Saturated fat…here is part three, where we will discuss the research on the topic.

Recap

In part one I discussed the problems with relying on science in general. Some people like accepting the “scientific consensus” on something because it seems safe to go along with majority opinion. The problem with this strategy is that you don’t end up doing the research yourself. When you do, you may find something the majority did not. Also, the conventional point of view regarding all public health related matters is not always based on evidence. We could debate that all day.

In part two I described the idea of food synergy, and why this is a missing link in nutrition science research.

In this final segment I will share what the actual research shows regarding saturated fat intake and cholesterol intake on your health. In addition, I will show you how to find this research easily.

What is the research question?

We will shortly go to pubmed to search for studies on saturated fat and cholesterol consumption. Before we go to pubmed, let’s first clarify our research question. The research question I am answering in this post is “what is the effect of saturated fat and cholesterol intake on cardiovascular disease (CVD) and all-cause mortality?” This is a specific question. “Is saturated fat bad for you” is NOT a specific question. In the research world you need specific questions for a few reasons.

For one, a specific question is easier to study and the results are easier to draw a conclusion from. If we were to design a research study to answer if saturated fat was good for you in general we would probably be answering a lot of other specific questions. We could assess if it’s good for your health, which leads to more specific questions about health. But we could also ask if it makes you feel good to eat it, which is an entirely different question. If we didn’t ask specific questions, and say just designed a survey that asked people if they thought saturated fat was good for you, and they could answer in an open ended way, our data would be quite jumbled and not as meaningful to interpret.

The effect of saturated fat, if any, on cardiovascular disease outcomes and all-cause mortality asks two different questions. The first question is looking at saturated fat and cardiovascular disease outcomes. We could define those outcomes as total heart attacks, deaths from heart attacks, number of strokes, deaths from stroke, and diagnosis of cardiovascular disease.

The second question asks if there is a relationship between saturated fat intake and all-cause mortality. All-cause mortality means death from any cause. Smoking, being sedentary, and eating a standard American diet (high sugar, high amount of processed foods, low antioxidant intake) increases your chances of dying in general from any cause. Generally, unhealthy things make you die sooner, so that is the idea this question is getting at.

Death from a specific cause or any cause is arguably the most important outcome from a medical standpoint. I personally care about all the things leading to death (because we may be living somewhat longer in modern times but it’s questionable if we are healthier), but getting wrapped up in the details sometimes isn’t very fruitful. Drugs for example may reduce risk factors for a disease but make you die sooner from that disease through some unknown mechanism or from some other disease, making the drug pointless.

The other research question is the same, but we will replace saturated fat with cholesterol to get this: “what is the effect of cholesterol intake on cardiovascular disease and all cause mortality?”

What is cardiovascular disease…

The next point I want to make before discussing the research is that cardiovascular disease is sometimes interchanged with heart disease and neither are a single entity. There are a multitude of afflictions affecting the heart, including coronary artery disease (CAD), peripheral artery disease (PAD), ischemic heart disease (IHD), angina pectoris, stroke, arteriosclerosis, hypertension, cardiomyopathies, aortic aneurysm, congestive heart failure, and valvular disorders. Many of them may involve atherosclerosis (plaque build up inside arteries, impeding blood flow). Cardiovascular disease affects the heart, either due to a dysfunction with the heart itself, plaque buildup in the coronary artery, or plaque buildup throughout the vasculature, making it harder for the heart to do its job.

So what is heart health?

In general, if something improves heart health it helps the heart do its job better. If you have lower extremity artery disease (LEAD), something good for promoting blood flow in the lower extremity arteries may improve the return of blood to the heart which could help it pump more effectively. In congestive heart failure, depending on what is causing it, treating that root cause will help the heart pump blood better, reducing stress on the myocytes (name of the cells composing the heart). Off the top of my head, I’m thinking maybe beet juice could help with this, as it promotes blood flow and nitric oxide signaling (many things do this), which dilates the arteries, enhancing blood flow. This might work. It depends on the type of CHF and cause, along with the individual person.

What is mostly true is that many heart diseases can be prevented by not smoking, limiting alcohol intake, exercising regularly, and eating a varied diet rich in antioxidants and nutrients. Most of the diseases that kill people most likely can be prevented this way.

Finding the research

Let’s go to pubmed now and look for some research. I’ve learned a few things from my research classes about getting a good search result here. It takes practice. So watch first what happens when I type in “saturated fat” in the search box.

Not bad actually, when you have “best match” chosen (circled). If you chose instead “most recent” you would get less relevant results. Try it out yourself. We will definitely look at articles 2 and 4 (check marked).

The thinner circles at the bottom bring up the next subject. Instead of pouring through individual studies, we can look for systematic reviews or meta-analyses. Dr. Uman defines these two terms in her article as follows:

“Systematic reviews, as the name implies, typically involve a detailed and comprehensive plan and search strategy derived a priori, with the goal of reducing bias by identifying, appraising, and synthesizing all relevant studies on a particular topic. Often, systematic reviews include a meta-analysis component which involves using statistical techniques to synthesize the data from several studies into a single quantitative estimate or summary effect size (Petticrew & Roberts, 2006).”

Reviews just review what’s out there, and a meta-analysis takes a bunch of studies, pools their data, and performs a new statistical analysis.

Refining the search

We will now search “saturated fat intake cardiovascular disease all cause mortality,” checking just systematic reviews and meta analyses. 13 results show up.

Not bad. Now we will go one step further and go to the advanced search. Click “advanced” below the search box. We are now going to tell the search feature to look for all studies matching two different search phrases. You can simultaneously search for two things at once with one search by using the phrase OR. My search query is now “saturated fat intake AND cardiovascular disease OR saturated fat intake AND all cause mortality.”

17 results! WOW. Just kidding…the 4 additional studies here aren’t really answering our question. So in this case the advanced search wasn’t necessary.

Now let’s compare this to google searching. To my surprise, there is one article (circled below) that did not show up in my pubmed search results. I’ll have to ask my professor about that. One of the other articles that shows up was in my search results.

We will talk about the article shortly. Next, let’s click on “scholarly articles” (where the arrows are pointing). To my surprise, most of the articles on the first page aren’t answering my question.

I’m not interested in flavonoid intake google! Well atually I am but not right now. I am drinking some pour over coffee I made myself and there are flavonoids and polyphenols in there.

Article discussion time

One of the articles google found was not in my pubmed search. This article is titled “Food Sources of Saturated Fat and the Association With Mortality: A Meta-Analysis.” The researchers here set out to answer a few different questions. They were interested in whether or not a high consumption of foods containing saturated fat increased all cause mortality, cardiovascular disease mortality, or cancer mortality. They found a slight inverse association with milk, a low positive association with meat, and a moderately positive association with processed meat consumption. In general they said the evidence is too weak to support the idea that eating meat promotes mortality from all causes. They reviewed 26 different studies. That study deserves a separate post. I will keep it brief here as we still have to talk about cholesterol after this.

The second study I want to discuss is titled “Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies” (it’s a free article). They answered the same questions I want to answer (we can decide if their answer is definitive or not) and a few more. They look for an association with saturated and trans unsaturated fat with all cause mortality, CHD mortality, CVD mortality, CVD incidence, ischemic stroke, and diabetes incidence. They found no association with saturated fat and all cause mortality or cardiovascular disease. For trans fat though it’s a different story; they differentiated between natural trans fats (the ones found in grass fed meat and milk) and industrial trans fats (products of hydrogenation of vegetable oils commonly found in processed foods). Total trans fat intake was associated with a statistically significant increase in all cause mortality. Ruminant trans fats were inversely associated with diabetes (but no association was seen with cardiovascular disease). This association was the strongest out of any other association in the study, and warrants a future post.

There are plenty of other articles like these you can find from the pubmed search we went through. In general it seems as if there is no association whatsoever with saturated fat intake and cardiovascular disease or all cause mortality. In part four we will discuss the strength of these findings and come to a conclusion on whether or not we should agree with this.

Cholesterol intake

Using the methods above, I searched for “cholesterol intake cardiovascular disease.” I found a paper titled “Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis.” This paper answered many questions. One of them was if cholesterol intake had an effect on VLDL (very low density lipoprotein). This is one of the “bad” cholesterols, but it’s not so simple. They evaluated three different trials to answer this question and basically found no association. They also didn’t find much association with cholesterol intake and other serum lipids in general.

They found six different trials investigating cholesterol intake on coronary artery disease (CAD). Only one (a study in a Japanese population) found a statistically significant association. For the rest no positive association was found. Cholesterol intake also had no effect on death from CAD, except in one study where an effect was seen in men who consumed about 430 mg of cholesterol per day. This study had more vegetarians than omnivores, so there could be something else mediating this relationship. 430 mg of cholesterol a day is about a few eggs worth. This may sound alarming but it’s not, as it was just one study, and many other factors could have potentiated this positive relationship. I will have to look into that study separately.

