Celiac and Fat-Soluble Vitamins

One of the things I've been thinking about lately is the possibility that intestinal damage due to gluten grains (primarily wheat) contributes to the diseases of civilization by inhibiting the absorption of fat-soluble vitamins. If it were a contributing factor, we would expect to see a higher incidence of the common chronic diseases in newly-diagnosed celiac patients, who are often deficient in fat-soluble vitamins. We might also see a resolution of chronic disease in celiac patients who have been adhering faithfully to a long-term, gluten-free diet.

One thing that definitely associates with celiac disease is bone and tooth problems. Celiac patients often present with osteoporosis, osteopenia (thin bones), cavities or tooth enamel abnormalities (thanks Peter).

An Italian study showed that among 642 heart transplant candidates, 1.9% had anti-endomyosal antibodies (a feature of celiac), compared with 0.35% of controls. That's more than a 5-fold enrichment! The majority of those patients were presumably unaware of their celiac disease, so they were not eating a gluten-free diet.

Interestingly, celiac doesn't seem to cause obesity; to the contrary. That's one facet of modern health problems that it definitely does not cause.

The relationship between cancer and celiac disease is very interesting. The largest study I came across was conducted in Sweden using retrospective data from 12,000 celiac patients. They found that adult celiac patients have a higher overall risk of cancer, but that the extra risk disappears with age. The drop in cancer incidence may reflect dropping gluten following a celiac diagnosis. Here's another study showing that the elevated cancer risk occurs mostly in the first year after diagnosis, suggesting that eliminating gluten solves the problem. Interestingly, celiac patients have a greatly elevated risk of lymphoma, but a lower risk of breast cancer.

There's a very strong link between celiac and type I diabetes. In a large study, 1 in 8 type I diabetic children had celiac disease. This doesn't necessarily tell us much since celiac and type I diabetes are both autoimmune disorders.

One last study to add a nail to the coffin. Up to this point, all the studies I've mentioned have been purely observational, not able to establish a causal relationship. I came across a small study recently which examined the effect of a high-fiber diet on vitamin D metabolism in healthy (presumably non-celiac) adults. They broke the cohort up into two groups, and fed one group 20g of bran in addition to their normal diet. The other group got nothing extra. The bran-fed group had a vitamin D elimination half-life of 19.5 days, compared to 27.5 for the control group. In other words, for whatever reason, the group eating extra bran was burning through their vitamin D reserves 30% faster than the control group.

Unfortunately, the paper doesn't say what kind of bran it was, but it was probably wheat or oat (**Update- it's wheat bran**). This is important because it would determine if gluten was involved. Either way, it shows that something in grains can interfere with fat-soluble vitamin status, which is consistent with the staggering negative effect of refined wheat products on healthy non-industrialized cultures.

Add to this the possibility that many people may have some degree of gluten sensitivity, and you start to see a big problem. All together, the data are consistent with gluten grains interfering with fat-soluble vitamin status in a subset of people. As I discussed earlier, this could contribute to the diseases of civilization. These data don't prove anything conclusively, but I do find them thought-provoking.

Thanks to Dudua for the CC photo

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Two Things That Get on My Nerves, Part II

Confusing Correlation and Causation

Recently, a paper was published that examined the association between sleep duration and the risk of death. Ferrie et al. showed that in their study population, subjects who slept either more or less than 7 hours a night had an increased overall risk of death. Here's how it was reported in Medical News Today:

Too Little Or Too Much Sleep Increases Risk Of Death

And here's a gem of a quote from one of the study's authors (excerpt from the article above):

In terms of prevention, our findings indicate that consistently sleeping around 7 hours per night is optimal for health and a sustained reduction may predispose to ill-health.

There's only one small problem: the study indicated no such thing. What the study showed is that people who sleep more or less than 7 hours tend to die more often than people who don't, not that the lack or excess of sleep caused the increased mortality. Have you ever noticed that you sleep more when you're not feeling well? Have you ever noticed that you sleep less when you're stressed? Could the increased mortality and sleep disturbances both be caused by some other factor(s), rather than one causing the other? We don't know, because the nature of the study doesn't allow us to answer that question!

The message the public ends up hearing is that no matter what feels right for your body, 7 hours of sleep is the optimum for health. Even though you'll have to go to work with bags under your eyes, feeling like crap, it's healthy. Even though you have the flu, you'd better not sleep more because it might give you a heart attack. I find that conclusion difficult to swallow.

The only way we could say that 7 hours of sleep is the healthiest amount (for the "average" person), would be to do an "intervention study", in which the subjects are manipulated rather than simply observed. Here's how it would work: we would take a large group of people and randomly assign them to either 5, 7 or 9 hours of sleep a night. We would then look at mortality over the course of the next few years, and see who dies more.

Intervention studies are the only way to establish causality, rather than simple association. At the end of our study, we could rightfully say that X amount of sleep causes an increase or decrease in mortality. Obviously, these types of studies are challenging and expensive to conduct, so it's tempting to over-interpret observational studies like the one I mentioned initially.  These studies are useful, but should be taken with a grain of salt.

This has to be one of the gravest, most frequent mistakes in the realm of health research and reporting. So many of the health recommendations we get from the media, the government, and even scientists are entirely based on associations! 

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Two Things that Get on My Nerves, Part I

The "Thrifty Gene" Hypothesis

The thrifty gene hypothesis is the darling of many obesity researchers. It was proposed in 1962 by the geneticist James V. Neel to explain the high rates of obesity in modern populations, particularly modernizing American Indians. It states that our species evolved under conditions of frequent starvation, so we're designed to store every available calorie. In today's world of food abundance, our bodies continue to be thrifty and that's why we're fat.  You practically can't read a paper on overweight without seeing an obligatory nod to the thrifty gene hypothesis. The only problem is, it doesn't make much sense.

