Is Coconut Oil Good for You?

Lately, food faddists have been claiming that coconut oil is a health food. They claim that it will help you lose weight. In reality, coconut oil is as fattening as any other fat. Some people even claim that coconut oil can cure Alzheimer’s disease. In reality, coconut oil can promote atherosclerosis, which is an important cause of vascular dementia. Also, fats of any kind, including coconut oil, tend to make your body less sensitive to insulin. For this reason, eating coconut oil would probably make type 2 diabetes worse. Coconut oil could even make Alzheimer’s disease worse, since Alzheimer’s disease seems to be related to insulin resistance in the brain. So why are people promoting coconut oil for brain health? The idea that coconut oil is good for your brain came out of the fact that some of the fatty acids from coconut oil are useful as part of a diet for children with severe epilepsy.

Epilepsy is a condition in which people suffer from seizures. A seizure is an electrical storm within the brain. In ancient times, epilepsy was called “the falling sickness” because it often causes people to lose consciousness suddenly. However, “partial” seizures may simply cause altered mental states or uncontrolled movements of the body. Many ancient people thought that epilepsy was caused by the gods or by evil spirits. However, the ancient Greek physician Hippocrates explained that epilepsy was an ordinary physical disease, with physical causes. The ancient Greeks knew that some people with epilepsy did not have seizures while they were fasting. Of course, you cannot fast forever. You have to eat something eventually, or you will starve to death. Once the person with epilepsy resumed eating food, the seizures would start up again.

By the 1920s, physicians were looking for a way to mimic some of the effects of fasting, without starving the patient to death. They knew that fasting causes ketosis, which is the buildup of chemicals called ketone bodies in the bloodstream. But they knew that you could also get ketosis from eating an extremely low-carbohydrate diet. For reasons that are still unclear, ketosis suppresses seizures in many people with epilepsy. For this reason, an extremely high-fat, low-carbohydrate “ketogenic” diet has been used since the early 1920s for the management of treatment-resistant epilepsy in children.

Why does an extremely low-carb diet cause ketosis? Even in the 1920s, it was obvious that ketosis meant that the liver was making huge amounts of sugar. Much of the sugar in the bloodstream of someone with untreated diabetes does not come from the starch or sugar in the food. Instead, it has been made out of protein from the food and from the body’s tissues. If the insulin-producing beta cells in the pancreas stop making insulin, the alpha cells in the pancreas assume that the blood sugar level must be low. As a result, the alpha cells will make huge amounts of a hormone called glucagon. Glucagon tells the liver to make glucose, to bring blood sugar levels back up to normal. An overdose of insulin kills people by preventing their pancreas from releasing glucagon, which would tell the liver to release glucose to correct the low blood sugar. That’s why glucagon is used as an antidote to insulin overdose.

The liver makes a lot of glucose out of its stores of a starch called glycogen. However, the liver can also make glucose out of amino acids (the building blocks of protein) and other noncarbohydrates. When the liver is making a lot of glucose, it may start to use up one of the materials that it needs for breaking fat down completely into carbon dioxide and water. As a result, more of the fat is processed through an alternative pathway that produces ketone bodies as byproducts.

If you are fasting, a little bit of ketosis is a good thing. Some of your brain cells can use some of the ketone bodies as an alternative fuel source. But the severe ketosis that goes along with severely high blood sugar in someone with untreated type 1 diabetes is a life-threatening emergency.
You can get ketosis from fasting, but you can also get it from an extremely low-carbohydrate diet. That is why children with severe epilepsy are sometimes fed an extremely low-carbohydrate (ketogenic) diet. This ketogenic diet has some important drawbacks. For one thing, it tends to stunt children’s growth, and it can lead to some severe side effects, including inflammation of the pancreas. Another drawback is that children do not like the diet, mainly because their food choices are limited. Eating even a little bit of carbohydrate stops the ketosis. For this reason, it is hard to get children to stick to the diet well enough to get benefits.

