrograde response which tells cells to start fermenting sugar for energy.

Decades into his research career, Tom Seyfried (who holds a master’s degree in genetics and a PhD in classical genetics) discovered that caloric reduction could have antitumor effects. Intrigued by this idea, Seyfried then discovered some of Pederson’s research. He also discovered research from Jerry Shay and Warren Schaeffer. Shay and Schaeffer, completely independently, found that inserting malignant cytoplasms (i.e. damaged mitochondria) into healthy cells led to tumor formation. And inserting a healthy cytoplasm into mutated cells led to mainly tumor-free results (only 1 in 68 mice developed tumors in this scenario). Looking at this research, despite never having heard of the metabolic theory of cancer until the 2000s, Seyfried became convinced that cancer is not genetic, but that it is a metabolic disease. He has since become an outspoken advocate of that view, and he published the 2010 paper Cancer as a metabolic disease and the 2012 book of the same name.

Once the metabolic theory of cancer is accepted, ketosis becomes a potentially therapeutic cancer treatment. If you fast, or if you have a very low intake of carbohydrates, your liver will produce ketones. Your normal cells with healthy mitochondria are fueled by these ketones in the absence of glucose. Cancer cells cannot utilize ketones for fuel, so a ketogenic diet can work to “starve” the cancer cells. At the same time, the ketones help the healthy cells deal with the stresses of radiation. So ketosis has a double benefit in cancer treatment. Because of this, Seyfried (building off the work of many other researchers) has become a major proponent of the restricted ketogenic diet for cancer patients. So far, the ketogenic diet’s success in cancer therapy is relatively small in scope: preclinical experiments, case studies, some trials, and many anecdotes. Many more clinical trials are needed. However, in the meantime, it shows tremendous potential as a non-toxic adjunct therapy. And the ketogenic diet’s early success could help reframe how cancer is viewed. Perhaps cancer could be more effectively battled if viewed as a single metabolic disease and not as one of thousands of indecipherably complex mutations. Nothing is certain; like the book says, “only time will tell.”

The Book's Afterword


This book was initially published in 2014. The version I read is the revised version published in 2017, and with it comes a very enlightening Afterword section. In this section, he provides some tidbits showing that the metabolic view of cancer continues gaining momentum and that the ketogenic diet is currently being used successfully as part of a cancer treatment strategy. But the most interesting part of the Afterword is the story how the author’s mother was diagnosed with endometrial cancer in July 2015, just nine months after the book’s publishing. It is a true “skin in the game” moment: how would his mother choose approach her own cancer treatment? At the age of 73, she underwent surgery to remove her tumor, followed by localized radiation treatment, the adoption of a ketogenic diet, and twice-weekly sessions of hyperbaric oxygen treatment. Christofferson’s mother “felt good and recovered remarkably fast from the radiation.” Actions speak loudly.

Other Topics Covered by Tripping


  • The FDA approving drugs based on tumor shrinkage despite that not being correlated with prolonged survival
  • History of how cancer came to be known as a genetic disease
  • Short history of chemotherapy and details of how controversial it has been to essentially poison cancerous and healthy cells indiscriminately
  • The struggle of Pederson’s lab partner Young Hee Ko to bring potential breakthrough cancer drug 3BP to human clinical trials
  • The success of chronic myeloid leukemia drug imatinib (Gleevec)
    • What it means in the big picture of cancer research
    • Whether it truly supports the somatic mutation or metabolic theory of cancer
  • The difficulty in getting funding for research of ketosis as a cancer treatment
  • The regulatory difficulties impeding the testing of cancer drugs in combination
  • The building momentum for metabolic approach to cancer research and treatment even from luminaries like DNA structure discoverer James Watson
  • Press-pulse strategy: constant stress on cancer cells (press) via ketosis, periodic acute cancer stress (pulse) via hyperbaric oxygen treatment
  • Notes about scientific consensus being overturned including the story of how Barry Marshall went from “quack” to Nobel Laureate by drinking bacteria juice and giving himself an ulcer


My Thoughts


Two concepts were constantly flowing through my mind while reading this book.
  1. Baseline beliefs and assumptions matter.
  2. The Pareto Principle is important.
Baseline beliefs and assumptions matter. I believe that, like other wild animals, humans evolved to be naturally healthy and largely free of chronic disease. The “primitive” populations studied by Weston A. Price did not eat white flour, sweetened goods, or vegetable oils. Those same populations had nearly nonexistent incidence of cancer. (For what it’s worth, other studies of traditionally-living hunter-gatherers also show the same low incidence of cancer.) This makes me skeptical of approaching cancer research in a gene-centric way*. The metabolic theory of cancer just explains the sudden increase in cancer rates upon Westernization better than the somatic mutation theory.