Other studies they evaluated found no association with cholesterol intake and any CVD. Whether its CAD or CVD the results are pretty consistent that there is no positive relationship between cholesterol intake and those diseases. I don’t think they answered all cause mortality so we will just skip over that for now and say don’t worry about it!

Conclusion: In general when studies are discussed we should look at their methods, the population studied, and the outcomes they assessed, in more detail. Here I am just sharing the overall conclusions from some of the most robust analyses on the questions we chose to answer. If there was a huge effect of eating more saturated fat, which is naturally found in milk, cheese, butter, meat, and coconuts, on your heart health, we would expect to see its effect in such large studies where tens of thousands of people are evaluated. There is strength in numbers; the larger the population size the stronger the conclusion from statistical analyses one can draw.

The downside is that individuality is lost. What about meat eating among those who follow a paleo diet versus meat eating in those who follow a standard American diet versus those who eat meat in moderation and try to be healthy but aren’t strict about following a diet? Those are all different populations and I’d have to do more digging to see if studies have been done on these populations. For now, it’s settled. Saturated fat won’t kill you. Eating cholesterol doesn’t cause heart attacks and likely has no relationship with all cause mortality. Emphasize whole food once again and try to connect to nature as much as you can. Choose grass-fed meat whenever possible. Choose pasture-raised eggs. Be proactive about what’s going in to your dinner plate. I know I could even improve in that with my busy lifestyle! I have a quiz tomorrow morning I have barely studied for!

In part four I will talk more about statistics and how to draw conclusions from studies like the ones we analyzed. Hope you learned something.

Stay tuned!

I’m also on Instagram, Twitter, and Facebook @sbcahealth. There is no newsletter at the current time. I may start one eventually but right now it’s not necessary! If you have questions about health you can also email me (stopbeingconfusedabouthealth@gmail.com).

I read the blood type diet years ago. I then read the Genotype Diet, an updated version of that book. In the latter one, naturopathic physician Dr. Peter J. D’Adamo devised a litany of physical measurements to determine what type of diet is best for one’s health in addition to the detailed reasons he outlined supporting his Blood Type Diet book published years before.

His work, based off of years of research and experimentation, was deemed debunked. People read about it online in press articles and decided that it wasn’t worth looking into. The BTD was now unscientific, just like all naturopaths apparently! Dr. Michael Greger, a highly biased vegan-diet-promoting doctor who cherry picks scientific studies and who I have even found to manipulate data to support his viewpoints published a critique. There was one on quackwatch too which is not a site I find trustworthy, to say the least.

As I have outlined in previous posts, like in a recent one about the saturated fat myth, science is often unable to study the complexities of reality. The study that “debunked” the blood-type diet did not really use the blood type diet. Dr. D’Adamo’s response to it addressed this and much more. His critique included that skeptics tend to never express curiosity. They come from a place of dismissiveness.

This was part of his response:

“A look at the core data used in the PLOS Study [1] debunking the Blood Type Diet (BTD) finds support for the researcher’s conclusions that if your experimental subjects eat potato chips, sandwiches, pizza, ‘beans,’ mac-and-cheese, French Fries and processed meat products while doing 13.7% of the Blood Type Diet, their final cardiometabolic markers will probably not vary much by blood type.”

If you want to learn about the blood type diet one day and read about how it was debunked but never do any research beyond that yourself, you have not honored your curiosity. You have not followed the scientific method. You have relied on “science” that someone else did to arrive at your conclusion about how things work. And you are wrong.

End of story.

I am not going to provide a detailed explanation on why I like the blood type diet. The main reason is that it is idividualized and based on trial, error, and lots of experimentation. Although I have no idea why some types can eat manchengo cheese and others cannot, I am open to the idea that some types may be more sensitive to certain proteins. I think that was his theory but I’ll have to save this discussion for a future post. There may be flaws to it but unlike other diets, it was devised by someone who seemed to put in more time and effort into it than people usually do it diet books. Based on these observations I do not think that the blood type diet debunking study came anywhere close to debunking the success stories people have had with it.

 

I’m finally going to start talking about food, which many people these days think way too much about. Some people want to know what to eat to achieve a certain goal, whether it be weight loss or improved health or curing cancer. For the purposes of this post, I will discuss “bad” foods you can eat while maintaining optimal health, which is more important than losing weight, but I guarantee you that you can eat these foods while losing weight too.

So, have you wondered if you can really eat sugar, or pizza, or cheeseburgers, and other foods you really want to eat without any remorse? Well, the good news is yes, you can. In my shortest post ever, I discussed how you can eat whatever you want and the method is pretty obvious. I don’t expect the orthorexic people to agree with this but it’s pretty straightforward here. Eating isn’t an intellectual exercise folks, it should be completely thoughtless. Sticking to whole foods is great, and some of these can be part of a whole foods diet (like red meat below), while others are foods you would find in a restaurant and you probably won’t be eating everyday! The key with this list is to really make an effort to make this an instinctual rather than an intellectual exercise. Even better, make it completely thoughtless, but if you can make it instinctual, your body will not eat too much of it anyway because you’ll get bored of it or sick of it eventually.

Now here is the list, enjoy:

1. Red meat

There is no evidence that you will die from eating red meat (including that recent study on meat that didn’t work out). People just want to prove their ideas correct in the nutrition field, and there won’t be any studies anytime soon on people who eat red meat and exercise a lot and don’t do all the other bad things people who tend to eat more red meat do: smoke, drink, have lower education, lower SES, lower physical activity, etc. You can’t trust big data studies on this one. Try to go grass-fed or pasture raised (just go to whole foods for your meat if that’s in your budget) but if you’re in a restaurant and that’s not available just don’t worry about it because you’ll be fine.

2. Sugar

If you don’t move and just eat a lot of sugar and develop cravings for it that way, it’s probably unhealthy. But after exercising, something health-minded people want to do, your body may crave more sugar than usual. Health conscious individuals who exercise though often try to limit calories and sugars after exercising because they think it’s full of empty calories. Professional athletes however are known to drink sodas and tons of carbohydrates to prepare for training sessions, because it will help with performance and reduce inflammation and stress form exercise, contrary to what the low carbohydrate diet advocates believe. If you want to get really lean, then I’d agree cut it out, but that won’t make you healthier forever. So after a long day, if you’re craving some sugar, go for it, but no one is telling you to binge on it!

3. Fat

Most people who go on a diet want to cut fat out. Well guess what, eating fat has nothing to do with you getting fat; it has a very similar chance of being stored as fat as any calorie in excess whether it be from a polysaccharide or an amino acid (carb or protein). Consuming vegetable oils (canola, soybean, corn, safflower) in massive quantities is probably bad, but eating nuts aren’t. Butter, ghee, lard, olive oil, etc., are all health promoting and are good oils to cook with (actually butter isn’t a good oil to cook with due to low smoke point). Also if you end up restricting fat, you may end up consuming more sugar. All the studies have shown no benefit to low-fat diets. If you want to consume less junk, try focusing on eating whole foods rather than fats, carbs, or proteins.

4. Ghee

A lot of Indian people think ghee makes them fat, when in reality, it’s the combination of milk and sugar in so many different dishes and desserts that does it. Ghee has been known to remove toxins from the body like an astringent substance, so it’s actually good for weight and detoxification for most people according to Ayurveda.

5. Fruit juice

Fruit juice has received a bad wrap because of the fitness industry’s orthorexic and misguided belief that it makes you fat therefore it’s unhealthy. We are hardwired to want to extract nutrition from food and refine it to make it taste better. Eating 5 oranges takes a lot longer than drinking some orange juice where you can get all the nutrition, except the fiber, and pound it down in a minute. Fruit juice contains fructose, which is sweet and therefore it tastes good. That’s how much you really should be thinking about this. If you’re thinking in terms of fructose and the krebs cycle you’re in lala land imo like Dr. Robert Lustig and Gary Taubes (they both have great points actually just poking fun). One quick note about fruit juice: read the damn ingredients. Often, you’ll find white grape and apple juice used to as a filler to make the product cheaper.

6. Pizza

I’m not a pizza-craver but I’ve seen more than a few people who crave it, especially during late nights. It has refined carbohydrates and cheese all wrapped up in a hot cheesy red sauce that is probably stress-relieving in some way. Thin people crave pizza all the time so there really should be no remorse for eating it. It doesn’t have to be considered a “guilty pleasure,” which is such a misguided phrase. Pizza can be very health-promoting because cheese is a very metabolism boosting food. Any food that is calorie dense can do this but with pizza, you’re getting some nutrition out of it too: not much but some.

pizza

7. Cheesecake

It’s made from cheese, so you’re going to get some vitamin A, calcium, and protein. It’s healthy in moderation.