The assumption that hunter-gatherers and non-industrial agriculturalists lived under chronic calorie deprivation isn't well supported. The anthropological evidence indicates that most hunter-gatherers had abundant food, most of the time. They did have fluctuations in energy balance, but the majority of the time they had access to more calories than they needed. Yet they were not fat.

The Kitavans are a good example. They are a horticultural society that eats virtually no grains or processed food. In Dr. Staffan Lindeberg's studies, he has determined that overweight is virtually nonexistent among them, despite an abundant food supply.

The cause of obesity is not the availability of excess calories, it's the deregulation of the bodyweight homeostasis system. We have a very sophisticated set of feedback loops that "try" to maintain a healthy weight. It's composed of hormones (leptin, insulin, etc.), certain brain regions, and many other elements, known and unknown. These feedback loops influence what the body does with calories, as well as feeding behaviors. When you throw a wrench in the gears with a lifestyle that is unnatural to the human metabolism, you deregulate the system so that it no longer maintains an appropriate "set-point".

Here's what Neel had to say about the thrifty gene hypothesis in 1982 (excerpts from Good Calories, Bad Calories):

The data on which that (rather soft) hypothesis was based has now largely collapsed.

And what does he think causes overweight in American Indians now?

The composition of the diet, and more specifically the use of highly refined carbohydrates.

RIP, thrifty gene.

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The Seat of Power

Have you ever wondered why the buttocks is one of the most attractive parts of the body on both sexes? I've heard it said that a man with a nice posterior will be better at thrusting during sex. I've also heard that it's purely aesthetic and nonfunctional, like a baboon's. Neither of these make any sense.

The shape of the buttocks comes mostly from the gluteal muscles (maximus and medius), superimposed by a layer of fat. The 'glutes' are some of the strongest muscles in the body, due to their large size and efficient leverage. Thrusting doesn't even come close to tapping into the glutes' tremendous power. What does? Heavy lifting. Sprints. Jumps. In short, some of the most functional full-body movements we perform as humans.

In any full-body movement, the hips are the central source of power. The strongest muscles surround the hips, and muscle strength diminishes progressively as you move further from them. A shapely buttocks is typically a strong buttocks, and a strong buttocks generally means a strong person. So if you want to decide at a glance whether a person is capable of sprinting and jumping after large prey, and then carrying it home, the buttocks is a good place to look.

The buttocks is also a storage area for fat. Humans tend to store a disproportionate amount of fat near their center of gravity: in the abdominal cavity, on the hips and on the buttocks. The right amount of fat indicates a healthy individual. A shapely buttocks is typically attached to someone who is strong and well-nourished. It's not so hard to imagine why we find it attractive.

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Real Food VIII: Ghee

All this talk about butter is making me hungry. Richard mentioned in the comments that he bought some ghee recently and has been enjoying it, so I thought I'd post a recipe. Ghee is the Hindi word for clarified butter. It's butter that has had everything removed but the fat. Rich in fat-soluble vitamins and lacking the sometimes problematic lactose and casein, ghee has rightfully been considered a health food in India since ancient times.

Another advantage of ghee is its high smoke point, which is higher than butter because it doesn't contain any protein or sugars. Consequently, food sauteed in ghee has a clean, rich taste.

The recipe is simple but touchy. I recommend using the best butter you can get your hands on. 100% grass-fed, unsalted cultured butter is the best.

Ingredient and materials

• Butter (1 lb minimum)
• Wide-mouth glass jars
• Cheesecloth
• Rubber bands
  

Recipe

1. Place the butter in a saucepan and turn the heat to medium until it's melted.
   
2. Once it begins to boil, turn the heat down to low. It's very important to calibrate the heat correctly. Typically, you will want the burner on its lowest setting. The idea is to evaporate the water without burning the oil. It should boil, but slowly.
3. The melted butter starts out cloudy but gradually clears up as the water evaporates. At the same time, a crust will form on the surface of the ghee and the bottom of the pan. Keep the heat very low.
   
4. Push a portion of the top crust to the side with a spoon to see inside of the saucepan. When the butter looks clear and bubbles only rise from the bottom every few seconds, it's done. You have to be very careful because once the water has evaporated, the fat heats up quickly and burns the crust. This gives the ghee an acrid flavor and color. Make sure to handle the pot cautiously, because hot oil can give severe burns.
   
5. Allow the ghee to cool until it's warm but not hot. Place a piece of cheesecloth over the lid of your jar. Secure it with a rubber band. Pour the ghee through the cheesecloth, into the jar.
   
6. Store ghee in the refrigerator or at room temperature. It keeps much longer than butter.

The picture above is of my last batch of ghee.

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More Fat-Soluble Vitamin Musing

If vitamin A, D and K2 deficiency are important contributors to the characteristic pattern of chronic disease in modern societies (the 'disease of civilization'), we should see certain associations. We would expect to find a lower fat-soluble vitamin status along with the most prevalent chronic diseases: cancer, cardiovascular disease, diabetes, osteoporosis, tooth decay, etc. We would also expect that improving vitamin status could reduce the incidence or recurrence of these diseases, which would be more convincing than a simple association.