The Pareto Principle is important. The Pareto Principle states that the 80% of benefits come from 20% of causes. Lots of brilliant, caring researchers have dedicated their entire careers to studying cancer. But Tripping causes me to wonder whether many of these researchers are simply looking at the wrong cause. Perhaps DNA mutations are not the cause (as suggested by Somatic Mutation Theory), but the effect of mitochondrial damage (Metabolic Theory). Perhaps focusing more on mitochondrial damage and reversal of the Warburg Effect would be the “20%” that provides “80%” of cancer research benefit. 80/20 probably actually undersells the Pareto distribution in this case, as 95% of cancers are PET-positive. PET-positive cancers are cancers that feed off of sugar, making cancer cell sugar starvation (reversal of the Warburg Effect) a potentially fruitful approach.

All of that being said, I think the ketogenic diet is likely to be a very important non-toxic approach for cancer treatment. It’s a simple idea: cancer cells feed off of glucose, so don’t ingest glucose. Starve the cancer cells while your healthy cells can still feed off of ketone bodies. Your body being in a ketogenic state (via fasting, a ketogenic diet, or a combination thereof) will help mitigate the nausea and weakness brought about by other cancer treatments such radiation and/or chemotherapy. Periodic hyperbaric oxygen treatments could be beneficial as well. Doing this could lead to a more effective and less toxic cancer treatment than standard of care**.

Cancer is often seen as something that just randomly happens to people, based on genetics. I do not share this view***. Seeing how much impact lack of nutrition had in previously healthy peoples in a single generation in Weston A. Price’s studies makes me a firm believer that what we eat is far, far more of a driver of cancer than genetics. (In other words, the people studied by Price were genetically healthy but their diets changed and they became afflicted by chronic diseases. Similarly, every single day I see anecdotal reports online of modern people making radical health improvements via diet. These observations significantly impact my view here.) Diet is not the only environmental factor that can cause cancer, but I find it likely to be the most prevalent one. I also find diet likely to play an important role in treating the disease.


*I am not saying there is nothing about cancer that is related to genetics. As the book says, about 5-7% of cancers are related to germline mutations (passed from parent to offspring). But even those inherited mutations interfere with mitochondrial function, consistent with the metabolic theory of cancer.


**I am not claiming that ketosis will cure cancer, nor that there are no possible negative side effects. Ketogenic diet cancer researchers at the OSU Low Carb conference in August mentioned the existence of a reverse Warburg effect in some types of cancer cells (where cancer is fueled by ketones), so ketosis is not a panacea. But ketosis has a lot of potential for improving cancer treatment in a large percentage of cancer cases.

***I also do not mean to blame anyone suffering from cancer. But I do want to provide the perspective that you don’t need to resolve yourself to the idea that “maybe I’ll get it, maybe I won’t, not much I can do”-- there may be steps you can take to lower your risk (steps mentioned in How to Improve Your Insulin Sensitivity here would be among steps that deserve consideration). And if you do suffer from cancer, perhaps you could find therapeutic benefits from fasting, ketosis, or other treatments targeting cancer metabolism (certainly, there are no guarantees, but it might be worth researching further).

Tuesday, September 18, 2018

My Favorite Podcasts

Here is a running list of my favorite podcast episodes.

It's already over 100 episodes. Shout out to the Tim Ferriss/Jocko Willink podcast that got me started down the rabbit hole. It's phenomenal.

Special shout-out to the Comedy Bang Bang podcast. . . I don't list its episodes here (most are more around health/nutrition/mindset), but it's so good it deserves its own separate mention.

Thursday, September 13, 2018

Don't Resist. Be (Insulin) Sensitive

Overview

Just take me to the bullet points. . .

Basics About Insulin

Insulin is a protein and hormone produced by the pancreas and released into the bloodstream; one of its primary functions is to reduce elevated blood glucose levels.
  • Insulin resistance: cells in the body are resistant to the effects of insulin. This is metabolically unhealthy.
  • Insulin sensitivity: cells in the body are sensitive to the effects of insulin. This is metabolically healthy. 
Insulin resistance is tightly coupled with hyperinsulinemia, a condition in which excess levels of insulin are in the bloodstream relative to the levels of blood glucose. Because the insulin-resistant cells do not properly process insulin, the pancreas is forced to secrete additional insulin in order to stabilize blood glucose levels. And those cells may have become insulin-resistant because of chronically elevated insulin. The cause-and-effect relationship between insulin resistance and hyperinsulinemia is a difficult puzzle to piece together, but as a general rule: where there's insulin resistance, there's hyperinsulinemia. And vice versa. And they're both very bad news.