8. Cheeseburgers

Continuing on the topic of cheese now, you may be realizing something; the reason why all these foods aren’t bad is because they relieve stress. If you want proof, let’s conduct a study where we force people to fight against their cravings and choose “healthy” options, for a period of at least 2 months, and compare this with another group that just follows their cravings. I bet you that the group that goes with the cravings will be healthier. Now, we could be craving a particular taste, rather than a food with nutrition in it, and not all cheeseburgers are created equal so this could be a problem. Again, aim for whole foods; a cheeseburger should contain meat, cheese, some vegetables and pickles if that’s your thing, and bread. The fillers and ingredients in a McDonald’s cheeseburger however aren’t food so I would recommend against that option.

9. White bread

It’s everywhere, and although it is very refined and spikes your blood sugar and can help you gain a lot of weight quickly, in moderation it’s a good source of calories and betaine even. Empty calories is a huge myth; sometimes our bodies just need calories to increase our metabolism. Some people are indeed sensitive to gluten, and I do not eat white bread myself except when I go out and eat burgers, because white bread contains canola oil and other junk that I don’t consider real food, but if you eat it and have adequate micronutrients in your diet or through supplementation and don’t gain 50 lbs you’ll be fine. If you’re sensitive you’ll know.

10. Other kinds of bread

I had a HUGE fear of bread when I was reading about the Paleo diet. Actually it wasn’t a fear, it was an irrational belief that since our ancestors didn’t eat bread it was somehow wrong for me to eat bread. Well I have realized that the paleo diet is probably the most nonsensical diet out there, as most people agree, and that bread makes me feel full and good. I have no gluten intolerance so I’m happy to eat naan, sandwiches, wraps, and stuff like that anytime. Of course, if you want to lose weight, cutting it out can help, but the most important factor is reducing your caloric intake. The thing with bread, just like cheeseburgers, is that they’re not all created equal. Bread is a product that comes from wheat, or other grains that can pack a lot of nutrition. There are some mills out there still that make bread without all the canola oil and high fructose corn syrup and other cheap fillers you will find in regular bread at the supermarket, so that is going to be my first choice. I don’t crave bread though so I rarely eat it anyway.

11. Non-organic produce

I prefer organic food, but I have met some hard-working farmers that use pesticides that they claim aren’t harmful, and the fact is that without these pesticides they wouldn’t have crops to sell to you. Farming isn’t easy, and most of us are so alienated from growing food we have no idea what the difference between organic and conventional is. If you want to know exactly how it works, try looking up the exact pesticide and doing research on how much exposure you are getting. The other thing is by supporting conventional you are basically supporting Monsanto, which sucks, so I would recommend going organic. But if you’re at a restaurant and aren’t eating a certain vegetable because it’s not organic, just realize you probably have absolutely no idea what the insignificant amount of pesticides are actually doing to do to you.

12. GMO food

The whole anti-GMO movement is full of hippies and natural-everything enthusiasts and not much real science. I am not in favor of Monsanto, so I wish to boycott GMOs, but I have to admit that people are really not thinking straight here. Whenever they hear about a new GMO they want to boycott it but there could be some benefits. Round-up ready corn on the other hand has been proven to be very dangerous to consume, but not all GMOs are round-up ready corn so just remember that things aren’t that simple.

13. Soda

Also known as pop, soda has a ton of sugar. I don’t recommend drinking coke, sprite, or any of those conventional sodas, because well, there are better ways to get your soda fix. I recommend Virgil’s sodas, and Fentman’s sodas, because they use herbs (they claim they do but I can make more herby ones that are better once I learn) and there is actual nutrition in there. Root beer was originally a medicinal tea by the way, but it was advertised as a beer because the guy who came up with it was smart and knew it would have greater appeal that way. The first time I drank Virgil’s soda was the first time I drank soda in years, and it was during a period of time when I was severely overtrained and stressed and the soda made me feel better. I was burning sugar every day from my intense exercise, so why not drink some?

Virgil’s soda

14. White rice

Thin asian people eat white rice all the time. So do fat asian people, but they’re really good at table tennis, martial arts, and have fast reaction times, so maybe the sugars help keep the brain fueled optimally; better than those ketones that the brain-dead paleo people like to talk about. But in all seriousness, even though again, people advertising weight loss routines and supplements claim that white rice has empty calories, there’s a lot more to health than what they say, and the fact is, most people hate brown rice; it doesn’t taste as good and that much is obvious. It also is harder to digest… I tend to have great bowel movements with a spicy Indian curry with white rice by the way: so trust me there is still fiber.

15. Bacon Bacon is good for the soul. And that’s all I have to say about it.

We’ve all been told that weight loss should lower the risk of heart disease, diabetes, cancer, and other degenerative diseases. Presumably, weight loss should then also extend life. The problem is that this cannot be assumed by judging the changes in biomarkers of health that changed with weight loss, such as changes in blood pressure, blood sugar regulation, or inflammation; the increased longevity must be observed. The closest thing we have to that are the longitudinal studies which track groups of people for a certain period of time, which for the most part agree that weight loss is associated with increased mortality, while weight gain is associated with decreased mortality.

Weight loss doesn’t mean fat loss of course; it could mean loss of muscle or wasting away of the body due to disease. This reverse causation hypothesis, that weight loss could have been associated with preexisting disease, has no evidence behind it. Anyway, subjects with preexisting illnesses have been excluded from these longitudinal studies, yet those who lost the most weight seemed to carry the highest incidence of cardiovascular disease, diabetes, and in some studies, cancer.

This relationship held true in a study on middle-aged Israeli men. All-cause mortality decreased with increasing weight gain over a follow-up of 18 years! They made sure to ask the participants before the follow-up period if they intended to lose weight, and still found increased mortality among those lost weight intentionally. Similarly the 1946 British Cohort Study, published earlier this year, found that those who lost more than 5kg between the ages of 43 and 53 saw a four-fold increase in mortality from all causes before the age of 65 compared to the moderate weight gain group (between 2 to 5 kg), a finding which isn’t new to this study.

In the Melbourne Collaborate Cohort Study, which was also published this year, researchers measured more than just weight, they looked at waist circumference too in order to track abdominal fat loss. They found that despite 35% of the participants losing weight, only 16% lost size on their waist. However, among those that did, obesity-related cancer deaths and cardiovascular disease deaths were the highest. Those who gained between 8.5 and 13 centimeters on their waist had the lowest rate of obesity-related cancer deaths, and those who gained between 5 and 13cm had the lowest cardiovascular disease deaths.

A recent meta-analysis found a more precise explanation: those who were healthy and obese saw an increase in mortality with weight loss, but those who were unhealthy, saw a decrease. There is more to the story but what most researchers conclude is that recommending weight loss to obese patients is premature, especially if they are healthy. In another study on overweight diabetic subjects, those merely intending to lose weight, whether or not they actually did lose weight, saw a 23% decreased mortality rate. Unintentional weight loss, as in other studies, was found to increase mortality by 58%.

Despite these findings, a plethora of studies, like this NEJM one, have associated abdominal adiposity with increased mortality. Although these longitudinal studies found increased mortality among those who lost weight, there was no information on the metabolic health of the subjects. We know that being obese can be unhealthy metabolically, but that it’s also possible to be lean and have the metabolic syndrome, and a Korean study showed that normal weight metabolically unhealthy people have higher mortality rates than metabolically healthy obese subjects. Metabolically healthy obese subjects however still seem to have higher mortality than metabolically healthy normal weight individuals in some studies. And of course, to contradict myself one more time, in another study, weight loss by personal choice decreased mortality, whereas for health reasons, it increased mortality.

So there is no conclusion here, except that we need much more than waist circumference to tease out the details, and continue to search beyond what can see with our eyes. If weight loss causes stress to the body in those who intend to lose weight, or muscle loss as researchers speculate, it should be measured more precisely to understand why the mortality is higher. Perhaps there are studies like these but so far, it doesn’t seem like there is a precise answer, except that it’s about what’s inside that counts, and fat-shaming is still based on intuition rather than reason.

 

It’s funny to me that the fitness industry doesn’t sell fitness. Fitness means fertility, and thus health, from a biological standpoint.

I’m on instagram a lot . . . I see IG accounts with hundreds of thousands of followers by ripped fitness junkies who may not fit the bill of true fitness. This is a huge problem because what people are being sold on (something I was sold on as well) is something that potentially reduces their health and vitality, or biological fitness.

