Interesting Articles in the AJCN

I just received an RSS alert for the American Journal of Clinical Nutrition's latest articles. This upcoming issue is full of very interesting material:

1. Dr. Neil D. Barnard reviews food consumption patterns in the US from 1909 to 2007 (1). This is something I've written about a number of times. The most notable change is that industrial seed oil use has increased by more than 3-fold in the last 40 years, and even more in the last 100 although he doesn't provide those numbers. Butter and lard use declined sharply. Meat consumption is up, but the increase comes exclusively from poultry because we're eating the same amount of red meat we always have. Grain consumption is down, although it peaked around 1900 so it may not be a fair comparison with today:

In the late 1800s, wheat flours became more popular and available due to the introduction of new [high-gluten] wheat varieties, [low extraction] milling techniques, and transport methods, and during this time new breakfast cereals were introduced by John Harvey Kellogg, CW Post, and the Quaker Oats Company. Thereafter, however, per capita availability of flour and cereal products gradually dropped as increased prosperity, improved mechanization, and transport (eg, refrigerated railway cars) increased competition from other food groups. [Then they partially rebounded in the last 40 years]

2. Dr. S.C. Larsson published a paper showing that in Sweden, multivitamin use is associated with a slightly higher risk of breast cancer (2).

3. Soy protein and isoflavones, which have been proposed to do everything from increase bone mineral density to fight cancer, are slowly falling out of favor. Dr. Z.M. Liu and colleagues show that soy protein and/or isoflavone supplementation has no effect on insulin sensitivity or glucose tolerance in a 6 month trial (3). This follows a recent trial showing that isoflavones have no effect on bone mineral density.

4. Dr. Ines Birlouez-Aragon and colleagues showed that high-heat cooked (fried and sauteed) foods increase risk factors for diabetes and cardiovascular disease (insulin resistance, cholesterol, triglycerides), compared to low-heat cooked foods (steamed, stewed) in a one-month trial (4). The high-heat diet also reduced serum levels of long-chain omega-3 fatty acids and vitamins C and E.

5. Dr. Katharina Nimptsch and colleagues showed that higher menaquinone (vitamin K2) intake is associated with a lower cancer incidence and lower cancer mortality in Europeans (5). Most of their K2 came from cheese.

6. And finally, Dr. Zhaoping Li and colleagues showed that cooking meat with an herb and spice blend reduced the levels of oxidized fat during cooking, and reduced serum and urinary markers of lipid oxidation in people eating the meat (6).

The take-home message? Eat stewed meat with herbs, but don't pre-brown it in vegetable oil. Throw out the tofu and have some artisanal cheese instead.

New Review of Controlled Trials Replacing Saturated fat with Industrial Seed Oils

Readers Stanley and JBG just informed me of a new review paper by Dr. Dariush Mozaffarian and colleagues. Dr. Mozaffarian is one of the Harvard epidemiologists responsible for the Nurse's Health study. The authors claim that overall, the controlled trials show that replacing saturated fat with polyunsaturated fat from industrial seed oils, but not carbohydrate or monounsaturated fat (as in olive oil), slightly reduces the risk of having a heart attack:

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs [how do you like the acronyms?]. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

Looking at the studies they included in their analysis (and at those they excluded), it looks like they did a very nice job cherry picking. For example:

• They included the Finnish Mental Hospital trial, which is a terrible trial for a number of reasons. It wasn't randomized, appropriately controlled or even semi-blinded*. Thus, it doesn't fit the authors' stated inclusion criteria, but they included it in their analysis anyway**. Besides, the magnitude of the result has never been replicated by better trials, not even close.
  
• They included two trials that changed more than just the proportion of SFA to PUFA. For example, the Oslo Diet-heart trial replaced animal fat with seed oils, but also increased fruit, nut, vegetable and fish intake, while reducing trans fat margarine intake! The STARS trial increased both omega-6 and omega-3, reduced processed food intake, and increased fruit and vegetable intake! These obviously aren't controlled trials isolating the issue of dietary fat substitution. If you subtract the four inappropriate trials from their analysis, which is half the studies they analyzed, the result disappears. Those four just happened to show the largest reduction in heart attack mortality...
  
• They excluded the Rose et al. corn oil trial and the Sydney Diet-heart trial. Both found a large increase in total mortality from replacing animal fat with seed oils, and the Rose trial found a large increase in heart attack deaths (the Sydney trial didn't report CHD deaths, but Dr. Mozaffarian et al. stated in their paper that they contacted authors to obtain unpublished results. Why didn't they contact the authors of this study?).

The authors claim, based on their analysis, that replacing 5% of calories as saturated fat with polyunsaturated fat would reduce the risk of having a heart attack by 10%. Take a minute to think about the implications of that statement. For the average American, that means cutting saturated fat nearly in half to 6% of energy, which is a real challenge if you want to have a semblance of a normal diet. It also means nearly doubling PUFA intake, which will come mostly from seed oils if you follow the authors' advice.

So basically, even if the authors' conclusion were correct, you overhaul your whole diet and replace natural foods with bland unnatural foods, and...? You reduce your 10-year risk of having a heart attack from 10 percent to 9 percent. Without affecting your overall risk of dying! The paper states that the interventions didn't affect overall mortality at all. That's what they're talking about here. Sign me up!