Let's start with cancer. This one is like shooting fish in a barrel. There are consistent associations between low vitamin D status and numerous cancers, most notably breast and colon. And it doesn't just stop at associations. Here's a double-blind, placebo-controlled trial showing a 60% reduction of internal cancers in 1,179 American women taking 1,100 IU of D3 (and calcium) per day for 4 years. I won't go through the rest of the mountain of data linking low vitamin D to cancer, but if you want to see more science go here.

Vitamin K2 has been less well studied in this respect, but preliminary evidence is promising. Cancer patients are often vitamin K deficient. Supplementation with menatetrenone (K2 isoform MK-4) may reduce the recurrence of liver cancer. There's a strong inverse association between K2 intake and advanced prostate cancer, with the effect coming mostly from dairy.

In my post on K2 last week, I mentioned a study in which investigators found a strong inverse association between K2 consumption and cardiovascular as well as all-cause mortality. Patients with severe arterial calcifications tend to be K2 deficient, and K2 deficiency can induce arterial calcification in rodents. Marcoumar, a drug that interferes with K2 status, also causes calcification in humans. There's a mechanism behind K2's effect on CVD. There are several K2-dependent proteins that may protect the arteries from calcification, lipid accumulation and damage: matrix Gla protein, gas6, and protein S.

There is also a compelling association between vitamin D status and cardiovascular disease. Here's a quote from one study that struck me:

The adjusted prevalence of hypertension (odds ratio [OR], 1.30), diabetes mellitus (OR, 1.98), obesity (OR, 2.29), and high serum triglyceride levels (OR, 1.47) was significantly higher in the first than in the fourth quartile of serum 25(OH)D levels (P<.001 for all).

In other words, the 25% of people with the lowest D status are more likely to have hypertension and high triglycerides, and much more likely to be obese and/or have diabetes than the 25% with the highest D status. Keep in mind it's just an association, but that is nevertheless an impressive list of problems that are linked to low D status. Here's a large study that looked specifically at the association of vitamin D status and heart attack risk, and found a strong association even for people who are only mildly deficient. Supplementing elderly women with a modest amount of D3 improves hypertension.

The link between fat-soluble vitamins and bone/dental health is very strong. Vitamins D and K2 are required for proper formation and mineralization of the bones and teeth, and proper development of the cranium and face (this is exactly what Weston Price saw). K2 supplementation has a major protective effect on osteoporosis and fractures, according to several controlled trials. The salivary glands have the highest concentration of K2 MK-4 of any organ, and they secrete it into saliva along with K2-dependent proteins. Weston Price documented the dramatic protective effect of cod liver oil (A and D) and butter oil (A and K2) against tooth decay.

I couldn't find any consistent associations between vitamin A status and chronic disease. This may be because, as opposed to D and K2, few people in the US or Europe are deficient. It's interesting to note that grain-fed dairy is still a good source of vitamin A, while it loses most of the vitamin D and K2 that's found in grass-fed dairy.

Osteoporosis and arterial calcification are not due to a lack or an excess of calcium. In fact, the two problems often come hand-in-hand. Calcium supplements are unnecessary at best. The Japanese, who eat far less calcium than the average American, have a lower risk of osteoporosis and fracture. The problem with both osteoporosis and arterial calcification is that the body is not using its calcium effectively. The studies mentioned above show that the fat-soluble vitamins are critical for proper calcium use by the body, among other things.

I hope you can see that a deficiency of fat-soluble vitamins could well be a major contributor to the characteristic pattern of diseases that afflict industrialized nations. There are two more facts that we need to complete the picture. First of all, some research suggest a high prevalence of vitamin D and K deficiency (or insufficiency). A, D and K are synergistic. A and D have their own nuclear receptors that alter the transcription of hundreds of genes, while K activates many of these genes once they are translated into proteins. Thus, you'd expect that giving them together would have a much larger effect that giving them alone. This suggests that the studies using single vitamins may be falling far short of the protection afforded by optimal status of all three.

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Meditation

Meditation is the single most effective tool I've ever found for cultivating calmness, positivity and self-acceptance. It's an ancient technique that's simple and free. In fact, it's so simple, I'm about to teach it to you in five minutes over the internet. I personally practice Zen meditation
several times a week, by myself and with a sitting group. Meditation is not fundamentally a religious practice, although it has been used by spiritual people in every major religion. Don't think you're patient enough for meditation? That's exactly why you should be doing it!

Let's start with posture. The main purpose of the meditation posture is to allow you to remain still for long periods of time without discomfort. I'll discuss two postures: cross-legged and kneeling. Before you elevate your mind though, you have to elevate your backside. Find something you can sit on- a firm cushion or a folded blanket will work well. Your pelvis should be at least four inches above the ground. Now cross your legs. Your knees should be lower than your pelvis. Adjust your posture until you can maintain a straight back without any muscle tension. You'll have to rotate the top of your pelvis forward slightly, curving your lower back in toward your stomach.

Now put your hands together so that your left fingers rest on top of your right ones, just above your lap. Your palms should face up. Now touch your thumbs lightly together. That's it! You are now sitting in a very nice meditation posture. It will get more comfortable over time as you adjust to it.

The kneeling posture is the same except you kneel and put the support under your pelvis, between your legs. Wooden 'seiza' benches work well for this, but are not necessary. Your pelvis should be at least six inches off the ground so that you don't hurt your knees. This is my preferred posture, but I'm admittedly in the minority.

Now that you know the posture, face a blank wall three or four feet away. You can also look at the floor (while keeping your head and neck straight) or anything else that isn't likely to capture your interest.