Of course it depends on the person as some people can exercise and diet and improve their health and fertility; however, the role models of the fitness industry don’t deserve to be the icons of true fitness because they never are pictures of optimal health. Optimal health doesn’t look extremely lean with augmented breasts; yet, that’s what the “fitness” industry sells.

Yea I know . . . not everyone on a magazine cover showing off their body and breasts is super-lean; I’ve seen plenty of people who are lean but still have a healthy level of body fat like me. Also some people are leaner genetically. However, if you have to diet to get there, and have trouble maintaining it, it’s questionable if your body actually loves you back from the torture you put it through.

So today, I’d like to turn people’s attention to something we all think about: attraction, fertility, and sex. The fitness industry sells sex first, then health; although, like I said, they f***ed up the part about health. If you look around though you will find circles discussing health in the fitness industry: they’re just more underground. But anyway, it’s not attractive to be infertile.

It CAN’T be because infertility opposes sex. However, due to some simple classical conditioning (fapping to leaner and leaner bodies on the internet) and habituation (leaner and more ripped bodies are needed to make us say “wow”), we can make less-fertile but leaner physiques achieved through dieting and stupid cardio look more attractive in our minds.

So if you didn’t get that, habituation occurs when a stimulus produces a weaker response with time and a stronger stimulus is needed to create the same response as before. As an example, consider Marylin Monroe with her curvy, feminine physique. If she were here today she would likely feel shameful for flaunting that body. She would look around and start to think she was fat because her body-shape is not up to the standards of the fitness or fashion industries anymore. The conditioning just occurs when we associate the leaner and “better” body with some sort of reward; in the crude example I provided it was an orgasm.

Marylin Monroe

The point is that our sex appeal and attractiveness involves a lot more than a body fat percentage; that number may have nothing to do with it even. In this post I won’t specifically cover the details of body-fat percentages and fertility (I’ll look into that for another post), but here I would like to draw our attention to other factors that signal attraction just to help us again realize that worrying about getting leaner for “aesthetic” reasons is less important than being healthy, but it’s also completely misguided. Here are just a few of those other factors.

Hunger: Hungry men find heavier women to be more attractive, possibly because it signals that she is better at obtaining food. There is that one saying about how the path to a man’s heart is through his tummy, so this makes sense. The heavier women though weren’t that heavy, it’s just that the satiated men preferred women with a surprisingly low BMI, of 20, whereas the hungry men rated women between 20-30 BMI as being highly attractive. This phenomenon seems to be common across different cultures as well.

Limbal Ring The limbal ring is a dark ring surrounding the iris. It decreases with age and is supposed to be beautiful. In one study, participants were presented with two faces of the same person, one with a more pronounced limbal ring than the other one. Partiicpants clearly preferred the face with the limbal ring, even when the face was presented upside-down. However, there is tremendous variation in limbal ring width among all ages so it’s hard to say if there is an ideal width. Here is a picture of Sharbat Gula though, the famous “Afghan girl” whose picture you may have seen. On the left she is 12 and on the right she is between 28 and 30 after she had had four childbirths. Her eyes definitely look less youthful in the right image.

And these are pictures from the study.

Images from limbal ring study

Images from limbal ring study

Unfortunately I haven’t been able to find any science explaining how a limbal ring contributes to fertility. When I do I’ll update this or make another post.

Waist to hip ratio and Waist to shoulder ratio: A low waist to hip ratio in females is not only more attractive, it is associated with greater health.  This number correlates strongly with lower risk for diabetes, heart disease, and all-cause mortality. Men with low WHRs, or wider hips, have poorer health. A lower waist to shoulder ratio however, contributing to the V-shaped body, is more attractive for females.

Christina Hendricks, from television series Mad Men, has a low WHR.

Digit ratio: Men with a lower 2D:4D ratio (shorter index finger, or second digit, than ring finger the fourth digit) may be more fertile with higher testosterone levels, have greater musical ability, greater spatial ability, and better heart health. The 2D:4D ratio indicates prenatal testosterone exposure and it’s unclear if it’s related to adult male levels of testosterone. Females with high 2D:4D ratios, and thus less testosterone exposure and more estrogen exposure in utero, may have higher fidelity, whereas females with more testosterone exposure may be more promiscuous. The low ratio in men and higher ratio in women is also associated with having more children, which means more fertility.

Golden ratio: Beauty may not be completely in the eyes of the beholder. It takes a fraction of a second for us to decide what we like and what we don’t like. Faces that fit Marquardt’s mask, and the golden ratio, are considered more beautiful. Faces that deviate from the golden ratio tend to be related to more health problems. Not everyone is convinced though that the golden ratio is more attractive as most people don’t have a golden ratio in their face.

Stubble: A full beard indicates paternal instincts more so than light stubble, which females find the most attractive in males.

The color red: Red is somehow more attractive to both females and males, influencing reproductive-relevant behavior. Oooo sounds sexy.

Body symmetry: Symmetrical faces and bodies are also more attractive. Manning and Scutt showed in 1996 that body symmetry is the highest when females ovulate, when they’re the most fertile and attractive. Females tend to orgasm more frequently with symmetrical male partners.

Smiling: This seemingly positive trait was ranked the least attractive in males and most attractive in women whereas pride was ranked most attractive in males and least attractive in women.

Well there you have it. Human attraction is complex and involves many other cues such as odor, but as you can see, there are many other qualities we may or may not possess that influence our attractiveness other than body-fat percentage. Dieting to lose weight and eventually lower our fertility isn’t more attractive. Unfortunately overly-lean male and female physiques have been accepted as new standards of beauty that confuse people and cause them to do weird and possibly health-deteriorating things with their life.

I guess the point is that although our digit ratios or body symmetry may make us more or less attractive than others, we can’t change those things. We can change our body fat percentages though, and maybe that’s why it’s more popular than Dr. Catherine Shanahan’s approach in Deep Nutrition. Dr. Shanahan says that beauty is influenced by maternal nutrition. Healthier moms produce more beautiful, and thus healthy, babies. In order to do this we must eat more ancestrally, keeping refined and processed junk to a minimum. She provides several examples of the second sibling effect, where the second sibling is less attractive than the first due to poorer maternal nutrition caused by the first childbirth. This approach to beauty takes generations, but may be worth it in the end.

So we’re not all perfect beautiful people, but that doesn’t matter because we don’t have to be. Part of this anti-diet crusade is to help people develop better images about themselves, and if we associate too much of our self-worth in our body shape or how much weight we can lift we will be miserable and may develop unhealthy habits. However, many of us have beauty that we don’t recognize. I provided Marylin Monroe as an example earlier: although at her time she was one of the most beautiful women known, if she were alive today she may not have been considered as beautiful because she wasn’t skinny. There are potentially millions of young women now who have normal healthy fertile attractive bodies who think they’re fat and are on diets to lose weight and like eating salads for lunch and want to see their ribs eventually. Males aren’t immune either.

Not ALL dieting is bad; dieting to lose some weight when needed can be good, but people are going way past that. Fitness models have to be strict about their diet and exercise plans in order to look a certain way. People then are sold emotionally by the flashy images and decide to do the same thing. It’s not about health. But fitness is supposed to be about health. So here, the discussion will be about improving fertility, or health, and thus, attractiveness. Whether or not we need to make bone broth and drink collagen to eat a more ancestral diet to achieve that is up for debate, but I’m much happier to recommend that than recommend an intense workout program with a structured diet that may cause you to fight against your body.

The solution for now is simply to listen to what your body is telling you and aim to achieve optimal health. Being in a good mood, feeling great, feeling warm, having a healthy appetite . . . these are good. Slaving away at the gym and feeling tired while dieting is not a path to better health obviously. So, what will you do to improve and embrace your health and fertility today? I will exercise less, because I really need to; and so far, it’s working quite well. Whenever I take days off I have much more energy, my brain works better, my motivation is higher, and I’m more focused. That means I needed it, but I must continue this positive trend.

Work smarter. Relax.

In my last post I discussed the bad of orthorexia, and I cited a few examples of orthorexia alive today in 2014. I’d like to discuss the degrees of orthorexia in this post however to answer a pressing question: how much is too much when it comes to thinking about the health consequences of food? If orthorexia exists on a continuum, where on the continuum is it healthy to be concerned with the health consequences of eating? Here we go.

When orthorexia is not bad

I believe in the next fifty years we will be observe the fate of orthorexics clearly. We will observe if their health deteriorates at a slower rate than average, and if they can live to one hundred and twenty years as many of them wish to. If they are able to do this, then you can argue that orthorexia is not bad, because greater health is achieved.