* Autopsies were not conducted in a blinded manner. Physicians knew which hospital the cadavers came from, because autopsies were done on-site. There is some confusion about this point because the second paper states that physicians interpreted the autopsy reports in a blinded manner. But that doesn't make it blinded, since the autopsies weren't blinded. The patients were also not blinded, so the study overall was highly susceptible to bias.

** They refer to it as "cluster randomized". I don't know if that term accurately applies to the Finnish trial or not. The investigators definitely didn't randomize the individual patients: whichever hospital a person was being treated in, that's the food he/she ate. There were only two hospitals, so "cluster randomization" in this case would just refer to deciding which hospital got the intervention first. Can this accurately be called randomized?

Sound the Alarm!

March 23rd is a 'wake-up' call to let people know about the seriousness of Diabetes. Take a short test to see if you or a loved one are at risk for developing Type 2 Diabetes.

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Observed on the fourth Tuesday of March (today), American Diabetes Alert Day is a one-day "wake-up" call to let Americans know about the seriousness of diabetes. Today, the 21st anniversary of this important event, the American Diabetes Association encourages people to take the Diabetes Risk Testto find out if they or their loved ones are at risk for developing type 2 diabetes. Dreamfields Pasta has sent you this email because we care about your health. And, we care about the nutritional needs of thousands of thousands of families who cook with Dreamfields daily. They know that there's more to our pasta than great taste. With the added health benefits of low digestible carbs and high fiber, Dreamfields is the pasta that the entire family can enjoy. - Join the effort to stop diabetes - Get printable version of test - Find out what's happening in your area - Tome el examen de riesgo en espa�ol

Fatty Liver: It's not Just for Grown-ups Anymore

The epidemic of non-alcoholic fatty liver disease (NAFLD) is one of my favorite topics on this blog, due to the liver's role as the body's metabolic "grand central station", as Dr. Philip Wood puts it. The liver plays a critical part in the regulation of sugar, insulin, and lipid levels in the blood. Many of the routine blood tests administered in the doctor's office (blood glucose, cholesterol, etc.) partially reflect liver function.

NAFLD is an excessive accumulation of fat in the liver that impairs its function and can lead to severe liver inflammation (NASH), and in a small percentage of people, liver cancer. An estimated 20-30% of people in industrial nations suffer from NAFLD, a shockingly high prevalence (1).

I previously posted on dietary factors I believe are involved in NAFLD. In rodents, feeding a large amount of sugar or industrial seed oils (corn oil, etc.) promotes NAFLD, whereas fats such as butter and coconut oil do not (2). In human infants, enteric feeding with industrial seed oils causes severe liver damage, whereas the same amount of fat from fish oil doesn't, and can even reverse the damage done by seed oils (3).

So basically, I think sugar and industrial oils are major contributors to NAFLD, and if you look at diet trends in the US over the last 40 years, they're consistent with the idea. Industrial oils are harmful due (at least in part) to their high omega-6 content, which is problematic partially because it disturbs normal omega-3 metabolism. A potential solution to fatty liver is to reduce sugar, replace industrial oils with natural fats, and ensure a regular source of omega-3. I've posted two anecdotes of people rapidly healing their fatty livers using diet changes* (4, 5).

I recently came across a study that examined the diet of Canadian children with NAFLD (6). The children had a high sugar intake, a typical (i.e., high) omega-6 intake, and a low omega-3 intake. The authors claimed that the children also had a high saturated fat intake, but at 10.5% of calories, they were almost eating to the American Heart Association's "Step I" diet recommendations**. Busted! Total fat intake was also low.

High sugar consumption was associated with a larger waist circumference, insulin resistance, lower adiponectin and elevated markers of inflammation. High omega-6 intake was associated with markers of inflammation. Low omega-3 intake was associated with insulin resistance and elevated liver enzymes. Saturated fat intake presumably had no relation to any of these markers, since they didn't mention it in the text.

These children with NAFLD, who were all insulin resistant and mostly obese, had diets high in omega-6, high in sugar, and low in omega-3. This is consistent with the idea that these three factors, which have all been moving in the wrong direction in the last 40 years, contribute to NAFLD.


* Fatty liver was assessed by liver enzymes, admittedly not a perfect test. However, elevated liver enzymes do correlate fairly well with NAFLD.

** Steps I and II were replaced by new diet advice in 2000. The AHA now recommends keeping saturated fat below 7% of calories. Stock up on those skinless chicken breasts! Make sure there isn't any residual fat sticking to the meat, it might kill you. I do have to give the AHA credit however, because their new recommendations focus mostly on eating real food rather than avoiding saturated fat and cholesterol.

7 Really Easy Ways to Save Money at the Grocery Store

And none require buying anything day old or suspiciously on sale. In fact, a few simple shopping adjustments will really make a difference to your wallet. Here are my favorites:  

1. Shop the Outer Aisles

In most markets you'll find the healthiest ingredients on the perimeter of the store�fresh fruits and vegetables, lean proteins including fish and chicken, and fat-free and low-fat dairy products. The inner aisles contain most of the processed foods, including soda, candy, chips, and snack foods. Aside from the fact that they contain empty calories, they also take a big (and unnecessary) bite from your food budget.

2. Buy in Bulk

Bulk items are usually cheaper. That�s because there�s no expensive packaging included, so those savings are passed directly on to you. You also have the freedom to choose how much or how little to buy. Best buys include whole grains, dried beans and legumes, nuts and seeds, and cereals. Some health food stores sell spices in bulk as well.