Try breathing 'into your stomach'. To do this, breathe using only your diaphragm, in such a way that it makes your stomach rise and fall rather than your chest. Breathe slowly and deliberatley, pausing after each exhale. Bring your full attention to the rise and fall of your stomach. That's it, you're meditating! Really. Don't get fancy: it's counterproductive to try to actively relax yourself or achieve some different mental state.

In Zen, we call meditation 'sitting'. We use such a simple word because that's all it is: paying full attention to the moment, while you sit. Just bring your attention to your breath. If your mind drifts, gently bring it back. Don't try to stifle your thoughts, just acknowledge them and come back to your breath. If you can't focus, that's normal.

Try this for 15 minutes at first. Every day is best, but do what you can. When you're more comfortable with the technique, increase your time to 30 minutes. Meditation is a practice that changes and ripens with time.

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The Dhamma Brothers

I saw a movie a few nights ago called 'The Dhamma Brothers'. It's about a meditation program at Donaldson correctional facility in Alabama, one of the most violent prisons in the country. Two Bhuddist teachers of Vipassana meditation led a 10-day silent retreat for a volunteer group of inmates. They got up at dawn and meditated for several hours each day. Some of the inmates went through an amazing transformation.

They were forced to confront and accept the horrible crimes they had committed. When you aren't allowed to talk for 10 days, and all you have are your thoughts to keep you company, it's hard to ignore your feelings. Many of them had breakdowns as they felt the full force of their own suffering for the first time.

At first, the warden was skeptical that the prisoners were just acting to get parole; "fake it 'til you make it". Then he started noticing major changes in the inmates' behavior. They became less violent and easier to deal with. Some of them left their gangs. Even after the program was discontinued thanks to an overzealous chaplain, many of the "Dhamma brothers" continued meditating on their own.

It's hard to doubt a grown man's sincerity when you see tears running down his cheeks. These men were hardened criminals, most of them serving life sentences for murder, who rediscovered perspective and humanity simply by spending focused time with themselves.

Meditation is a powerful tool. There are two types of knowledge: intellectual and visceral. You can read books until you're cross-eyed and you will never connect with the fundamental, animal, visceral side of living. We like to think of ourselves as rational, conscious beings. It's reassuring to us. We're in control of our minds and therefore our lives. But that's more illusion than reality.

Neuroscience and meditation have shown us that the human mind is like a monkey riding an elephant. The monkey is our conscious and the elephant is our subconscious. The monkey can tell the elephant where to go, but ultimately the elephant is going to do what it wants. The monkey likes to be in charge however, so it retroactively decides it was the one that chose the direction.

To illustrate the point, imagine doing a simple algebra problem. Do you have to go over everything you ever learned about algebra in your head to solve that problem? No, your subconscious navigates the strata of accumulated knowledge and practically hands you the answer. What happens when you decide on an entree at a restaurant? Do you make a pro/con list for each item and weigh them accordingly? Or do you decide based on a feeling? Where does that feeling come from?

Meditation is plugging back into the vastness of human experience. It's acknowledging that your conscious, declarative mind is only a small slice of the pie.

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Vitamin Deficiency

I'm going to do some speculating today. More than usual. What are some of the deficiency symptoms of A, D and K2? Another way of putting the question is, what problems can you prevent or cure by giving people the right fat-soluble vitamins? If you read my last post, you know that cardiovascular disease, osteoporosis (and resulting fractures) and tooth decay are all linked to fat-soluble vitamin status, perhaps in a causal way. There's also a suggestion that they could be involved in diabetes, kidney stones, resistance to infection and cancer. Well, we've just about covered all the major modern health problems, haven't we?

What if the 'disease of civilization' is simply a deficiency of fat-soluble vitamins? What if the only reason we haven't realized it yet is because we haven't understood the critical importance of K2 MK-4, and its synergy with A and D? I'm not totally convinced it's true, but it does make sense. I'm interested to hear other peoples' opinions on this.

There are two mechanisms that could cause deficiency. The first is the obvious: reduced intake. In general, we have a lower intake of A, D (from sunlight) and K2 than non-industrial populations past and present that did not suffer from the disease of civilization. Most Westerners fall short of optimal serum vitamin D, and K2 insufficiency may be common (this will require further research).

Reading Nutrition and Physical Degeneration, as well as other accounts of non-industrial groups transitioning from their traditional diets to a more Westernized one, it struck me how badly these people were being affected. Even when they were still eating some nutrient-dense traditional foods, their development and health suffered tremendously. I asked myself this question: could the Western food they were eating have actively interfered with their vitamin status, and could it be doing the same to us?

The most common foods that replaced traditional diets in Weston Price's studies were white wheat flour and sugar. Wheat contains a lot of gluten, which in some people causes celiac disease. Celiac is an immune response to gluten that causes the degeneration of the intestinal lining, which is responsible for absorbing nutrients, among other things. Celiac patients are often deficient in many nutrients, including fat-soluble vitamins. So there's a potential link between gluten damage and fat-soluble vitamin status.

The interesting thing about celiac is it may actually be a spectrum, with many people showing some degree of gluten damage, but only severe cases being diagnosed. The diagnosis involves looking for antibodies against gluten, but there is evidence that some people may mount an immune response without producing antibodies (through the innate immune system). Peter pointed this out a while back.

So the hypothesis goes: the disease of civilization is caused by a deficiency of fat-soluble vitamins, due to both a lower intake and inefficient absorption through a damaged intestinal lining. Comments?