But how can we know now if orthorexia can be good in some contexts? The National Eating Disorders Association’s (NEDA) article on orthorexia mentions how there are more important things to life than food . . . but SO WHAT? So what if someone wants to be obsessed with their food in the attempt to live to a hundred and fifty years old? In the biohacking community, greater health is associated with greater productivity; so a longer life means that they can accomplish more and get more out of life than someone living “normally.” This rationalization however only applies to a small population of orthorexics however, as most of them experience worse health.

This is when it all gets really philosophical. Everything is “bad” when it ruins your health or impairs your life in other ways, but they can be good in other ways right? A bodybuilder who lowers his testosterone and body temperature but achieves the physique of his dreams may believe it was. With this mentality you can argue that any thing is bad for us. I’d like to share a story of Alexander Graham Bell, inventor of the telephone, and a workaholic, as an example. From Destiny of the Republic:

“Even when he had fallen in love with Mabel, her family had assumed that he was nearly ten years older than he was. Six years later, as he hunched over the induction balance, his face seemed to be set in a permanent scowl of concentration. No one would have guessed that the dour scientist had only recently celebrated his thirty-fourth birthday” (Millard, p. 219).

I admire Bell’s workaholic spirit, but this quote brings up really important idea. Bell invented a device that was met with great enthusiasm at the time, and he worked very hard to achieve it. He made “no excuses” and took “no days off” and was never satisfied. When he did rest, he played the piano late into the night with the same ferocity in which he attacked his work. These traits are exactly what orthorexics aspire to, without looking ten years older than they currently are (that would be the worst nightmare ever). They want to eat the perfect diet to be the best they can be and, and, and . . .

Well that’s the difference. Bell worked hard because his head was teeming with ideas and he couldn’t stop. Orthorexics “work hard” to achieve something that may not be their original idea (low body fat or live to 120). I argue that society has inadvertently programmed into the orthorexic his or her mission, destroying free will (although humans have been interested in immortality for a long time). But that aside, it’s up to the orthorexic to answer what the point of taking “no days off” and “making no excuses” really is. In my frank opinion, there is no damn point, because that mentality usually involves dieting strictly to lower body fat to below attractive levels. But if the point of paying strict attention to food involves improving sleep quality, improving mood, productivity, etc., it doesn’t seem bad at all. Also, some people pay strict attention to their diet for medical reasons. In this case, it’s still arguable if the changes were justified.

So here are some guidelines I came up with for evaluating where you or other orthorexics you know lie on the scale of orthorexia. I came up with these guidelines based on my personal experiences with orthorexia, and observation of others. On one end of the scale is “healthier orthorexia” and on the other end is “unhealthy orthorexia.” There will be an overlap between the unhealthy and the healthier orthorexia’s, but in general someone with clearly unhealthy orthorexia will not be doing what the person with healthier orthorexia is.

Unhealthy orthorexia:

  • Adamant: Refusal to admit that beliefs may be unsubstantiated and eating normal foods may not cause the problems they are believed to cause. Individual has stubborn, rigid beliefs.
  • Psychosocial stress: Stress is caused by being in an environment not conducive to the orthorexic’s food plans, such as at a dinner party. This stress prevents the orthorexic from being able to live healthfully.
  • Feelings of superiority: The orthorexic feels superior to others for following a healthier eating plan, refusing to admit that his or her ideas may not be completely substantiated.
  • Denial: Refusing to admit that something is wrong with his or her health. Refusal to admit that beliefs are unsubstantiated as well.
  • Desire to control: Many orthorexics and anorexics feel positive when they have control over their diet. This psychological aspect of eating has nothing to do with health.
  • Defensiveness: The orthorexic may rationalize his or her beliefs immediately without considering possibilities that implicate the diet to be faulty.
  • Body dissatisfaction: Having unrealistic perceptions of the body: too skinny, too fat, etc. This orthorexic may go on a diet despite already being slim!
  • Selfharm: If goals are not met, the orthorexic may hurt his or herself as a form of punishment. At this point, orthorexia may start to turn into a real eating disorder.
  • Time-consuming thoughts and habits: If practices related to eating healthy and thoughts about eating healthy take up a significant portion of the day, the orthorexic may be overdoing it.

Healthier orthorexia:

  • Spirit of experimentation: This orthorexic is on a strict diet out of experimentation. Biohackers fit in nicely here.
  • Ability to let go: The willingness to experiment often requires the ability to let go of previous beliefs. If this ability is present, the orthorexic may be healthier mentally and physically.
  • Not defensive: The orthorexic will be able to admit that further exploration is needed before coming to a conclusion. When presented with an opinion that contradicts the orthorexic’s beliefs, he or she will listen, because experimentation and continually learning is key.
  • Healthy body image: This orthorexic isn’t dieting to maintain a super-low body fat and doesn’t look at himself in the mirror and think he’s not lean enough every morning. The goal is health rather than thinness as in anorexia nervosa.
  • Social, without stress: This orthorexic can politely decline offers of “unhealthy” food or drink and still be comfortable in social situations without experiencing psychosocial stress from his or her strict habits.
  • No guilt: If a food rule isn’t followed, or in the spirit of experimentation a Krispy Kreme donut needs to be eaten to raise the metabolism, guilt will not be experienced.
  • Acceptance of others: This orthorexic will not judge others for eating “unhealthy” foods.
  • Acceptance of uncertainty: This orthorexic will be comfortable knowing that his or her approach isn’t certain to result in perfect health, and that it’s ultimately just a fun experiment. Being able to accept that his beliefs are uncertain, the orthorexic will be less likely to get defensive or experience psychosocial stress
  • Medical condition: strict diets are often prescribed to treat certain medical conditions. In these cases orthorexia isn’t present, because the strict diet was prescribed to improve health and thus doesn’t fulfill the criteria of orthorexia (an unhealthy fixation on eating healthy). Sometimes people who are interested in healing themselves with food go to extremes however become orthorexic in the process.

I cannot call any level of orthorexia healthy, because we simply don’t know yet if paying strict attention to food will confer the health benefits the orhorexic believes it will; that’s why I called it “healthier” orthorexia. And well, healthy orthorexia doesn’t exist; a strict diet that is healthy however may. Honestly, I’m in the latter group, although my experimentation involves eating a lot of foods the average orthorexic would not be able to fathom consuming (refined sugars, pastries, white rice, etc), in which case I don’t have orthorexia. I’m still experimenting though and want to be able to be as productive as possible in a day, minimize stress during stressful tasks, recover faster from stressful events like intense exercise, sleep optimally, think better, and age gracefully. Eating these forbidden foods is my form of experimentation. I want to do this because I believe that if I can be healthy, I will do more of the things I love in my life. I have realized however that many of the foods the orthorexic, such as my former self, believes are unhealthy, aren’t unhealthy: eating starches and sugars, meat, pork, peanuts, donuts, soda, may not be as bad for us and may even promote health . . .

Wait so can orthorexia be worth it?

Well, there’s a difference between being overly obsessed with your health and making small changes in the diet to improve health for a specific reason. But that’s at the heart of this idea: understanding how much is too much. If we can observe biohackers living exceptionally long, high-quality lives, paying strict attention to their diet, I might listen. The problem is our diet isn’t the ONLY thing that affects our health or the aging process. Genetics, exercising, the environment, and our mental health can be equally if not more important. Some people with worse genetics or environment growing up may have to focus on their diet more in the future due to the health problems they’ve accrued, while others with healthy genetics can stay slim and just live normally eating whatever they want in moderation and live long happy lives. One common problem that Dr. Bratman explains in his must-read essay on orthorexia (remember this is the guy who coined the term) is an exaggerated faith that their diet is the ultimate factor driving our health. This is what the NEDA may be referring to when they say there is more to life than food; there is also more to health than what we eat.

See, there are many interesting things people can do to be healthier, through food and other lifestyle modifications but it’s difficult to quantify what difference it makes long term. I know that the research shows bright light before bed can hurt sleep quality but what if I just go to bed later and still look at bright lights after sunset? The problem may arise when we get stressed out over a bright light in the evening that disrupts our control over our circadian patterns. When this desire to control is thwarted, the added stress could arguably negate benefits we hoped to achieve. I went to bed super early and did the no lights thing for a while, but my sleep quality wasn’t optimal because of adrenal issues I faced from being orthorexic.