3. Go Seasonal

Out-of-season fruits and vegetables are sometimes imported, expensive, and often tasteless. Plan menus and choose recipes around what's currently in season. You�ll enjoy better flavor and lower prices anytime of year. (And yes, there is good in-season produce in late winter�citrus fruit, anyone?)

4. Shop Locally

Local grocers carry plenty of regional produce. Farmers� markets are a great source for healthy bargains too.

5. Grow Your Own

Slash your spending even further by supplementing your produce purchases with homegrown items. If you don�t have space for a garden, you can at least grow your own herbs. Plant your favorites in small pots near the kitchen. Take a snip or two as needed.

6. Make It from Scratch

Yes, it takes a little more time, but preparing a dish at home rather than picking up a pre-made version can save up to 50% or more. It also ensures your dish is healthier because you dictate the amount of oil or salt it contains. And best of all, this guarantees no hidden preservatives.

7. Load Up on Legumes

Beans and legumes offer a myriad of health benefits as diverse as their varieties. Black beans, garbanzos, pintos�they�re all excellent sources of fiber. They�re also rich in folic acid, calcium, iron, potassium, zinc, and antioxidants. The complex carbohydrates they contain provide steady energy that lasts well beyond mealtime. A stellar source of protein, legumes may be the biggest money saver of all, as they cost a fraction of the price of most animal proteins.

10 Ways to feed your family for $100 a week!

With planning and a little more time in the kitchen, you can stick to your budget without sacrificing taste or nutrition. Here are 10 tips that can help you feed your family for about a hundred bucks a week.
1. Plan in Advance

Create the week's menu, but leave some room for flexibility. The most important step in sticking to a weekly budget is to come up with a plan for every meal, snack, and beverage you'll need for 7 days. Make sure you account for every item you put in your cart. This will keep you from adding expensive impulse buys that may go to waste.


2. Steer Clear of Convenience

Check your grocery store's weekly circular for discounts and coupons. These specials can be a starting point to plan your meals for the week. Foods packaged for convenience, such as individually boxed raisins, juice, and yogurt, are a no-no for those on a tight budget, says nutritionist Elizabeth Somer, RD, author of 10 Habits That Mess Up a Woman's Diet. Ditto for those 100-calorie packs of cookies. Marinate your own meat instead of buying the premarinated, packaged kind. Swap out those milk or juice boxes in your child's lunch for a Thermos. These options are all less expensive, and the reduction in packaging is better for the environment.


3. Be Brand Blind

If the peanut butter you usually buy is not on sale, but its competitor is, go for the cheaper one. Being flexible with brands lets you score the best deals. Be open to store brands as well. They�re typically the least expensive option for most canned, packaged, and frozen foods and usually taste just as good as their brand-name counterparts.



4. Use Coupons...Wisely - Click coupon links to the left in sidebar

Manufacturers put out 285 billion coupons last year, according to coupon processor NCH, but only a fraction of them are worth using. Many may lead you to purchase unnecessary�and often unhealthy�items loaded with artificial colors, preservatives, and sugar. Your best bet is to use coupons for household staples like beans, yogurt, spaghetti sauce, and pasta. Some of the best coupons can be found for vitamins, cleaning products, laundry detergent, and toiletries such as toothpaste, she says.



5. Consider Your Alternatives

Although that big grocery store may be the most convenient place to shop, it's not necessarily the cheapest. Check out ethnic markets, bag-your-own-warehouses, and farmers� markets, which can often yield better buys on produce, meat, eggs, milk, and fish. Don't rule out deals at a drugstore, either. With reward cards and coupons, you can often score big deals on cereal, granola bars, and beverages.



6. Don't Dismiss the Deep Freeze

When certain fruits or vegetables move out of season or go up in price, consider buying bags of inexpensive frozen produce instead. Growers flash freeze their harvest at its peak, which locks in most of the nutrients. Plus, there's the bonus of not having to wash, peel, or chop them yourself. Frozen veggies make quick, convenient additions to soups and stews, pasta, or rice dishes.



7. Put On Your Apron

One of the easiest ways to eat well on a tight budget is to make some ingredients yourself. If you have a bread maker buried at the bottom of a cabinet, haul it out, and you can cut at least $3 from your budget for each store-bought loaf. Likewise, making your own juice ice pops, salad dressing, hummus, granola, and desserts can shave money off the bottom line without making you feel deprived.



8. Become a Flexitarian

One of the healthiest ways to save money is to swap meat for beans as your protein source a few meals a week. Packed with high amounts of protein, fiber, and antioxidants, beans are one of the healthiest foods out there. They are also one of the cheapest items in the grocery store, especially if you buy them dry and soak and cook them yourself. Try them in burritos, soups, chili, and salads.

Cutting back on meat is not just good for your wallet, it's good for your health as well. Most Americans far exceed the recommended meat and protein allowances for our diet, and with that meat can come unwanted saturated fat.



9. Leftovers Again!

Use last night�s dinner to make tonight�s meal�one of the easiest ways to cut your grocery bill is simply by reducing the amount of food you throw out. Leftover meat can become a base for soup or stew for the next night's dinner. Or serve it on whole grain bread for lunch the next day. Extra vegetables can be paired with eggs to make a frittata or added to tofu for a stir-fry dinner.