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Vitamin K2, menatetrenone (MK-4)

Weston Price established the importance of the MK-4 isoform of vitamin K2 (hereafter, K2) with a series of interesting experiments. He showed in chickens that blood levels of calcium and phosphorus depended both on vitamin A and K2, and that the two had synergistic effects on mineral absorption. He also showed that chickens preferred eating butter that was rich in K2 over butter low in K2, even when the investigators couldn't distinguish between them. Young turkeys fed K2-containing butter oil along with cod liver oil (A and D) also grew at a much faster rate than turkeys fed cod liver oil alone.

He hypothesized that vitamin A, vitamin D and vitamin K2 were synergistic and essential for proper growth and subsequent health. He particularly felt that the combination was important for proper mineral absorption and metabolism. He used a combination of high-vitamin cod liver oil and high-vitamin butter oil to heal cavities, reduce oral bacteria counts, and cure numerous other afflictions in his patients. He also showed that the healthy non-industrial groups he studied had a much higher intake of these fat-soluble, animal-derived vitamins than more modern cultures.

Price found an inverse correlation between the levels of K2 in butter and mortality from cardiovascular disease and pneumonia in a number of different regions. A recent study examined the relationship between K2 (MK-4 through 10) consumption and heart attack risk in 4,600 Dutch men. They found a strong inverse association between K2 consumption and heart attack mortality risk. Men with the highest K2 consumption had a whopping 51% lower risk of heart attack mortality and a 26% lower risk of death from all causes compared to men eating the least K2! Their sources of K2 MK-4 were eggs, meats and dairy. They obtained MK-5 through MK-10 from fermented foods and fish. The investigators found no association with K1, the form found in plants.

Perigord, France is the world's capital of foie gras, or fatty goose liver. Good news for the bon vivants: foie gras turns out to be the richest known source of K2. Perigord also has the lowest rate of cardiovascular mortality in France, a country already noted for its low CVD mortality.

Rats fed warfarin, a drug that inhibits K2 recycling, develop arterial calcification. Feeding the rats K2 completely inhibits this effect. Mice lacking matrix Gla protein (MGP), a vitamin K-dependent protein that guards against arterial calcification, develop heavily calcified aortas and die prematurely. So the link between K2 and cardiovascular disease is a very strong one.

Mammals can synthesize K2 MK-4 from K1 to some degree, so dietary K1 and other forms of vitamin K may contribute to K2 MK-4 status. 

The synergism Weston Price observed between vitamins A, D and K2 now has a solid mechanism. In a nutshell, vitamins A and D signal the production of some very important proteins, and K2 is required to activate them once they are made. Many of these proteins are involved in mineral metabolism, thus the effects Price saw in his experiments and observations in non-industrialized cultures. For example, osteocalcin is a protein that organizes calcium and phosphorus deposition in the bones and teeth. It's produced by cells in response to vitamins A and D, but requires K2 to perform its function. This suggests that the effects of vitamin D on bone health could be amplified greatly if it were administered along with K2. By itself, K2 is already highly protective against fractures in the elderly. It works out perfectly, since K2 also protects against vitamin D toxicity.

I'm not going to go through all the other data on K2 in detail, but suffice it to say it's very very important. I believe that K2 is a 'missing link' that explains many of our modern ills, just as Weston Price wrote. Here are a few more tidbits to whet your appetite: K2 may affect glucose control and insulin release (1, 2). It's concentrated in the brain, serving an as yet unknown function.

Hunter-gatherers didn't have multivitamins, they had nutrient-dense food. As long as you eat a natural diet containing some vegetables and some animal products, and lay off the processed grains, sugar and vegetable oil, the micronutrients will take care of themselves.

Vitamin K2, MK-4 is only found in animal products. The best sources known are grass-fed butter from cows eating rapidly growing grass, and foie gras. K2 tends to associate with beta-carotene in butter, so the darker the color, the more K2 it contains (also, the better it tastes). Fish eggs, other grass-fed dairy, shellfish, insects and other organ meats are also good sources. Chris Masterjohn compiled a list of food sources in his excellent article on the Weston Price foundation website. I highly recommend reading it if you want more detail. K2 MK-7 is found abundantly in natto, a type of fermented soybean, and it may be partially converted to MK-4.

Finally, you can also buy K2 supplements. The best one is butter oil, the very same stuff Price used to treat his patients. I have used this one personally, and I noticed positive effects on my skin overnight. Thorne research makes a synthetic liquid K2 MK-4 supplement that is easy to dose drop-wise to get natural amounts of it. Other K2 MK-4 supplements are much more concentrated than what you could get from food so I recommend avoiding them. I am generally against supplements, but I've ordered the Thorne product for a little self-experimentation. I want to see if it has the same effect on my skin as the butter oil (update- it does).

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Activator X

Activator X, the almost-mythical vitamin discovered and characterized by Weston Price, has been identified! For those of you who are familiar with Weston Price's book 'Nutrition and Physical Degeneration', you know what I'm talking about. For the rest of you, allow me to explain.

Weston Price was a dentist and scientist in the early part of the 20th century. Practicing dentistry in Cleveland, he was amazed at the poor state of his patients' teeth and the suffering it inflicted. At the time, dental health was even worse than it is today, with some children in their teens already being fitted for dentures. Being a religious man, he could not bring himself to believe that 'physical degeneration' was what God intended for mankind. He traveled throughout the world looking for cultures that did not have crooked teeth or dental decay, and that also exhibited general health and well-being. And he found them. A lot of them.

These cultures were all considered 'primitive' at the time, and were not subject to the lifestyles or food choices of the Western world. He documented, numerically and with photographs, the near-absence of dental cavities and crooked teeth in a number of different cultures throughout the world. He showed that like all animals, humans are healthy and robust when occupying the right ecological niche. Price had a deep respect for the nutritional knowledge these cultures curated.