Conclusion

Orthorexia in my humble opinion is unhealthy when it consumes us to the point where our preoccupation with food prevents us from living our lives in the way we want and causes poorer health. I guess this definition can be understood both objectively and subjectively. If you are orthorexic by someone else’s standards, but you are living the life you want, and you feel great, and aren’t seeing your health suffer, then who cares? You won’t have the social life that society may wish you had in order to fit in, but you will have the social life you want. You also may be able to live to 256 years of age like Li Qing Yuen, who drank goji berry juice and took chinese herbs and lived in the mountains (joking, but same idea).

In conclusion, I think orthorexia is dangerous for a few reasons: it can hurt people’s health, cause orthorexic health gurus to “inspire” a younger generation of orthorexic and eating disordered individuals, mislead already healthy people about “healthy” eating with unsubstantiated beliefs, and it can lead to an unsatisfying life. I can’t stress this enough but the perfect diet just doesn’t exist. Orthorexics are often perfectionists, so I think this realization can help them and normal people avoid going to extremes. But dietary changes can improve our health, and even improve medical conditions, so some cases of orthorexia may seem more warranted than others.

In the final post of this series, we’ll cover some of the ugly aspects of orthorexia and disordered eating. Stay tuned.

 

How bad is orthorexia? The simple answer is this: any planning, thinking, worrying, counting, tracking, biohacking, etc. involving food that does not hurt your mental, physical, and emotional health isn’t bad for you. But in most cases, it does hurt, and understanding when that happens is the point of this discussion. In this post we’ll cover mostly the bad side to orthorexia.

Henceforth, orthorexia, disordered eating, and partial syndrome eating disorders will be synonymous, but I will only use orthorexia, even though there are some major differences. People with orthorexia don’t binge and purge or maintain an extremely low body weight, but they have similar traits to people with eating disorders and may be playing the same mental games with food; so in discussing orthorexia we’re also discussing other eating disorders. I will also discuss health obsession in general, which involves more than just an obsession with food. Let’s get started.

What is orthorexia?

Orthorexia is a term coined by Dr. Bratman in 1997 that means “correct diet.” He was an alternative medicine doctor who praised healthy eating like it was gospel. He realized though that most people just didn’t know what they were talking about, and that it was possible to have an unhealthy outcome from trying to eat healthy foods. He named the condition after the unhealthy relationship with food that people developed, which often involved attempting to eat “clean” or “pure” foods. The reason it’s unhealthy is because it can interfere with people’s social lives, interfere with their own lives, and ironically result in poorer health. People with orthorexia tend to interpret research on healthy eating with a bias, due to several reasons: body dissatisfaction, the desire to be immortal and achieve superhuman health, or to be in control of their lives, among other reasons. Unlike anorexia nervosa, people with orthorexia openly voice their lifestyles. From my personal observations of myself when I had orthorexia and of others today on social media sharing their orthorexia with the world, I strongly believe body dissatisfaction and a desire to be thin for women and lean but muscular for men is the most significant reason normal individuals become orthorexic. In contrast to anorexic patients however, a greater emphasis is placed on health and the quality of the food rather than the quantity. The mentality drives people to think that only the cleanest and best foods will result in “optimal” health, when in reality their bodies may have optimal functioning in a variety of environments.

Different manifestations of orthorexia in today’s online health communities

  • The biohacking circles display a lot of orthorexia, and from just my observations, they tend to follow a ketogenic diet, which may not be sustainable long term. These individuals want to maximize their quality of life by maximizing their health. Cold showers, hormetic theories of ageing, grassfed butter, and minimizing advanced glycation end products (AGEs) in their bodies are a few of their passions. Most of these people don’t exercise that much, as they believe too much exercise can increase free radicals in the body and accelerate aging. They’re not just obsessed with food, but with everything that affects their health. Like patients with eating disorders, high self-oriented perfectionism may be common.
  • Paleo: Often devout low-carbers, paleo dieters overlap with the crossfit and biohacking circles. They usually don’t follow a diet that would be considered paleolithic by our paleolithic ancestors, but they still eat lots of bacon, eggs, sausage, and low carb products anyway, while believing that carbohydrates are unnecessary in our diet.
  • Veganism: Not all vegans are orthorexic, as many are more concerned with the ethical and sustainability aspects of our diet, but many vegans from my observation, like the biohackers, want to live long and healthy lives, while maintaining a slim physique. They tend to believe that all animal products are unhealthy for humans, and all protein can be obtained from plants. Their heroes are endurance athletes like Brendan Brazier and any vegan who decides to workout and has a decent physique. I started in this crowd with the raw foodists, the ultimate clean eaters, who only ate algae, seaweed, B12 supplements, raw fruits, vegetables, and nuts, while becoming more and more gaunt.

Traits among the orthorexic

  • Perfectionism: this is actually a trait found in all eating disorders. It involves setting very high standards and becoming upset when standards are not met. Unrealistic expectations ultimately lead to these people’s downfalls. I’m a perfectionist, but only recently stopped looking for the perfect or optimal diet. There is none.
  • Ability to rationalize any belief: orthorexic individuals may sound very knowledgeable, but they may be searching for information that confirms their hypotheses. Biohackers will argue that sugar consumption increases advanced glycation end products which can increase diabetes risk or the oxalates in spinach can wreak havoc on your teeth, and vegans will try to show that saturated fat causes insulin resistance and cite Dr. Dean Ornish’s research as evidence.
  • Food rules and avoidance: common in other eating disorders as well, this trait involves avoiding “forbidden” foods that one believes may hurt their health or other rules regarding the consumption of food, such as filling up the stomach only 80% during meals like the Okinawans. Some people are very good at explaining why certain food rules are beneficial, but their views may not consider long term effects that have any basis in longitudinal studies (many of which don’t exist and won’t ever thus the discussion is pure speculation).
  • Impaired social life: Orthorexics may still have a social life, but not in the same way as other people. When I had orthorexia I never felt as if my social life was impaired, but in reality, I couldn’t do a lot of things that people do. I didn’t want to do them, so it worked out fine. Others however may feel tempted to socialize and may feel awkward denying ice cream, pizza, and other foods at parties and other social events.
  • Logical fallacies involving fat shaming: Orthorexics may discount nutritionists or other health professionals with real credentials for being overweight, and be more likely to believe a hippie’s advice if they have a more attractive physique. They may also be more likely to trust someone who displays impressive feats of athleticism, like a fruitarian doing an L-sit, something that five-year olds can do with some practice.

When orthorexia becomes bad:

Socially: For Dr. Bratman, the man who coined the term, orthorexia became an undesirable way to live when he realized that he was thinking about eating sprouts during normal conversation. When food becomes so important that you miss out on living the way you want to, it obviously signals that something needs to change. When I studied abroad in Peru freshman year of college when I was on the raw food diet, I consumed less food than usual because I tried to eat only fruit. I lost some weight and was hungry because I couldn’t deviate from my raw food plans and enjoy the local cuisine. I never went out to eat either during my diet, except once at an overpriced raw food “restaurant.” Let’s call it a health-freakaurant instead. Not being able to do what others did however did not bother me one bit. For others however, social life is an important part of health and being unable to have a healthy social life with fellow human beings may cause psychosocial stress. I have a feeling though that most orthorexics don’t really care what others think and are committed to making adjustments in their social life to maintain their focus.

Poorer health: Just as obviously, when your hair is thinning or you feel as if your health is suffering, you may eventually realize that your diet isn’t perfect after all. Some people hurt their bodies so much from dieting that they need a recovery plan to restore their health back and are often put on hormones carelessly by their doctors. Hypothyroidism, amenorrhea, low testosterone in males, weight gain, lethargy, brain fog, cracked lips, cold hands and feet, and low body temperature are just few of the symptoms that people who diet excessively often develop. Of course it’s up to the individual person to accept that their health is deteriorating and change. Oftentimes, orthorexics will rationalize a symptom as being a good thing and ignore reality. Raw foodists for example believe that their amenorrhea means that the body is completely detoxified and no longer needs to eliminate toxins from the body through regular periods.

Misguided beliefs: People should be free to do what they want, I guess, so it’s hard to argue against a fruitarian mother who seems to be starving her child. Misguided beliefs are a core element to the diverse orthorexic lifestyles out there however. This is a huge point of contention to any orthorexic, because the orthorexic can rationalize most of his beliefs, but when he fails to do so, he’ll ignore what he does not understand anyway. It’s so difficult for me to explain this, but I haven’t met a single orthorexic or biohacker, vegan, or any health-obsessed nut who can convincingly explain to me that their lifestyle is going to improve their health. I thought I knew it all when I was vegan, and even my future self wouldn’t be able to convince me that I was a moron. Sure, some people will have reasons for doing things that are warranted, but when it comes to diets, usually they’re extreme, and these are never warranted. In addition, the extreme dieters have subconscious reasons for continuing their diet that aren’t easy to identify.