Most of the fats in our food contain mainly long-chain fatty acids. However, nutrition researchers realized that short- and medium-chain fatty acids are better at producing ketosis. Perhaps it is because the shorter-chain fatty acids go straight to the liver from the intestine. The longer fatty acids are absorbed through a different pathway, which does not go through the liver before it reaches the general circulation. Coconut oil is a relatively rich source of medium-chain fatty acids. So if you feed an epileptic child coconut oil, you can let them eat a bit more carbohydrate and protein, while still keeping them in ketosis.

Since coconut oil is so good at generating ketone bodies, there has been some interest in it for patients with Alzheimer’s disease. In Alzheimer’s disease, the brain is having some trouble with using glucose for energy. For this reason, some researchers suspect that the brain of someone with Alzheimer’s disease might work better if some ketone bodies were available. Yet this theory remains unproven.

The ketogenic diet is useful in cases of childhood epilepsy that do not respond to any other treatment. However, it is not a health-promoting diet for the general public. No society on earth has ever subsisted on a ketogenic diet for any length of time. Even Inuit (Eskimo) people, who lived on nothing but fatty meats and fish during the winter, did not go into ketosis unless they were fasting. Also, there is plenty of evidence that high-fat, low-carbohydrate diets lead to rapid aging and early death, even if they do not produce ketosis.

Like antiseizure drugs, a ketogenic diet may be good for some children with epilepsy but should not be routinely given to people who do not have epilepsy. Unless you have treatment-resistant epilepsy, you would be better off eating an extremely low-fat, high-carbohydrate diet based on starches and vegetables. The societies that have traditionally used coconut oil tend to have low rates of heart disease. However, that is usually because their overall intake of fat and cholesterol is low. Most of their calories came from carbohydrates (starches and sugars) in the rice and starchy vegetables (such as sweet potatoes and poi) that made up the bulk of their diet. Since these people lived in the tropics, they also ate a lot of fruit and vegetables. Some Polynesians eat a lot of coconut. However, they are generally eating whole coconut, rather than coconut oil. As a result, they get a lot of protection from the fiber content of the coconut. In the intestine, fiber binds to the cholesterol that the liver produces to help you digest fat. As a result, the cholesterol can leave the body with the feces, rather than being reabsorbed into the bloodstream.

If you want to lose weight and protect your heart and brain, don’t add coconut oil to your diet. Instead, remove oils and animal-source foods from your diet. The populations that eat a starchy, high-fiber diet based on low-fat plant-source foods have the cleanest arteries and the best chance at a long and healthy life.

What Does Ketosis Mean?


Ketosis does not mean that you are losing weight. It really just means that your liver is turning a lot of protein and other noncarbohydrates to sugar. Today, many people on the Internet are urging people to eat a ketogenic diet: a diet that is so high in fat and so low in carbohydrates that it causes people to go into a state of ketosis. Ketosis means that “ketone bodies,” which are the chemical byproducts of an alternative method of burning fat, build up in the bloodstream. Ketogenic diets are often described as “Paleo” because many laymen imagine that human beings must have eaten ketogenic diets during the Paleolithic era (early stone age). Yet there is no reason to believe that stone age people ate a ketogenic diet.

Most people in the stone age would have eaten the starchy plant material, especially roots and tubers, that they could safely and easily obtain from their environment. As a result, stone age people would have gotten more than enough carbohydrate to keep them from going into ketosis. In fact, when anthropologists look at the skeletal remains of stone age people, they find starch grains embedded in the tartar on their teeth. Even the Inuit’s (Eskimos’) traditional winter diet, which consisted entirely of fatty meats and fish, did not produce ketosis. Studies done in the early 20th century found that the Inuit did not get ketosis unless they were fasting. The Inuit were eating raw meat that was either freshly killed or frozen immediately after being killed. Unlike the meat you would buy at a supermarket, this fresh or rapidly frozen meat still contained a starch called glycogen. The Inuit also used a method of meat preservation that converted some protein to sugar. As a result, the Inuit’s traditional diet contained a surprisingly large amount of carbohydrate: enough to keep people out of ketosis.