Store leftovers in clear containers where you can see them to keep them top of mind�and out of the trash. If the fresh fruit or vegetables in your crisper are in danger of going bad, chop them and freeze for later.



10. Go Less and Buy More

Make fewer trips and buy more of the basics

The fewer times you go to the market, the fewer opportunities there are to fill your cart with impulse buys. Stick to your list and buy a little bit more than you think you need of the basics like milk, bread, and fruit. Most people underestimate how much they will use over the course of a week, say experts.

Ten Minutes About Pesach

Book Review: The Primal Blueprint

Mark Sisson has been a central figure in the evolutionary health community since he began his weblog Mark's Daily Apple in 2006. He and his staff have been posting daily on his blog ever since. He has also written several other books, edited the Optimum Health newsletter, competed as a high-level endurance athlete, and served on the International Triathlon Union as the anti-doping chairman, all of which you can read about on his biography page. Mark is a practice-what-you-preach kind of guy, and if physical appearance means anything, he's on to something.

In 2009, Mark published his long-awaited book The Primal Blueprint. He self-published the book, which has advantages and disadvantages. The big advantage is that you aren't subject to the sometimes onerous demands of publishers, who attempt to maximize sales at Barnes and Noble. The front cover sports a simple picture of Mark, rather than a sunbaked swimsuit model, and the back cover offers no ridiculous claims of instant beauty and fat loss.

The drawback of self-publishing is it's more difficult to break into a wider market. That's why Mark has asked me to publish my review of his book today. He's trying to push it up in the Amazon.com rankings so that it gets a broader exposure. If you've been thinking about buying Mark's book, now is a good time to do it. If you order it from Amazon.com on March 17th, Mark is offering to sweeten the deal with some freebies on his site Mark's Daily Apple. Full disclosure: I'm not getting anything out of this, I'm simply mentioning it because I was reviewing Mark's book anyway and I thought some readers might enjoy it.

The Primal Blueprint is not a weight loss or diet book, it's a lifestyle program with an evolutionary slant. Mark uses the example of historical and contemporary hunter-gatherers as a model, and attempts to apply those lessons to life in the 21st century. He does it in a way that's empowering accessible to nearly everyone. To illustrate his points, he uses the example of an archetypal hunter-gatherer called Grok, and his 21st century mirror image, the Korg family.

The diet section will be familiar to anyone who has read about "paleolithic"-type diets. He advocates eating meats including organs, seafood, eggs, nuts, abundant vegetables, and fruit. He also suggests avoiding grains, legumes, dairy (although he's not very militant about this one), processed food in general, and reducing carbohydrate to less than 150 grams per day. I like his diet suggestions because they focus on real food. Mark is not a drill sergeant. He tries to create a plan that will be sustainable in the long run, by staying positive and allowing for cheats.

We part ways on the issue of carbohydrate. He suggests that eating more than 150 grams of carbohydrate per day leads to fat gain and disease, whereas I feel that position is untenable in light of what we know of non-industrial cultures (including some relatively high-carbohydrate hunter-gatherers). Although carbohydrate restriction (or at least wheat and sugar restriction) does have its place in treating obesity and metabolic dysfunction in modern populations, ultimately I don't think it's necessary for the prevention of those same problems, and it can even be counterproductive in some cases. Mark does acknowledge that refined carbohydrates are the main culprits.

The book's diet section also recommends nutritional supplements, including a multivitamin/mineral, antioxidant supplement, probiotics, protein powder and fish oil. I'm not a big proponent of supplementation. I'm also a bit of a hypocrite because I do take small doses of fish oil (when I haven't had seafood recently), and vitamin D in wintertime. But I can't get behind protein powders and antioxidant supplements.

Mark's suggestions for exercise, sun exposure, sleep and stress management make good sense to me. In a nutshell: do all three, but keep the exercise varied and don't overdo it. As a former high-level endurance athlete, he has a lot of credibility here. He puts everything in a format that's practical, accessible and empowering.

I think The Primal Blueprint is a useful book for a person who wants to maintain or improve her health. Although we disagree on the issue of carbohydrate, the diet and lifestyle advice is solid and will definitely be a vast improvement over what the average person is doing. The Primal Blueprint is not an academic book, nor does it attempt to be. It doesn't contain many references (although it does contain some), and it won't satisfy someone looking for an in-depth discussion of the scientific literature. However, it's perfect for someone who's getting started and needs guidance, or who simply wants a more comprehensive source than reading blog snippets. It would make a great gift for that family member or friend who's been asking how you stay in such good shape.

Chushah l�ezrati - Make haste to help me!

OFTEN THE ONLY PRAYER we have is "Help!" I use this one on a daily basis, that is, whenever I am confronted with the truth of my condition.

The word translated "hasten" comes from the Hebrew word "chush," which means to hurry,

to act quickly, or to come quickly. The Psalms often plead urgently, "hasten to help

me" (chushah l�ezrati).

An old Jewish prayer says, "O ETERNAL, I know that you will help us; but will you help us before you will help us?"

Although the ETERNAL sometime tarries, He declares, "I am SOVERIEGN; in its time I will hasten

it" (Isa. 60:22). But still the anxious heart sighs, �Is it time, ETERNAL? Will you now restore

the kingdom to Israel?� But as Yahushua said, "It is not for you to know times or seasons that the Father has fixed by his own authority" (Acts 1:6-7). We are left waiting for the ultimate Elohim�s answer: His glorious coming to fulfill our salvation.