Ketogenic diets (essentially zero carb diets except for vegetables) for instance are popular among the biohacking and anti-aging enthusiasts because they believe a lot of age-related diseases are related to impaired insulin signaling; thus by reducing insulin in their bloodstream as much as possible, they may avoid those diseases and live much longer. This belief is unsubstantiated because weight gain can still occur in these diets easily, which can increase fasting insulin levels and prediabetes. Oops.

And of course, as I mentioned, excessive “clean” eating eventually can result in adrenal fatigue, infertility, lower thyroid function, and other health problems that shorten peoples lifespans. The misguided beliefs were the cause of that.

Well, that’s the bad and part of the ugly. In the next post I’ll cover the (potential) good of being orthorexic, but more realistically, the benefit of being concerned with diet at all. Changes in diet can improve our health in many ways; the problem is that going to an extreme as in orthorexia can hurt it. So how much is too much? That’s what we’ll ultimately get to in the next post, and where things will start to get complicated and philosophical. Cheers.

 

Calories in minus calories out. This follows the first law of thermodynamics. You cannot lose weight without restricting calories and you cannot build muscle without being in a caloric surplus. Thus, to lose weight, restrict your calories and to gain weight, increase them.

Although this makes sense, I just find the idea odd, and unnecessary. I have a better solution. I also find calorie counting to be a product of Western thinking that aims to reduce things to its parts and focus on finding causes and effects rather than looking at things holistically and seeing the interactions of all the factors at play. I grew up in Western society and learned to adopt a Western mind, but perhaps my genes cause me to want to view the big picture at all times. That part of me says that calorie counting isn’t enough: there’s better. There are also some serious downsides to it, and that’s the part I hate the most, because I hate seeing people who want to become healthy become obsessed with calories and hurt their bodies from trying so hard. It makes no sense, and it can really hurt our hormonal health to the point of causing infertility, and even death in the worst cases. Those most susceptible to this are type A health enthusiasts, perfectionists, and athletes who must maintain a low body weight such as fighters, track and field athletes, weightlifters, dancers, bodybuilders, and fitness models. One step in the wrong direction is a misstep.

Maybe I’m going overboard; most people won’t run into these problems from simply counting their calories you might be thinking. You’re somewhat correct: it’s not that big of a deal if you want to count your calories or try to control your portions and such, because you can lose some weight and perhaps keep it off; it’s the obsessive trap of tracking everything that can cause problems. Most people try for some time, achieving some success, but then go back to following their instincts anyway. Can calorie counting work and make people happy? Yes.

But here are five reasons why you definitely don’t need to count them or pay any attention to them; I will discuss only points one and four below this list:

  1. You don’t need to count your calories to restrict them. You also don’t need to restrict your calories to achieve the purported benefits.
  2. The way we measure our metabolisms is inaccurate: basing your requirements off of that is a shot in the dark.
  3. There aren’t 3500 kcal in a pound of fat unfortunately: it can vary quite a bit
  4. Eat less, burn less: the less you decide to eat the harder it is for you to create a negative energy balance and the more weight you are likely to gain back.
  5. Eat more, burn more: overfeeding studies have clearly shown that we store much less fat than we’d think based on the myth that there are 3500kcal per pound of fat. You won’t become obese from eating 30kcal extra per day either, or even 100 extra kcal.

1. Neither calorie counting nor restriction is necessary to restrict calories. If you have a fair amount of processed foods in your diet, foods that in general aren’t as satiating as foods with more fiber and better nutrition, you will automatically eat less by consuming less addicting and more wholesome foods. A lot of diets that involve calorie restriction sell low-calorie food products like protein bars and such: it can be a sales pitch as well, so beware. Advocating intuitive eating isn’t a sales pitch for any food product that I’m aware of. But also, most people don’t need to count their calories. I think it’s best to eat until we’re FULL, unless there’s a problem with this system such as a genetic predisposition to obesity that involves a failure to regulate hunger and satiety in which case restriction will cause even greater problems.

You also interestingly don’t need to restrict your calories to achieve the purported benefits of caloric restriction. Caloric restriction turns on thousands of genes, and a few things have been shown to activate the same pathways: resveratrol supplementation, intermittent fasting, restriction of methionine or the addition of glycine into the diet, and exercise. It’s a neat idea to want to live to a hundred and twenty, or beyond, but variability in the lifestyles of the long-lived make the exact method to get there seem unclear; and the preoccupation with food can once again cause poorer health, because your body is smarter than you are.

5. That aside, let’s move to our final point here, that our bodies tightly control energy balance. See, when you restrict your calories, your body restricts its metabolism, and you will stop losing fat. The longer this vicious cycle continues, the more likely it is you will gain weight back upon eating normally again. Ever seen the biggest loser contestants a few months after the show? Many of them gain back hundreds of pounds. Many people on low carb diets who stress their bodies out even more by restricting carbs gain back a lot of weight too. Could I get leaner and look more like a fitness model with a structured approach? Sure! But why would I want to? I enjoy the way I look regardless and don’t care that I’m a little fatter than I was last year (um, barely, and let’s get rid of that negative connotation). It’s natural, and it’s a good thing for me compared to having cold hands and feet and a lower functioning thyroid.

Conclusion:negative energy balance is involved in weight loss, but deliberately restricting calories by counting them isn’t the only way to achieve a negative energy balance. A chronically negative energy balance simply isn’t good for us either: metabolic damage is a big concern of mine and a lot of people who might look good on the outside have a messed up thyroid and hypothalamus from excessive dieting and exercising. Not everyone does, but I’ve seen too many people with already normal, healthy, attractive looking bodies decide to restrict themselves further to achieve something even more, something unnecessary and not even biologically attractive. People who already have a flat stomach, think they don’t have a flat stomach: it’s ABSURD. People who’ve come from this disordered eating background tend to understand this instantly but others who are in the zone slaving away in the gym with no free will whatsoever don’t care to understand. Others who really do need to lose weight for health reasons can still follow their instincts: initially these people may feel great eating a bit less, but once the high goes away, it’s time to start a maintenance rather than restriction routine.

As far as longevity, the idea that having fewer toxic metabolic byproducts from eating is a good idea that has plenty of evidence to back it up in animal models, but showing that humans can achieve that simply by eating a lot less has not been shown yet. There are other factors that contribute to longevity and you don’t need to restrict calorie intake to achieve them. Obese humans who exercise live longer for example than lean humans who don’t. Why are we interested in looking young and lean anyway? That’s a topic for another time.

You don’t need to think about calories, so stop. It’s completely unnecessary. Instead, let’s eat real food, local food, and tasty food, develop a more positive body image, and break free from the restrictive traps the fitness industry causes people to fall into with their deceptive advertising. Cook food. Be you, and enjoy this kinda blurry picture of blueberry, chocolate chip, chia seed pancakes made with whole wheat sprouted flour. There are some baklava crumbs on top.

image

Blueberry chocolate chip pancake with maple syrup

 

Bananas and whipped cream, with maple syrup.

Bananas and whipped cream, with maple syrup.

First it was fat, but now sugar consumption is believed to be a major cause of obesity and the metabolic syndrome. But I think people are taking things out of context.

Fear of getting fat is a strong motivator for forming rules about our food; getting over them is the cornerstone for helping patients overcome eating disorders. Whether or not people will admit it to themselves, many who discuss health have an unhealthy relationship with food and lifestyle, displaying traits that patients with eating disorders have, as I’ll discuss in the future. Not all food rules are bad; we need some rules when food industry giants are stocking shelves with frankenfoods, but we have to be rational about weighing the risk to benefit ratio: something difficult to do when a society is increasingly concerned with looking good naked and preserving its youth. For example, an increase in sugar consumption per person since the 1970s has been blamed as a cause of weight gain. These extra calories have purportedly been stored as fat. Since the 1970s however, more people exercise and burn more calories as well due to a fitness boom. Since I started exercising, I ate more calories and more sugar, and I actually lost fat in the process. This n of 1 provides personal valuable insight that helps me guide my decisions and is a valid counterpoint to the idea that sugar promotes obesity.

Whether one wishes to lose fat, avoid fat gain, or just be healthy long term, there are some major unarticulated thoughts about how consuming sugar affects us. See, people with a disease process in their cells, such as insulin resistance and prediabetes, will have different consequences from consuming sugar than someone who is healthy. The cause of obesity isn’t sugar consumption per se, but it’s likely a mix of genetic predispositions and having a positive energy balance. Concentrated doses of sugar in sodas and sweets are more likely to increase the energy balance when consumed than sugars from fruit or honey for instance, increasing the chance of gaining fat mass, the precursor to insulin resistance. Perhaps this also explains why sugar consumption has risen in the past several decades; it’s prepared in tasty and addictive ways. Avoiding sugar seems warranted, but will this take us out of “balance?”