It is good that the Inuit diet did not cause ketosis. The Inuit already had extremely high rates of osteoporosis, because of the metabolic acidosis caused by their high-protein diet. Adding even more acid, in the form of ketone bodies, would have made this problem even worse. Eating a lot of calcium, in the form of fish bones, did not solve this problem.

Some “Paleo” advocates claim that ketosis means that you are burning fat and are therefore losing weight. Some of them even claim that you cannot lose weight or burn fat unless you are in ketosis, which is total nonsense. The Krebs cycle, which is the body’s normal way of burning fat, does not produce ketone bodies. Having ketones in your urine does not even guarantee that you are losing weight. To lose weight, even on a ketogenic diet, you must burn up more calories than you take in. Even on a ketogenic diet, you can still gain weight. The burst of insulin that is released in response to eating foods that contain protein could drive the fat from the food into the fat cells.

The ketosis does not mean that you are losing weight. It is simply a sign that your liver is turning a lot of noncarbohydrate substances, including protein, into a sugar called glucose. Your liver is working so hard to make glucose, to compensate for your low carbohydrate intake, that it is even using up oxaloacetate, which is one of the chemicals involved in the Krebs cycle. As a result, some of the fat gets broken down through an abnormal pathway that produces ketone bodies.

During a fast, a little bit of ketosis is a good thing. Your brain can use a little bit of the ketone bodies as an alternative fuel source. In contrast, the severe ketosis that results from a severe shortage of insulin in people with untreated type 1 diabetes mellitus is life-threatening. Before the discovery of insulin, people with what is now called type 1 diabetes would always progress to ketoacidosis, coma, and death. Ketoacidosis means that the ketosis is so bad that it lowers the blood pH. Patients with diabetic ketoacidosis have four problems at once: high blood sugar, dehydration, low blood pH, and an electrolyte imbalance. These problems must be corrected carefully, in an intensive care unit.

In a healthy person, the total amount of ketone bodies in the blood is usually less than 1 mg/dL. The amount of ketone bodies in the urine is normally too low to be detected by routine urine tests. You can boost your production of ketone bodies by fasting or by eating a low-carbohydrate diet. You can get into a state of ketosis either way. However, the effects of a fast are far different from the effects of a low-carbohydrate diet. Scientists are only beginning to understand the potential benefits of periodic fasting. Besides being a sure-fire way to lose weight, fasting can help to suppress a runaway inflammatory response. A medically supervised water-only fast is also a useful first step in identifying which foods might be triggering a patient’s health problems. The Paleo advocates are hoping that eating bacon and eggs—but no toast—would produce the same effect as eating nothing at all. It is a foolish hope.

Many people swear by the Paleo diet. They have managed to survive on it for months or even years, and they claim that they have achieved other benefits, such as weight loss. Yet these testimonials should be viewed with great skepticism. No populations anywhere on earth have managed to achieve good health statistics or a long life span on a ketogenic diet. The populations who eat a diet that is most like the ketogenic diet may seem healthy while they are young, but they have long been known to suffer from rapid aging and a short life expectancy. In contrast, the populations with the longest, healthiest lives are the ones who are eating the opposite of a ketogenic diet: they eat a diet based on low-fat plant-based foods. One of the important findings of an enormous epidemiologic study called the China-Cornell Oxford Project was that the less animal-source food a population eats, the lower its average cholesterol level is and the lower its risk of death from chronic disease is. There did not seem to be any safe level of intake of animal-source foods.

A ketogenic diet may be a useful as a desperate attempt to suppress seizures in children with some severe forms of epilepsy. Yet in those children, the diet can have side effects. It can cause dehydration, constipation, vomiting, high cholesterol, and kidney stones. Some children have had severe side effects, such as heart rhythm problems, inflammation of the pancreas, and possibly loss of calcium from the bones. In short, a ketogenic diet may be useful as a way to treat some rare but serious diseases that respond poorly to any other available treatment. However, it is unlikely to improve health for the general public in the long run.