He also documented the result when these same cultures were exposed to Western diets of white flour, sugar and other industrially processed foods: they developed rampant cavities, their children grew with crooked teeth due to narrow dental arches, as well as a number of other strikingly familiar health problems. I think it's worth mentioning that Price's findings were universally corroborated by doctors in contact with the same cultures at the time. They are also corroborated by the archaeological record. Many of his findings were published in respected peer-reviewed journals. 'Nutrition and Physical Degeneration' is required reading for anyone interested in the relationship between nutrition and health.

Naturally, Price wanted to understand what healthy diets had in common besides the absence of white flour and sugar. Having studied cultures as diverse as the carnivorous Inuit, the dairy-eating Masai and agricultural groups in the Andes, he realized that humans are capable of thriving on very diverse foods. However, he did find one thing in common: they all ate some amount of fat-soluble, animal-derived vitamins. Even the near-vegetarian groups ate insects or small animals that were rich in these vitamins. He looked for, but did not find, a single group that was entirely vegetarian and had the teeth and health of the groups he described in 'Nutrition and Physical Degeneration'.

There were three vitamins he found abundantly in the diets of healthy non-industrialized people: A, D, and an unknown substance he called 'activator X'. He considered them all to be synergistic and critical for proper mineral metabolism (tooth and bone formation and maintenance) and general health. He had a chemical test for activator X, but he didn't know its chemical structure and so it remained unidentified. He found activator X most abundantly in grass-fed butter (but not grain fed!), organ meats, shellfish, insects, and fish eggs. Many of these foods were fed preferentially to pregnant or reproductive-age women in the groups he studied.

Price used extracts from grass-fed butter (activator X), in combination with high-vitamin cod liver oil (A and D), to prevent and reverse dental cavities in many of his patients. 'Nutrition and Physical Degeneration' contains X-rays of case studies showing re-calcification of severe cavities using this combination.

After reading his book, I wasn't sure what to make of activator X. If it's so important, why hasn't it been identified in the 60+ years since he described it? I'm happy to say, it finally has. In the summer of 2007, Chris Masterjohn wrote an article for the Weston Price foundation website, in which he identified Weston Price's mystery vitamin: it's vitamin K2, specifically the MK-4 isoform (menatetrenone).

It occurs exactly where Weston Price described it, and research is beginning to find that it's also critical for mineral metabolism, bone and tooth formation and maintenance. Its function is synergistic with vitamins A and D. To illustrate the point, where do A, D and K2 MK-4 all occur together in nature? Eggs and milk, the very foods that are designed to feed a growing animal. This is true from sea urchins to humans, confirming the ubiquitous and critical role of these nutrients. K2 has not yet been recognized as such by the mainstream, but it is every bit as important to health as A and D. The scientific cutting edge is beginning to catch on, however, due to some very tantalizing studies.

In the next post, I'll go into more detail about K2, what the science is telling us and where to get it.

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Foraging

A friend and I went hunting for morels today in the Wenatchee forest. There was only one on the entire mountain, but we managed to find it:


We also found two "spring kings": spring-fruiting boletus edulis, also known as porcini or cepe. Firm and nutty, without a trace of bugs:


Raw is my favorite way to eat a good spring king. Here's an older one that was 6" across. Too old for me so I left it for the amateurs:

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More Masai

I left out one of the juicier tidbits from the last post because it was getting long. Investigators Kang-Jey Ho et al. wanted an explanation for why the Masai didn't have high serum cholesterol despite their high dietary cholesterol intake (up to 2,000 mg per day-- 6.7 times the US FDA recommended daily allowance).

They took 23 male Masai subjects aged 19 to 24 and divided them into two groups. The first group of 11 was the control group, which received a small amount of radioactive cholesterol in addition to a cholesterol-free diet that I will describe below. The second group of 12 was the experimental group, which they fed 2,000 mg cholesterol per day, a small amount of radioactive cholesterol as a tracer, and the exact same cholesterol-free diet as the control group. For the duration of the 24-week trial, the subjects ate the experimental diet exclusively. Here's what it was (in order of calories, descending):

• Nondairy coffee creamer (made of corn syrup solids and vegetable oil)
• Beans
• Sugar
• Corn
• Corn oil
• A vitamin pill

Not a healthy diet by most peoples' standards, but those items are nevertheless widely eaten in the US. Over the course of the 24-week study, the investigators found no difference in serum cholesterol between the control and experimental groups. This isn't really surprising. The body has mechanisms for regulating blood cholesterol, and if you aren't eating any it just synthesizes more to stay at its preferred level.

The really interesting thing is that serum cholesterol increased dramatically in both groups. It went from 125 mg/100 mL to over 170 mg/100 mL, despite a large decrease in the saturated fat they were eating. The change took about two weeks to occur, and remained fairly stable for the remainder of the trial.

Both groups also gained weight. In the first week, they gained an average of 3 pounds each. To be fair, the initial gain was probably most water, which is what happens when a person increases their carbohydrate and salt intake. The investigators freaked out and cut their calorie intake by 400 kcal, only allowing them 3,600 kcal per day. Initially, they were voluntarily consuming 4,000 kcal per day. I find that interesting as well. Something tells me they weren't chugging non-dairy creamer because it was so delicious, but because their confused hormones were telling them to EAT.

Even after putting the subjects on calorie restriction (not letting them eat as much as they wanted, by an average of 400 kcal/day), they continued gaining weight. By the end of the study, the 23 subjects had gained an average of 7.8 lbs per person.