We’re hardwired to love sweets, naturally occurring or not. When we consume addictive combinations of sugar mindlessly, emotionally, and when we aren’t necessarily craving it however, sugar may lead to the negative consequences. What hasn’t been answered yet though, is how this balanced diet affects our physiology: is any processed sugar worse than no sugar? I don’t have the data to answer that question, but my guess is a big and emphatic NO. In fact from my experiences, some of which I’ll highlight further in this post, sugar can be health-promoting, especially for those obsessive health enthusiasts depriving themselves by food rules, while exercising intensely.

My goal here on SBCAH is to promote instinctual eating; instincts however can change based on what we put into our bodies. For some, eating more sugar may increase sugar cravings, and create an unhealthy pattern of sugar consumption. Those in the low-carbohydrate communities experience a reduction in sugar cravings following an elimination from their diet. This may have positive consequences, as foods start to become sweeter, and those previously addicting sugars now taste too sweet. For others, such as myself, consuming more sugar felt very “natural” after three to four years of consuming almost no added sugar of any kind. So how do you know if consuming sugar is right for you? Although there aren’t any studies on this, I believe if we try to follow our instincts with this, being in tune with ourselves, we’ll slowly develop a better grasp. Instead of restricting ourselves, fearing weight gain every time we crave an unhealthy treat, we’ll stop when our bodies tell us to. Although a “balanced” diet or one where we consume everything in “moderation” seems inferior to a strict diet that eliminates all seemingly unhealthy foods, there’s no science showing that, and it won’t ever show that in my opinion. Of course, nothing is ever certain, but here is a way for you to be in better tune with your instincts when it comes to sugar:

  • Reintroduce sugary foods that you once liked, or new foods with sugar that you want to consume
    • My favorite for example is Virgil’s Root Beer (I have no affiliation with the company). The first time I drank it was the first time I had consumed soda since I was a kid. It felt like heaven, and I felt stress melt away instantly. It was available at a local food co-op; I had never consumed it before. It’s pure sugar without any fat, digesting rapidly.
    • The purpose of doing this is to associate the sugar consumption with the response you get from sugar consumption. Initially, if you’ve avoided sugar for a while, you may not even have an instinct to consume it. That doesn’t mean you won’t benefit from it.
  • Pay attention to how you feel
    • How do you feel during and immediately after consuming it? One hour after? A couple?
    • How is your energy affected the next day?
    • How does your brain feel? Mood, cognition, alertness?
    • How is your digestion? Processed junk sugary foods may be more difficult to digest than homemade sweets.

Unfortunately there are no studies I’m aware of looking at how consuming sugar based on an instinctual eating approach affects health (there is no need for these studies anyway). Why isn’t consuming sugar in healthy people seen as a healthy thing? I agree with author Matt Stone that we need a robust and warm metabolism for optimal health, rather than a slower one, and this cannot be achieved by restricting calorie dense foods in our diets. The problems those on extreme diets develop include a low body temperature, low thyroid function, lowered fertility, and other metabolic problems. For these individuals, consuming sugar will likely be health promoting, improving fertility, thyroid, and cognitive function. For the nine to five sedentary man or woman with an office job, the excess sugar may lead to blood glucose imbalances, fatigue, and all the other problems; yet, if the instincts are followed, I have a strong hunch the vast majority, if not every single negative health implication of sugar can be avoided.

The takeaway here is that it’s perfectly fine to consume sugar when you’re hungry, as long as you can follow your instincts with it; something that most human beings do effortlessly. People who believe in “everything in moderation” already know this. These are the people who are less prone to creating unsubstantiated food rules in their life, because their instincts prevent them from doing so. My mother for example, she tells me she will start dieting tomorrow every day, but she enjoys eating her favorite sweets in moderation while staying slim and having no need to go on a restrictive diet. The fact that I need to write about it is unfortunate as well; people have misinterpreted research on sugar consumption, falsely applied it into their life in order to lose weight or be “ripped” and “shredded” and misinformed others about what to eat, causing severe consequences for their health and for others. Much of the research on sugar’s negative health effects have tested unrealistic amounts of sugar. Many people have improved their health by reducing sugar and may have substantiated reasons for doing so, but it’s the unwarranted sugar-phobia based on reductionist research methods that we must take with a grain of salt. Few people do a good job of restricting their sugar, because it just seems so natural and hard-wired, yet people seem to think they have to restrict sugar, salt, and eat “clean” to be healthy.

I reintroduced sugar back into my life almost a year ago, and my thyroid certainly improved since the sumer of 2013, when from my heavy lifting schedule and still strict food rules, I developed mild adrenal fatigue symptoms. I have gained two percentage points of body fat, going from around eleven or so with a six-pack to a still lean body with visible abs, staying pretty weight stable. I look great, and am perfectly happy with myself, but the question is: I gained body fat from consuming sugar, but my thyroid and other symptoms of a low metabolism improved, so what should I do? I can’t answer that question without more lab tests which I don’t need or have access to at the moment: tests to measure my coronary calcium score, visceral body fat, CRP, HbA1c . . . see where I’m going with this? These endless speculations are fun and interesting to ponder, but I doubt they’ll reveal much. I used to eat only fruits, vegetables, nuts, and seeds on a raw vegan diet but was higher in body fat than I am now. This fear of being fat as I mentioned in the beginning is just such a strong motivator. I shouldn’t even discuss it, because it gets people thinking. “Oh this woman has a great body, she must know what she’s talking about, whereas this dietician is fat and ugly, therefore her diet must be very poor;” I’ve had similar thoughts before as well, but now I’ve realized that it’s just so so complex that I don’t even know how to explain it; being at a lower body fat doesn’t mean greater health. There are forms of obesity where insulin resistance is not present and these individuals live normal healthy lives whereas metabolic syndrome and insulin resistance can affect lean people! Confusing!

But anyway, I try to be in tune with my cravings, consuming sugar when I feel I can handle it. I can tell when I’m full, and not in the mood for as many carbohydrates or sugars, and sometimes I really want starches over sugar. During the first few weeks when I began drinking the root beer I mentioned, I had an entire bottle, 40g of sugar, right before bed and slept more deeply than I had in a long time. I haven’t been able to replicate that experience but it was lovely. I often only drink half of the root beer too, consuming only 20g of sugar because that’s all I want to consume. I feel satiated and don’t form an addiction. Sometimes I go a week without any added sugar as well and have fewer cravings. I often only consume eggs for breakfast, which contains no sugar or carbohydrates, and notice steady blood sugar and energy for the rest of the day. Things are variable! When I decide to go back to my chocolate chip pancake routine, I happily will. This may sound confusing, but when I follow this instinctual pattern, it’s second nature and little to no thinking is involved. I’m hungry, I eat. Remember, it’s high blood sugar that’s dangerous for us, and this is caused by weight gain, especially in the abdominal region. Eating sugar won’t necessarily raise your blood sugar in the long term or cause weight gain if you can get better at following your elusive instincts. Being obsessive about diet is also dangerous, because people never have the full picture and restrict too heavily. If you’re healthy and consume a balanced diet with nutrient dense foods and adequate micronutrients, consuming empty calories when you’re hungry is not likely to cause any health issues and may keep you in “balance;” a term which I will continue to work towards more adequately defining. If you have strict food rules, slowly begin to introduce foods you once feared back into your life and pay close attention to the results; you just may not become obese or feel horrible. It might on the converse satiate you, and put you in a sweeter mood instead.

I know this explanation may be lacking in references, but there aren’t any adequate studies to my knowledge studying sugar composition in the context of a balanced and active lifestyle. If there are I’ll happily read them and revise my hypothesis. Using more of our common sense however is important here on SBCAH because I believe too much reliance on nutrition science is hurting people’s abilities to follow their own hunger cues. Of course, I’m not recommending a diet consisting of the types of processed foods found in the aisles of supermarkets; I think real food is a great foundation, but after that, there is so much variability that it leads me to conclude that it’s okay to eat oreos, to drink some Coke, and do other things that have become curse words among health-minded folk. The lack of holistic evidence also leads me to happily say that as well: that sugar phobia is unfounded, and much more than processed and refined sugar has caused the obesity epidemic. Letting go of dogma and being able to experiment is your friend. Being stuck up about food rules is a path to an enlightened place that probably does not exist. So once again, if your instincts feel inclined to do so, if you are willing to break through mental barriers and food phobia, if you’re active and haven’t eaten much sugar in a while, it may be time for you to get back in touch with that sweet tooth I know you have. Cheers.