Dietary Protein, Not Sugar, Promotes the Growth of Cancer

Some researchers in Belgium just did an interesting study about how cancer cells use sugar. The researchers found that one of the byproducts produced as a result of cancer cells’ abnormal metabolism could be promoting the growth of the cancer. In short, the researchers have figured out a plausible explanation for something that had been known since the 1920s: most cancer cells use anaerobic metabolism, even when plenty of oxygen is available. By the 1950s, it was clear that tumors that are most likely to use anaerobic metabolism tend to be the most aggressive. Unfortunately, the reporters who have been covering this study for the popular press do not understand what the study is about or what its results really mean. Many of the reporters have falsely concluded that the study shows that something in sugar is somehow causing cancer. As a result, they are urging people to avoid eating carbohydrates. Unfortunately, if people avoid carbohydrates, they will end up eating more fat and more protein, and we know that high-protein diets are the real culprit in promoting the growth of cancer.

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Jane Brody’s Misleading Attack on What the Health

New York Times columnist Jane E. Brody has written a silly attack on the documentary What the Health. Germany’s Iron Chancellor Otto von Bismarck supposedly once quipped, “Never believe anything in politics until it has been officially denied.” Since the New York Times is regarded as the “Newspaper of Record” in the United States, we could amend this saying to “Never believe anything in American politics until it has been officially denied in the New York Times.”

Brody focused on one alarming statement about the harmful effects of eating eggs. She then concluded that the entire documentary was full of bad science. Somehow, she failed to mention the main message of the documentary, which is that the major health-focused nonprofits are taking money from the food industry. Not coincidentally, those nonprofits are systematically failing to warn people of the health risks posed by the foods that their sponsors are selling. What the Health even showed that these nonprofit organizations have sometimes been urging people to eat the very foods that are known to contribute to the disease that the nonprofit is supposedly trying to fight. If the New York Times were really serving as the “watchdog press,” then it would have been sounding similar warnings for many years. (I sound that warning in my book Where Do Gorillas Get Their Protein? What We Really Know About Diet and Health.) Instead, the public had to wait for an independent documentary filmmaker to articulate this message, and for Netflix to broadcast it.

What the Health is reporting on a story that the Newspaper of Record presumably finds “not fit to print.” Word about What the Health is spreading via social media. Since our Newspaper of Record can no longer ignore the documentary, it is time for one of its columnists to tell us to “move along, there’s nothing to see here.” Brody claimed that several of her “well-meaning, health conscious young friends” (a description that simply drips with condescension) urged her to watch the documentary, but that she had to quit watching it partway through, supposedly because the science reporting was intolerably bad. Yet several of the people interviewed in the documentary are prominent scientists, while Brody is just a newspaper columnist.

The online version of Brody’s screed was entitled “Good Vegan, Bad Vegan.” The “bad vegans” are presumably “those who distort science.” Yet Brody herself is guilty of that offense. The research really does show that egg consumption, like cigarette smoking, is correlated with the buildup of plaque in the arteries. If the effect of eating two eggs a day is equivalent to half of the effect of smoking a pack of cigarettes a day, that would work out to a five cigarettes per egg ratio, which is not unrealistic. The research also shows that eating processed meats really is associated with an increased risk of type 2 diabetes. As a consumer of eggs and meat, Brody is presumably unhappy about those findings, but her unhappiness does not make those findings untrue.

Although Brody rails against bad science, she promoted some of the worst of it in her column. In particular, she put forth the long-discredited myth that plant proteins are incomplete and that vegans must therefore combine different plant proteins in the same meal to get a complete protein. In reality, nutrition scientists have known for more than 100 years that any practical plant-based diet would automatically provide enough protein for a human being, as long as the person ate enough food to get enough calories. In the 1950s, William Cumming Rose showed that ordinary staples, such as rice and potatoes, provide more than enough of all of the amino acids that are essential in human nutrition. There has never been any evidence that human beings need to combine different plant-based foods to “complement the proteins.” If Brody had read even an introductory-level textbook on nutrition, she would know this.