Why are Insulin Resistance and Hyperinsulinemia Relevant?

Insulin resistance and hyperinsulinemia are connected to most of the major health problems that plague modern humanity: type 2 diabetescardiovascular diseasepolycystic ovary syndromeerectile dysfunctionAlzheimer'scertain cancersosteoarthritisatherosclerosis. . . the list goes on and on.

In general, the higher your fasting insulin is, the higher likelihood you have of getting a chronic disease.

Most people today are on the path to a chronic disease. That is harsh, but likely accurate. A 2015 JAMA study found that in 2012, 49 - 52% of American adults have either prediabetes or diabetes. And that number undersells the true scale of the metabolic problem, as the measurements used in the study are plasma glucose or HbA1c levels. Elevated insulin levels precede elevated glucose levels by up to 24 years. If half of American adults have elevated glucose levels, significantly more than half of American adults have elevated insulin levels and are therefore headed towards chronic disease.


How to Know if You Are Insulin Resistant

There are several ways to test out how insulin resistant you are.

Two Hour Insulin Glucose Challenge Test

You can ask your doctor if he/she will prescribe the test for you. Otherwise, you can order it without a doctor's orders from WalkInLab. Fasting insulin levels are checked at fasting, then one hour after ingesting 75 or 100 grams of glucose, then two hours after the glucose.

The lower your insulin levels are, the better, at all three measurements.

HOMA-IR Score (Fasting Insulin and Fasting Glucose Levels)

HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance. It is composed of two tests: fasting glucose and fasting insulin. You can ask your doctor if he/she will prescribe these tests for you. Otherwise, you can order them without a doctor's orders from WalkInLab (fasting glucose and fasting insulin). It is relatively inexpensive. You can then plug your fasting glucose and fasting insulin numbers into this calculator to figure out your HOMA-IR score. Or calculate it yourself: HOMA-IR = (insulin uIU/mL * glucose mg/dL) / 405

Generally speaking, the lower your HOMA-IR score is, the more insulin sensitive you are. Definitions for insulin resistance are slippery, so different groups define insulin resistance at different levels. It is likely wise to use the ranges from The Blood Code: 0.5 - 1.4 is optimal, 1.9 - 2.89 is early insulin resistance, and 2.9+ represents significant insulin resistance.

LP-IR Score

LP-IR stands for Lipid Profile Insulin Resistance. You can get it tested without doctor's orders from WalkInLab. The lower your score, the more insulin sensitive you are. The lab report should provide decent reference ranges so you know how your insulin sensitivity compares to other people's.

Triglyceride : HDL Ratio

You may be able to get an idea of what your insulin sensitivity is through a standard lipid test. A lipid panel can be ordered inexpensively without a doctor's orders here. Lipid panels return basic information about your cholesterol (total, HDL, and LDL) and your triglycerides.

A high ratio of triglycerides to HDL cholesterol (>= 3.5) has been found to be a straightforward way to identify insulin resistant people. Triglyceride-to-HDL ratio is not a perfect measure of insulin resistance. But if all you have are results from a standard lipid test, the results are useful. You want a low ratio-- the lower, the better.

How to Improve Your Insulin Sensitivity

Now you know how crucial it is to be insulin sensitive and how to measure whether or not you are insulin sensitive. With that in mind, how can you improve (or maintain) your insulin sensitivity?

Six ways to improve insulin sensitivity are nutrition, exercise, sleep, reducing stress, not smoking, and sunshine.

Nutrition

There are multiple ways to improve your insulin sensitivity via diet. Whichever dietary approach you follow, make sure you avoid processed foods that were never eaten by healthy traditional peoples studied by Weston A. Price. Exclude white flour, sugary products, and vegetable oils!

Low Carbohydrate Diet

A low-carbohydrate diet is a terrific way to improve your insulin sensitivity. In a controlled study, Type 2 Diabetes patients treated with a low-carbohydrate ketogenic diet improved their HOMA-IR scores by an average of 55% (measured by insulin levels, 29% measured by C-peptide). Fasting insulin levels themselves dropped by 43% in the same study. [Note: That study is groundbreaking and amazing. 60% of the patients reversed their diabetes in the first year. (!!!!!!!!!!!!!) Check out more about it here.]

Results from a continuous glucose monitoring device before and after adopting a low-carb diet. Notice how there is no blood sugar "rollercoaster" in the "After Low Carb" section. This is one reason low-carb diets are effective for treating insulin resistance. This image comes from the Twitter account of RD Dikeman, who is a prominent partner of Dr. Richard Bernstein.