Living in the �already-not-yet� state of redemption is a soul-building venture that helps us

to acquire the precious middah (quality) of patience: 

"In your patience possess ye your souls" (Luke 21:19).

Suffering produces endurance (Rom. 5:3), but the ETERNAL surely is faithful "to keep you from falling, and to present you faultless before the presence of his glory with exceeding

joy" (Jude 1:24). May He come speedily, and in our day. Omein.

Morning Prayer - Modeh Ani

When we wake in the morning, YHWH graciously restores our soul (neshamah or nefesh) within us in order to experience another day of life. This awakening is an analog of the resurrection from the dead:

Just as YHWH revives us from the depths of our sleep and enables our eyes to once again receive light, so will He ultimately revive the dead from their state and bring them into the glorious presence of His Light. The Modeh Ani, one of the first blessings a Jewish child is taught, expresses gratitude to YHWH for the gift of a new day of life.

Modeh ani l�faneykha, melech chai vekaiyam,

shehechezarta bi nishmati bechemlah, rabbah emunatekha.

I thank you, living and eternal King,

for returning my soul within me in compassion,

great is your faithfulness.

Interview on Bizymoms

I recently did a written interview for the website Bizymoms.com. It was the first time I had been invited to do an interview, so I figured what the heck. They bravely posted the interview, despite the fact that my responses could be seen as controversial. You can find it here.

Shabbat Shalom Mishpochah!

Co-op offers Passover foods

Many  Jews find it challenging to prepare meals for the Passover holiday, beginning March 29, because of the temporary dietary restrictions Passover creates.

Last year members of the Chapel Hill Kehillah Synagogue found a solution, and they are bringing it back with their second annual "Passover Ko-oP."

They have worked with national vendors to bring a wide variety of reasonably priced Passover items to the Triangle while helping needy families and raising money for their religious school.

For a Ko-oP joining fee that is 18 percent of the order up to $36, community members can select kosher Passover items from a catalog featuring a variety of candies, desserts, matzo, teas, cake mixes, jams, gefilte fish and wine. Most are below retail price.

Included on the order form is an option to donate a basket of Passover food or a monetary amount to a needy Jewish family through Jewish Family Services of Durham-Chapel Hill or Jewish Family Services of Raleigh-Cary. Every year, both organizations distribute Passover baskets to local families so that everyone will be able to celebrate the holiday.

Friday is the deadline for placing orders that can be picked up March 21.

The reason Passover food is different from all other foods lies in the story of the biblical exodus of the Jewish people from slavery in Egypt. Because they had so little time to prepare for their leaving, bread had no time to rise, resulting in a flat, crackerlike food called matzo. To commemorate the eight-day festival of Passover, Jews eat matzo and avoid leavened foods, grains and other foods that have historically been used to make bread products.

These temporary dietary restrictions leave  Jews searching for special food for the holiday.

Whole Wheat Matzo

Look what I found!  Whole Foods Market Kosher for Pesach-
Whole Foods Market grocery and meat purchasing teams have been hard at work making our stores a Passover destination. We know that many of our customers are looking for kosher for Passover products that meet our strict quality standards for packaged foods that are free of artificial preservatives, colors, flavors, sweeteners and hydrogenated fats. We also know you are looking for kosher poultry that weren�t given antibiotics in their feed and were raised with plenty of room to roam around. Meeting all of these requirements can be quite a challenge, but we persevered and made it happen for you!


Did you know that many kosher suppliers still use artificial preservatives and other ingredients that we do not allow in our products? Our grocery buyers partnered with kosher food producers to help them reformulate their products and then our stores and customers provide a market for their natural products. In December, we blogged about our partnership with Streit�s, the only family owned and operated Matzo producer in the U.S, who have now removed the artificial additives and preservatives from many of their products. Our partnership with Streit�s is having a nice ripple effect on the kosher food industry as a whole. Andrew Lansman, head of kosher distributor A&L Foods, says: �Five years ago, kosher manufacturers didn�t even care about being all natural. Now, most are trying to reformulate their product line so they can be all natural. Many new items have been developed because of Whole Foods Market�s influence, including many whole grain and organic products.�


Aviv Organic Matzo


Certified organic, this traditional recipe is crafted with organic whole wheat flour and water. Exclusively available at Whole Foods Market.

Yehuda Organic and Whole Wheat Matzo




Yehuda Matzo is a favorite for Passover. With a great flavor and a crisp crunch it�s also good for matzo brei! Choose from Organic, Whole Wheat, Minis and egg. Exclusively available at Whole Foods Market.

Are you Smarter than a 10 year old Passover Dilemma

Pesach and Diabetes - What to Do?

Pesach (Passover) is coming and I was  so sure that it will be impossible to get through the very popular matzo, potato and egg holiday.I have decided to start looking for solutions and substitutions for traditional ingredients. Living a Torah Observant lifestyle does not have to mean living unhealthy�in fact, quite the opposite. We have a Torah commandment to "take very good care of ourselves" (Deuteronomy 4:15).  We do not live the life that was lived one hundred years ago so we cannot expect to get away with eating many of the foods that they ate�most of theirs got worked off throughout the day�we hardly move and our present day foods are terribly refined.