Brody concedes that “responsible, well-informed sources” already recommend a plant-based diet. Then she assures us, on the basis of no evidence whatsoever, that a plant-based diet can be “fleshed out” with low-fat protein sources from animals. In contrast, one of the major findings of the China-Cornell-Oxford project was that even a small amount of animal-source food in the diet was associated with an increased risk of death from degenerative disease. There did not seem to be any safe level of intake. T. Colin Campbell, who is a nutritional biochemist and a professor emeritus of Brody’s alma mater, Cornell University, was the lead author of the article that reported that finding. Brody has no excuse for being ignorant of it. If Brody is willing to run the increased risk of early death that results from eating foods from animal sources, that is her choice. But as a journalist, Brody has a professional and humanitarian responsibility to tell people that the risk exists, so that they can make informed decisions.

Brody warns, “A vegan diet laden with refined grains like white rice and bread; juices and sweetened drinks; cookies, chips and crackers; and dairy-free ice cream is hardly a healthful way to eat.” Yet that is a straw-man argument. Nobody interviewed in What the Health endorses junk-food veganism. On the other hand, Dr. Walter Kempner of Duke University discovered in the 1930s that he could save the lives of patients with malignant hypertension by having them eat a diet of nothing but white rice, fruit, and sugar. Brody’s audience deserves to know things like that.

Brody’s choice of title is telling. It alludes to Gary Taubes’ book Good Calories, Bad Calories. On July 7, 2002, the New York Times Magazine launched Gary Taubes’ career as a nutrition guru by running his article “What if it’s all been a big fat lie?” That article claimed that the low-fat, high-carbohydrate diet that doctors had supposedly been recommending was really the cause of our obesity epidemic. Like Brody, Taubes has no formal training in nutrition or dietetics or epidemiology. Thus, like Brody, Taubes does not even recognize the mistakes that he makes in his writings about nutrition. Note that Taubes has been roundly criticized by nutrition scientists for misrepresenting their views by making it seem that they endorsed a low-carbohydrate diet.

Some of the people interviewed in What the Health are famous scientists who did landmark research related to the effects of dietary choices on health. Brody is not a peer of the scientists interviewed in What the Health. Thus, she is not qualified to serve as a reviewer for any of the journals that published their scientific work. Yet because of Brody’s platform at the New York Times, she has been able to encourage a broad readership to “skip” watching a documentary in which these scientists explain their findings to the public. The people who take her advice will miss the chance to hear a potentially life-saving message that they will never read in the Newspaper of Record. Fortunately, they may hear about it through social media.

The Inuit (“Eskimo”) Diet Causes Rapid Aging, Early Death

Since the 1970s, there has been a lot of hype about the diet of the Inuit, who were indigenous people in Greenland as well as northern Canada and Alaska.  (The Inuit were often called Eskimos, but that name is considered offensive. The correct name is Inuit. The singular form of the word is Inuk.) The Inuit had managed to survive in a hostile environment: one that was frozen and covered in snow for many months out of the year. As a result, the Inuit’s traditional diet for most of the year consisted of meat and fish, often eaten raw. Since the 1970s, many food faddists have been claiming that the Inuit’s diet somehow magically protected the Inuit against coronary artery disease. The goal of this propaganda is to encourage people to eat meat and fish and to take fish oil capsules but to shun carbohydrates. Yet even the earliest outside observers of the Inuit noticed something odd about them. The young Inuit seemed hale and hearty, but the Inuit seemed to age quickly, and there were practically no Inuit older than 60 years. Studies of mummified and skeletal remains of Inuit who had died before the arrival of the Europeans confirmed that the traditional Inuit diet caused atherosclerosis and osteoporosis.