One of the driving ideas behind a low-carb diet is that it keeps your blood sugar levels relatively stable. When your blood glucose levels stay stable, your pancreas does not have to produce much insulin in order to lower your blood glucose. Keeping the insulin levels consistently low helps avoid insulin resistance and hyperinsulinemia.

General idea: Low blood sugar -> low insulin levels -> better insulin sensitivity

Intermittent Fasting

Intermittent fasting involves deliberately shrinking the window of time during the day in which you eat. Some people consider it intermittent fasting to eat within 12 hours (e.g. eating occurs between 7 AM and 7 PM), while others do things such as One Meal A Day (OMAD). No matter what eating window an intermittent faster uses, their general idea is to spend more time in the "fasted" state as opposed to the "fed" state.

There is a lot of research on intermittent fasting in animals, and slightly less in humans (but there is some). But anecdotal and clinical experience shows terrific results. Intermittent fasting leads to improved insulin sensitivity. This may be partially because shrinking your daily eating window leads to a shrunken window of time during the day where insulin is elevated.

General idea: Shrink your eating window -> shrink number of blood sugar spikes -> shrink number of insulin spikes -> better insulin sensitivity

Caloric Restriction

Caloric restriction involves consistently eating significantly less than what you would eat naturally. Caloric restriction can also improve your insulin sensitivity. The mechanism by which it does this is not clear, but it is consistent with the idea that losing weight leads to improved insulin sensitivity.

Caloric restriction is difficult to sustain, especially for the long term. However, it can be a viable option for improving insulin sensitivity. Some research even shows that it can be very beneficial for quality of life.

General idea: Caloric restriction works for improving insulin sensitivity, but it may be tough to deal with the rather consistent hunger.

Exercise

Exercise to improve your insulin sensitivity!

Sleep

Not getting enough sleep increases insulin resistance in as little as two days! Get plenty of sleep to improve your insulin sensitivity!

Reducing Stress

Stress hormone cortisol is negatively associated with insulin sensitivity. Stress reduction is beneficial for improving insulin sensitivity. Find something that brings you joy. Have meaningful social interactions, meditate, hug a puppy... whatever it takes, reduce that stress!

Not Smoking

Smoking is bad for you. It's bad for insulin resistance. Don't smoke.

Sunshine

Low Vitamin D is associated with increased insulin resistance. The sun is the most natural source of Vitamin D there is. Get adequate sunlight to improve your insulin sensitivity!

Summary

  • You want to be insulin sensitive. You don't want to be insulin resistant. You don't want hyperinsulinemia.
  • Insulin resistance and hyperinsulinemia are intertwined; they are associated with diseases such as type 2 diabetes, cardiovascular disease, male and female reproductive problems, Alzheimer's, certain cancers, atherosclerosis, and many more.
  • Insulin levels are better markers of disease than blood glucose levels; elevated fasting insulin levels can be detected years or decades before elevated fasting glucose levels.
  • If you aren't already being intentional about your nutrition, there is a good chance that you have elevated fasting insulin levels and are on your way to developing a metabolic disease.
  • You can easily and inexpensively get your insulin resistance tested. Everyone should do this; generally speaking, learning your insulin resistance levels lets you know your disease risk years or decades before it will be detected by mainstream medical checkups.
  • There is good news; you can do something about your insulin resistance! Diet and lifestyle play a huge role. Dietary approaches effective in improving insulin sensitivity are low carbohydrate diets, intermittent fasting, and caloric restriction. Other interventions effective at improving insulin sensitivity are exercise, getting sunshine, getting enough sleep, and stress reduction.

References that Dig Deeper

It's the Insulin, Stupid - blog series by Amy Berger
Hyperinsulinemia: A Unifying Theory of Chronic Disease? by Catherine Crofts et. al. - narrative review of hyperinsulinemia and chronic disease
Hyperinsulinemia: Best Management Practice by Catherine Crofts et. al. - narrative review of best ways to manage hpyerinsulinemia
Hyperinsulinemia and Insulin Resistance: Scope of the Problem - editorial by Jason Fung, Amy Berger
The One Test Your Doctor Isn't Doing That Could Save Your Life by Mark Hyman
Why a Low Insulin Lifestyle is Essential for Health by P.D. Magnan
Low Carb Cardiologist Podcast Episode 27 - Bret Scher and Jason Fung
BioHackers Lab Podcast Episode 42 - Gary Kirwan and Ben Bikman
A Guide to Intermittent Fasting - Ted Naiman