To summarize, this is what the investigators saw when they put 23 unfortunate Masai men on a bottom-rung industrially processed diet: elevated cholesterol, hyperphagia (excessive eating), and weight gain. Sounds familiar, doesn't it?

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Masai and Atherosclerosis

I've been digging deeper into the health of the Masai lately. A commenter on Chris's blog pointed me to a 1972 paper showing that the Masai have atherosclerosis, or hardening of the arteries. This interested me so I got my hands on the full text, along with a few others from the same time period. What I found is nothing short of fascinating.

First, some background. Traditional Masai in Kenya and Tanzania are pastoralists, subsisting on fermented cow's milk, meat and blood, as well as traded food in modern times. They rarely eat fresh vegetables. Contrary to popular belief, they are a genetically diverse population, due to the custom of abducting women from neighboring tribes. Many of these tribes are agriculturalists. From Mann et al: "The genetic argument is worthless". This will be important to keep in mind as we interpret the data.

At approximately 14 years old, Masai men are inducted into the warrior class, and are called Muran. For the next 15-20 years, tradition dictates that they eat a diet composed exclusively of cow's milk, meat and blood. Milk is the primary food. Masai cows are not like wimpy American cows, however. Their milk contains almost twice the fat of American cows, more protein, more cholesterol and less lactose. Thus, Muran eat an estimated 3,000 calories per day, 2/3 of which comes from fat. Here is the reference for all this. Milk fat is about 50% saturated. That means the Muran gets 33% of his calories from saturated fat. This population eats more saturated fat than any other I'm aware of.

How's their cholesterol? Remarkably low. Their total serum cholesterol is about half the average American's. I haven't found any studies that broke it down further than total cholesterol. Their blood pressure is also low, and hypertension is rare. Overweight is practically nonexistent. Their electrocardiogram readings show no signs of heart disease. They have exceptionally good endurance, but their grip strength is significantly weaker than Americans of African descent. Two groups undertook autopsies of male Masai to look for artery disease.

The first study, published in 1970, examined 10 males, 7 of which were over 40 years old. They found very little evidence of atherosclerosis, even in individuals over 60. The second study, which is often used as evidence against a high-fat diet, was much more thorough and far more interesting. Mann et al. autopsied 50 Masai men, aged 10 to 65. The single most represented age group was 50-59 years old, at 13 individuals. They found no evidence of myocardial infarction (heart attack) in any of the 50 hearts. What they did find, however, was coronary artery disease. Here's a figure showing the prevalence of "aortic fibrosis", a type of atherosclerotic lesion:


It looks almost binary, doesn't it? What could be causing the dramatic jump in atherosclerosis at age 40? Here's another figure, of total cholesterol (top) and "sudanophilia" (fatty streaks in the arteries, bottom). Note that the Muran period is superimposed (top).


There appears to be a pattern here. Either the Masai men are eating nothing but milk, meat and blood and they're nearly free from atherosclerosis, or they're eating however they please and they have as much atherosclerosis as the average American. There doesn't seem to be much in between.

Here's a quote from the paper that I found interesting:

We believe... that the Muran escapes some noxious dietary agent for a time. Obviously, this is neither animal fat nor cholesterol. The old and the young Masai do have access to such processed staples as flour, sugar, confections and shortenings through the Indian dukas scattered about Masailand. These foods could carry the hypothetical agent."

This may suggest that you can eat a wide variety of foods and be healthy, except industrial grain products (particularly white flour), sugar, industrial vegetable oil and other processed food. The Masai are just one more example of a group that's healthy when eating a traditional diet.

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Diet and Body Composition of the Masai

I just read a recent paper from the British Journal of Sports Medicine, "Daily Energy Expenditure and Cardiovascular Disease Risk in Masai, Rural and Urban Bantu Tanzanians". The study caught my eye because I think we have a lot to learn from healthy traditionally-living populations worldwide.

The Masai have a very unique diet consisting mostly of whole cow's milk, cow's blood and meat. As you might imagine, they eat a lot of fat, a lot of saturated fat and a modest amount of carbohydrate (mostly from lactose). They also have low total cholesterol, low blood pressure, and virtually no overweight. They have been a thorn in the side of the lipid hypothesis for a long time.

The Bantu are an agricultural population that traditionally eat a diet low in fat and high in carbohydrate. Their staples are root vegetables, corn, beans, fish and wild game. The paper also describes a group of urban Bantu, which eats a diet intermediate in fat and carbohydrate. Incidentally, the investigators describe it as a "high-fat diet", despite the fact that the percentage fat is about the same as what Americans and Europeans eat.

The investigators recorded the three groups' diets, activity levels, physical characteristics and various markers of cardiovascular disease risk. Here's what they found: only 3% of Masai were obese, compared to 12% of rural Bantu and 34% of urban Bantu (they'd fit right in here!). The Masai, despite smoking like chimneys, had generally lower CVD risk factors than the other two populations, with the urban Bantu being significantly worse off than the rural Bantu.

Overall, the Masai came out looking really good, with the rural Bantu not too far behind. The urban Bantu look almost as bad as Americans. How do we make sense of these two conflicting facts? 1) The urban Bantu eat an amount of fat and saturated fat that's right in the middle of what the Masai and the rural Bantu eat, yet they seem the most likely to keel over spontaneously. 2) Saturated fat KILLS!! Answer: keep digging until you find something else to blame your results on.