The Inuit have always had a remarkably short life expectancy because they were at risk for both of the major categories of causes of death: diseases of poverty and diseases of affluence. The diseases of poverty are the things that tend to afflict the poor: starvation, exposure, accidents, and general lack of medical care and social supports. The diseases of affluence are the things that tend to afflict the rich: mainly a diet that is high in fats and cholesterol. In tropical and temperate regions, only the rich could afford to eat meat and other animal-source foods on a regular basis. But in the Arctic, meat was the only available food for much of the year. Thus, the Inuit were poor people eating a rich diet. As a result, they aged rapidly and died young.

The Inuit’s traditional diet of fatty meats and fish can sustain a young person. Otherwise, the Inuit would not have succeeded in settling in the Arctic region. However, the Inuit diet is bad for your health in the long run, for several reasons:

  • People can catch parasitic diseases by eating raw meat. (More than 12% of elderly Inuit in Greenland had trichinosis).
  • The high fat and cholesterol content of the Inuit diet leads to clogging of the arteries.
  • A high-protein diet increases the risk for liver and kidney disease, as well as osteoporosis.
  • Animal-source food contains a concentrated dose of pollutants from the environment.

Advocates of a ketogenic diet often use the Inuit diet as a model. The goal of a ketogenic diet is to put someone into a state of ketosis. Ketosis means that the person has an abnormally large amount of keto acids in the blood. This condition normally happens during fasting or when the person is eating no carbohydrates. It can also result from insulin deficiency. Since the Inuit were eating practically no plant material for months at a time, many people assume that the Inuit would have been in a state of ketosis most of the time. Yet a study done in the 1920s showed that Inuit who were eating their traditional diet did not have ketosis unless they are fasting. By the 1980s, the explanation was clear: the Inuit were eating far more carbohydrate than you might expect. The Inuit were eating a lot of raw meat that was fresh-killed or had been frozen immediately after being killed. For this reason, the meat that the Inuit were eating contained far more glycogen (animal starch) than you would find in meat that you buy at a butcher’s shop or grocery store. Also, the Inuit had a way of preserving a whole seal or bird carcass under an intact whole skin with a thick layer of blubber. This method of preservation allowed some of the protein in the meat to ferment into carbohydrate.

Back in the 1970s, some scientists from Denmark wrote some articles that claimed that the Inuit of Greenland were being protected from coronary artery disease by the large amounts of omega-3 fatty acids in their diet. In reality, the Inuit have a high risk of coronary artery disease. The earlier research simply underestimated the number of fatal heart attacks because the causes of deaths among the Inuit populations were not being accurately recorded. In the 1970s, the Inuit in Greenland seldom got medical attention while they were alive, and they seldom underwent autopsy after their death. So the true cause of death was seldom recorded.

The Inuit’s diet is a model for how Stone Age people can survive in the Arctic. It is not a model for how to live a long and healthy life when you have many food choices. The populations that live the longest, healthiest lives are those who have access to modern medical care but eat a diet similar to that of peasants in the temperate and tropical regions: a practically vegan diet based mainly on starches and vegetables.

Photo by Internet Archive Book Images

Omega-3 Fatty Acids Come From Green Plants

The food industry has been urging me to eat fish. The supplement companies have been urging me to take fish oil supplements. They claim that omega-3 fatty acids prevent heart attacks. Some people even claim that a baby cannot develop a normal brain unless its mother ate fish or took fish oil supplements. In contrast, nutrition scientists tell me that green plants are an excellent source of the only omega-3 fatty acid that is essential in human nutrition. This could explain why populations that rarely if ever eat fish can have healthy hearts and healthy brains. In fact, the healthiest populations are the ones that eat very little fat of any kind and lots of vegetables.

All of the omega-3 fatty acids in the food supply came originally from the green plants and blue-green algae (cyanobacteria) that are at the bottom of the food chain. An omega-3 fatty acid called alpha-linolenic acid is an important part of the thylakoid membranes that are involved in photosynthesis. No animal can make an omega-3 fatty acid. Animals do not have the enzymes that would be needed to put a double-bond in the omega-3 position in the hydrocarbon chain of a fatty acid. However, animals can lengthen the carbon chain of an omega-3 fatty acid. Thus, fish and other animals (including human beings) can convert alpha-linolenic acid to longer-chain omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). For this reason, you can find EPA and DHA in fish but not in ordinary plant-source foods.