Our eating requirements are intimately bound up with our religion, culture, and ethnic identity. Food is the focus of Passover, especially the Seder, which is the ceremonial meal eaten on the first two nights of Passover to commemorate the exodus of the Jews from Egypt. The issues at Passover for people with diabetes are the amounts and different foods and the change in schedule, eating late at night. A Torah Observant person with diabetes needs to learn how to navigate their way through all these eating opportunities, and stay in control of their blood sugar levels.

Go and try to explain to a doctor why you absolutely have to have 4 cups of wine at one meal and a given amount of matzah. Do you know what havoc FOUR CUPS of WINE will do to a diabetics glucose levels?

Not to mention the Matzah that we must eat throughout the 7 days of the feast. OH MY, what a challendge! But Elohim is merciful and I am on a quest to find the healthy alternatives that my family and I will use this year. I will post my finds for you to enjoy.

Jewish Diabetes Association  Pesach Newsletter Version (PDF) � 19 pages

Vitamin D May Prevent Flu and Asthma

The AJCN just published a new controlled trial evaluating the effectiveness of vitamin D supplements on flu and asthma (1). Dr. Hiroyuki Ida's group gave Japanese schoolchildren (10 years average age) 1,200 IU of vitamin D3 or placebo per day from December through March. They found that children taking vitamin D had a significantly lower incidence of influenza A but not influenza B. These are two strains of flu that each accounted for roughly half the flu incidence in this population. Sadly, if you add the total flu incidence for A and B together (which the authors don't do in their tables), vitamin D supplementation didn't reduce total flu incidence significantly.

They also found that in the subset of children not already taking vitamin D supplements, the effect was greater, with unsupplemented children contracting nearly three times as many influenza A infections as children receiving vitamin D. They didn't analyze the influenza B or total influenza incidence in that way, so we don't know if prior supplementation makes a difference there.

The most striking finding of the paper is that the vitamin D group suffered from 6 times fewer asthma attacks than the placebo group. This needs to be repeated but it's consistent with other data and I find it very encouraging.

The paper did have some limitations. They didn't measure vitamin D status so they have no way to know exactly how effective their pill-based supplements were.

Another problem is that they began collecting data immediately after beginning supplementation. Vitamin D is a fat-soluble vitamin that can take 3 months to reach maximum concentration in the body following supplementation. By the time the children were reaching their maximum serum concentration of vitamin D, the trial was over. It would be nice to see the next trial begin supplementation in the fall and look at flu incidence in the winter.

This paper comes on the heels of another showing that vitamin D is necessary for the activation of an immune cell called the killer T cell (2). These are important for resistance to infections and cancer. Overall, these papers add to the accumulating evidence that vitamin D is important for the proper functioning of the human immune system. However, mice may not be the best model for use in studying vitamin D biology. From the first paper:

The evolution of different mechanisms for the regulation of PLC-?1 activity in human and mouse T cells parallels the development of divergent VDR-dependent and VDR-independent antimicrobial pathways in human and mouse macrophages31, respectively, and may reflect the fact that mice are nocturnal animals with fur and humans are daytime creatures that synthesize vitamin D in the skin after exposure to ultraviolet light.

In other words, mice don't use vitamin D in the same way as humans because they have a different evolutionary relationship to it.

Diabetes attacked my family!

Recently my husband fell very, very ill. We did not know what was wrong with him. Brother B (as he is affectionately known) is a Personal Fitness Trainer, who exercises daily and has always been in great shape. Never sick with anything more than an occasional cold or maybe sinus problem, he is a picture of health. Over the past few months he had gained weight, but no one thought anything about it.

Then, it began... He was feeling tire and excessively thirsty. His appetite went away and he lost 30 pounds in about two weeks. There was a foul odor on his breathe and my wonderful mother decided to come over and take his blood glucose level. It was over 600! We went to the doctor the next morning and of course, it was the Big "D" - Type 1 Diabetes.

He was put on four insulin shots per day and an oral medication. His diet had to change and all the family as well. It took two weeks after the initial diagnosis to regain a sense of normalcy and to balance his glucose level.

All "white" foods had to be iliminated, including our weekly Shabbat Challah! Oh my, what that did to our Torah observant, shabbat keeping, bread eating family. I went on a quest to find an alternative whole wheat Challah that I could make in my bread machine. HalleluYAH, I found an alternative.

Join our "Bread from Heaven" group

All of our pasta is now whole wheat and we love it. My children enjoy eating in our new manner and I feel as if I am giving everyone the best that I can. The Torah gives us a blue print for healthy eating and I am following it.

In my research I found several natural herbs that are historically used for the treatment of diabetes. Gymnema Sylvestre is the one that I started my husband on immediately and now he is down to one insulin shot per day. I say Todah to YHWH daily for His mercy and insight into the herbs of the field.

(Psa 104:14) He causeth the grass to grow for the cattle, and herb for the service of man: that he may bring forth food out of the earth;

A False Dichotomy

In the discussion section of the last post, the eternal argument about non-industrial people arose: were their lives (a) "nasty, brutish and short" (Hobbes), or were they (b) "noble savages" (Shaftesbury) living in Eden? The former argument states that they had awful lives, and we should be glad we're living int he 21st century. The latter argument implies that we should emulate them as much as possible. Each side is bursting with anecdotes to support their position.