They certainly did find something, and it's the reason the study was published in the British Journal of Sports Medicine rather than the American Journal of Clinical Nutrition. The Masai exercise more than either of the other two groups. I don't have too much trouble believing that. However, the authors used a little trick to augment their result: they normalized calorie expenditure to body weight. They present their data as kcal/kg/day. In other words, the fatter you are, the lower your apparent energy expenditure! It makes no sense to me. But it does inflate the apparent exercise of the Masai, simply because of the fact that they're thinner than the other two groups.

Due to this number massaging, here's what they got (data re-plotted by me):


I'm going to try to un-massage the data. Here's what it looks like when I factor bodyweight out of the equation. Calories expended (above resting metabolic rate) is on the Y-axis. The bars look a bit closer together...



Here's what it looks like when you add back resting metabolic rate. I assumed 1500 kcal/day. This graph is an approximation of their total energy expenditure per day:



Hmm, the differences keep getting smaller, don't they? I'm not challenging the fact that the Masai exercise more than the other two groups, but I do wish they had presented their findings more straightforwardly.

Their conclusion is that exercise is protecting the Masai from the deadly saturated fats in their diet. A more parsimonious explanation is that saturated fat per se doesn't cause heart disease. It's also more consistent with other healthy cultures that ate high-fat diets like the Inuit, certain Australian aboriginal groups, and some American Indian groups. It's also consistent with the avalanche of recent trials of low-carbohydrate diets, in which people tend to see improvements in weight, blood pressure, and CVD markers, among other things.

My conclusion, from this study and others, is that macronutrients don't determine how healthy a diet is. The specific foods that compose the diet do. The rural Masai are healthy on a high-fat diet, the rural Bantu are fairly healthy on a low-fat, high carbohydrate diet. Only the urban Bantu show a pattern really consistent with the "disease of civilization", despite a daily energy expenditure very similar to the rural Bantu. They're unhealthy because they eat too much processed food: processed vegetable oil, processed grain products, refined sugar.

Thanks to kevinzim for the CC photo

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Hormesis

Why are we so soft today? Why is it that our ancestors were able to perform feats like killing bears and wooly mammoths in snow-swept grasslands? How do present-day tribesmen withstand days of ultra-cold temperatures in Northern Greenland and prolonged periods without water in scorching hot Kenyan deserts? Why is it that a century ago, children in the Swiss alps ran barefoot through ice-cold mountain streams on cold days, while now they get carpal tunnel syndrome playing video games? How did they do all this without succumbing to the chronic diseases that are so rampant today? I believe part of the answer lies in hormesis.

Hormesis is the process by which a mild or acute stressor increases resistance to other, more intense or chronic stressors. It can increase resistance to a variety of stresses, not only the one to which you are exposed.

It might sound like a foreign concept, but you're more familiar with it than you think. Exercise is a form of hormesis. It's a stress placed upon the body that increases resistance to a number of other stressors: physical exertion, cardiovascular disease, depression, diabetes, age-related cognitive decline, neurodegenerative disease, etc.

Intermittent fasting is one of the most promising forms of hormesis. It's consistent with the variable energy intake our hunter-gatherer ancestors probably experienced. As with some other forms of hormesis, it has broad-ranging effects on health and stress resistance. Alternate-day fasting, a version in which food is available for 24 hours ad libitum and then not available for the next 24 hours, increases mean lifespan in mice under some conditions without reducing calorie intake. It increases resistance to neurodegeneration, stroke, myocardial infarction, toxins, cancer and diabetes in rodents. It increases the expression of heat shock proteins and SIRT1, both implicated in general stress resistance. Basically, it makes them tougher all-around.

Although only a few studies have been performed in humans, IF looks promising for preventing or reversing diabetes, cardiovascular disease, overweight and possibly other health problems. It can also decrease fasting insulin and increase insulin sensitivity considerably. I fast for 24 hours, once a week. No calories, only water. It's not a form of caloric restriction, because I eat like horse the day after fasting. It's just a mild stressor that toughens my body to other stressors.

I also take cold showers. Here the scientific data are more sparse, but it has a long history of use as a form of "body hardening". I do it to increase my cold resistance by firing up my non-shivering thermogenesis. It seems to be working. It certainly wakes me up in the morning! Have you ever noticed how you can get into cold water and be surprisingly comfortable once you're used to it, even though you're practically naked and water is conducting heat away from your body 20 times faster than air would? That's probably your non-shivering thermogenesis kicking in.

There are probably many other ways to induce hormesis. Do any of you have techniques to share? By the way, hormesis is one of the central tenets of homeopathy. Solid principle, incorrect application. I'd be happy to sell anyone sugar pills for 50% less than his or her local homeopath is selling them. I promise mine are equally effective...

Soft living makes a soft body. Give it some controlled stress from time to time!


Thanks to Kirill Tropin for the CC photo.

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Nature's Laws

Last night I was watching a little video clip of the Jack LaLanne show. LaLanne was an advocate of strength training and whole foods nutrition whose TV show ran from the 1950s through the 1980s. In the clip, he describes how his father died an early death due to heart and liver disease. A quote that really stuck with me was when he said his father died due to "disregarding nature's laws". That pretty much sums up my philosophy. Live in a way that generally mimics what our genes evolved to thrive on. Why did our paleolithic ancestors have strong, healthy bodies? Why are there still cultures that are free of chronic disease to this day, even into old age? Because they are following nature's laws. Break the law at your own risk.

Jack LaLanne and I do differ a bit on what constitutes a natural diet. For example, I don't throw out my egg yolks... But hey, the man is 94 and going strong. Here's another quote of his: "If man made it, don't eat it". Words to live by. Quite literally.

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