Any time the discussion reaches this point, it stops providing us anything useful. The argument is a false dichotomy, one in which neither answer is correct. The correct answer is (c): none of the above. Some aspects of hunter-gatherer life are preferable to ours, and some aspects of our lives are preferable to theirs. Understanding that we spent a lot of evolutionary time as hunter-gatherers, as well as a few thousand years in small, tightly knit agricultural communities, may be useful in understanding how to work constructively with our own bodies and minds in the modern world.

So please, let's leave behind the false dichotomy and foster a more nuanced understanding of hunter-gatherer life.

The Paleolithic Mind

I went to a meditation retreat this week with the Red Cedar Zen community in Bellingham. It was a good experience. Staring at a wall from 6 am to 9 pm for a few days gives you the opportunity to learn a few things about your mind. Some of these are things you already know on some level, but you just need to have them reinforced. For example, the weight of psychological stress that we carry in modern societies like the US. It's only when it goes away for a while that you can see how heavy it was.

I'm totally ignorant of the scientific literature on this, but the way I see it, there are at least two main sources of psychological stress in the modern world for which we aren't well equipped as human beings:

• Being eternally and inescapably subordinate in a large social structure
• Having too many responsibilities such as possessions and obligations

I recently read an excellent article by Michael Finkel in National Geographic magazine on the Hadza of Tanzania. The Hadza are a hunter-gatherer group living in a way that may resemble how our ancestors lived for most of the last million years. Here are a few characteristics of the Hadza lifestyle as described by the author:

The Hadza do not engage in warfare [although they do have homicide]. They've never lived densely enough to be seriously threatened by an infectious outbreak. They have no known history of famine; rather, there is evidence of people from a farming group coming to live with them during a time of crop failure. The Hadza diet remains even today more stable and varied than that of most of the world's citizens. They enjoy an extraordinary amount of leisure time. Anthropologists have estimated that they "work"�actively pursue food�four to six hours a day. And over all these thousands of years, they've left hardly more than a footprint on the land.

This isn't intended to idealize their lifestyle, but to point out that being a hunter-gatherer has its advantages. One of these is a minimal social structure in which each person is has full authority over himself:

The Hadza recognize no official leaders. Camps are tra�ditionally named after a senior male (hence, Onwas's camp), but this honor does not confer any particular power. Individual autonomy is the hallmark of the Hadza. No Hadza adult has authority over any other. None has more wealth; or, rather, they all have no wealth. There are few social obligations�no birthdays, no religious holidays, no anniversaries.

Even "marriage" doesn't carry much obligation. The author describes the Hadza as "serial monogamists". The idea of an eternal bond between two individuals doesn't exist. Women are not subordinate to men:

Gender roles are distinct, but for women there is none of the forced subservience knit into many other cultures. A significant number of Hadza women who marry out of the group soon return, unwilling to accept bullying treatment. Among the Hadza, women are frequently the ones who initiate a breakup�woe to the man who proves himself an incompetent hunter or treats his wife poorly. In Onwas's camp, some of the loudest, brashest members were women.

Contrast this with modern civilizations in which everyone has a boss-- whether it's at a job, in a marriage or under your country's legal system. I think this feeling of perpetual subordination is destructive to an animal such as ourselves, that has spent so much of its existence mostly free of these pressures.

The author says this about their possessions:

Traditional Hadza, like Onwas and his camp mates, live almost entirely free of possessions. The things they own�a cooking pot, a water container, an ax�can be wrapped in a blanket and carried over a shoulder.

This resembles other African hunter-gatherer groups that have few and simple tools. From the book The !Kung San: Men, Women and Work in a Foraging Society:

!Kung tools are few in number, lightweight, made from locally available materials, and multipurpose.

Again, this is in sharp contrast to the modern world, where we have so many belongings it's impossible to keep track of them all. We have giant houses that we "need" to store all these things, and still it doesn't seem like enough. Many of our possessions are indispensable if we want to fit in to society. We need (or feel we need) clothes, cookware, identification, money, transportation, furniture, tools, sports gear, et cetera. Having to be responsible for this extraordinary quantity of possessions (by evolutionary standards) is a heavy weight on our minds.

Unfortunately, we have more than just possessions on our minds. To live in the modern world is to be pricked to death by a thousand small responsibilities. Remember to make your lunch. Remember to make a doctor's appointment, shop for groceries, tie your shoes, get your oil changed, send that e-mail, make dinner, go for a jog, vacuum the floor, take a shower, pick up the kids-- the list is endless. Are our memories as defective as we think they are, or are we simply not designed to keep track of so many details?

In hunter-gatherer times, we had stress. Homicide, accidents, infectious disease and predation were always stalking us. But it was a totally different kind of stress-- it was occasional, powerful and brief rather than a constant flow of obligations clogging the paths of our minds. Most days were leisurely, with plenty of time for gossiping, staring at the clouds and dozing off.

Those times are gone for us, but perhaps keeping them in mind can help us live more constructively in the modern world. I find that meditation helps keep the thousand pricks of modern life in perspective, perhaps bringing my mind closer to the paleolithic state.

Book Review: S.P.E.E.D.

This book was sent to me by Matt Schoeneberger, who co-authored it with Jeff Thiboutot. Both have master's degrees in exercise science and health promotion. S.P.E.E.D. stands for Sleep, Psychology, Exercise, Environment and Diet. The authors have attempted to create a concise, comprehensive weight loss strategy based on what they feel is the most compelling scientific evidence available. It's subtitled "The Only Weight Loss Book Worth Reading". Despite the subtitle that's impossible to live up to, it was an interesting and well-researched book. It was a very fast read at 205 large-print pages including 32 pages of appendices and index.

I really appreciate the abundant in-text references the authors provided. I have a hard time taking a health and nutrition book seriously that doesn't provide any basis to evaluate its statements. There are already way too many people flapping their lips out there, without providing any outside support for their statements, for me to tolerate that sort of thing. Even well-referenced books can be a pain if the references aren't in the text itself. Schoeneberger and Thiboutot provided appropriate, accessible references for nearly every major statement in the book.

Chapter one, "What is a Healthy Weight", discusses the evidence for an association between body weight and health. They note that both underweight and obesity are associated with poor health outcomes, whereas moderate overweight isn't. While I agree, I continue to maintain that being fairly lean and appropriately muscled (which doesn't necessarily mean muscular) is probably optimal. The reason that people with a body mass index (BMI) considered to be "ideal" aren't healthier on average than people who are moderately overweight may have to do with the fact that many people with an "ideal" BMI are skinny-fat, i.e. have low muscle mass and too much abdominal fat.

Chapter 2, "Sleep", discusses the importance of sleep in weight regulation and overall health. They reference some good studies and I think they make a compelling case that it's important. Chapter 3, "Psychology", details psychological strategies to motivate and plan for effective weight loss.

Chapter 4, "Exercise", provides an exercise plan for weight loss. The main message: do it! I think they give a fair overview of the different categories of exercise and their relative merits, including high-intensity intermittent training (HIIT). However, the exercise regimen they suggest is intense and will probably lead to overtraining in many people. They recommend resistance training major, multi-joint exercises, 1-3 sets to muscular failure 2-4 days a week. I've been at the higher end of that recommendation and it made my joints hurt, plus I was weaker than when I strength trained less frequently. I think the lower end of their recommendation, 1 set of each exercise to failure twice a week, is more than sufficient to meet the goal of maximizing improvements in body composition in most people. My current routine is one brief strength training session and one sprint session per week (in addition to my leisurely cycle commute), which works well for me on a cost-benefit level. However, I was stronger when I was strength training twice a week and never going to muscular failure (a la Pavel Tsatsouline).

Chapter 5, "Environment", is an interesting discussion of different factors that promote excessive calorie intake, such as the setting of the meal, the company or lack thereof, and food presentation. While they support their statements very well with evidence from scientific studies, I do have a lingering doubt about these types of studies: as far as I know, they're all based on short-term interventions. Science would be a lot easier if short-term always translated to long term, but unfortunately that's not the case. For example, studies lasting one or two weeks show that low glycemic index foods cause a reduction in calorie intake and greater feelings of fullness. However, this effect disappears in the long term, and numerous controlled trials show that low glycemic index diets have no effect on food intake, body weight or insulin sensitivity in the long term. I reviewed those studies here.

The body has homeostatic mechanisms (homeostatic = maintains the status quo) that regulate long-term energy balance. Whether short-term changes in calorie intake based on environmental cues would translate into sustained changes that would have a significant impact on body fat, I don't know. For example, if you eat a meal with your extended family at a restaurant that serves massive portions, you might eat twice as much as you would by yourself in your own home. But the question is, will your body factor that huge meal into your subsequent calorie intake and energy expenditure over the following days? The answer is clearly yes, but the degree of compensation is unclear. Since I'm not aware of any trials indicating that changing meal context can actually lead to long-term weight loss, I can't put much faith in this strategy (if you know otherwise, please link to the study in the comments).

Chapter 6, "Diet", is a very brief discussion of what to eat for weight loss. They basically recommend a low-calorie, low-carb diet focused on whole, natural foods. I think low-carbohydrate diets can be useful for some overweight people trying to lose weight, if for no other reason than the fact that they make it easier to control appetite. In addition, a subset of people respond very well to carbohydrate restriction in terms of body composition, health and well-being. The authors emphasize nutrient density, but don't really explain how to achieve it. It would have been nice to see a discussion of a few topics such as organ meats, leafy greens, dairy quality (pastured vs. conventional) and vitamin D. These may not help you lose weight, but they will help keep you healthy, particularly on a calorie-restricted diet. The authors also recommend a few energy bars, powders and supplements that I don't support. They state that they have no financial connection to the manufacturers of the products they recommend.

I'm wary of their recommendation to deliberately restrict calorie intake. Although it will clearly cause fat loss if you restrict calories enough, it's been shown to be ineffective for sustainable, long-term fat loss over and over again. The only exception is the rare person with an iron will who is able to withstand misery indefinitely. I'm going to keep an open mind on this question though. There may be a place for deliberate calorie restriction in the right context. But at this point I'm going to require some pretty solid evidence that it's effective, sustainable, and doesn't have unacceptable side effects.

The book contains a nice bonus, an appendix titled "What is Quality Evidence"? It's a brief discussion of common logical pitfalls when evaluating evidence, and I think many people could benefit from reading it.

Overall, S.P.E.E.D. was a worthwhile read, definitely superior to 95% of fat loss books. With some caveats mentioned above, I think it could be a useful resource for someone interested in fat loss.