According to the Food and Nutrition Board of the National Academy of Sciences, there is only one omega-3 fatty acid that is essential in human nutrition. It is the alpha-linolenic acid that is found in thylakoid membranes of the chloroplasts of green plants. For this reason, you can get this omega-3 fatty acid from eating green vegetables. Flaxseeds, hempseed, and walnuts are also good sources of alpha-linolenic acid.

You need only a little bit of alpha-linolenic acid from your food. The dietary requirement for the two essential fatty acids (alpha-linolenic acid and an omega 6 fatty acid called linoleic acid) was discovered only after hospitalized patients started being fed fat-free solutions for an extended period. Yet even their need for these essential fatty acids could be met by rubbing a little bit of vegetable oil on the skin.

For years, many people have been urging the public to eat fish or take fish oil supplements, to reduce the risk of heart attack. Populations that eat a lot of omega-3 acids, from cold-water fish, do have a somewhat lower-than-expected rate of fatal heart attacks. However, this is probably because of the blood-thinning effects of omega-3 fatty acids, which could also lead to more deaths from major bleeding. If you really want to make yourself heart-attack-proof, eat a low-fat, plant-based diet to keep your total cholesterol below 150 mg/dL.

Some manufacturers of baby formula have been adding DHA so that the formula will have a DHA content similar to that of breast milk. Yet whether the additional DHA provides real benefits to the baby is still unclear. However, these studies do raise concerns about giving too much long-chain omega-3 fatty acid without also providing a supplement of arachidonic acid.

I do not know whether any vegans (such as pregnant women or the elderly) would benefit from supplementation with the longer-chain omega-3 fatty acids. If these supplements are beneficial, it would be best for them to come from a plant source. Plants are less likely to be contaminated by the pollutants that build up in animal tissue.

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Cats Cannot Get Vitamin A From Carrots

Beta-carotene is a yellow pigment that is found in many yellow, orange, and dark-green vegetables. For human beings and many other mammals, beta-carotene is a provitamin of vitamin A. This means that beta-carotene does not have vitamin A effects until the body converts it to retinol. Human beings can convert beta-carotene to retinol. Thus, human beings can get vitamin A from the beta-carotene in fruits and vegetables. In contrast, cats cannot convert beta-carotene to retinol. Retinol is found only in meat and other animal products, such as egg yolk. For this reason, cats cannot survive on a purely plant-based diet. If you want to make a purely plant-based (vegan) cat food, you must add the nutrients, such as retinol, that normally come only from animal sources.

Cats must get their vitamin A in the form of retinol or related compounds (such as retinyl palmitate). In contrast, it is better for human beings to get their vitamin A in the form of beta-carotene. The human body converts beta-carotene to retinol on an as-needed basis. If you eat a huge amount of the fruits and vegetables that contain beta-carotene, some of the extra beta-carotene might build up in your skin. As a result, you will get a healthy golden glow that is more attractive than a suntan. In contrast, if you overdose on retinol, either from taking supplements or from eating polar bear liver, you will get a potentially fatal swelling of the brain. This condition is called pseudotumor cerebri (which literally means fake tumor of the brain). If the brain swelling damages the nerves that connect the eyes to the brain, the result can be permanent blindness.

Human beings should get their vitamin A in the form of beta-carotene. And they should get their beta-carotene from fruits and vegetables, rather than from pills. People who eat a lot of fruits and vegetables tend to have better health, including lower rates of cancer. You cannot get the same effect by taking the vitamins in pill form. In fact, the vitamin pills might actually increase the risk of cancer.

In the 1980s, the National Cancer Institute launched a major study called the Carotene and Retinol Efficacy Trial (CARET). The purpose of the study was to see whether pills containing beta-carotene and retinol (in the form of retinyl palmitate) could reduce the risk of cancer in people who were at high risk for lung cancer. The study was stopped early because the cancer rate turned out to be higher in the people who got the vitamin A pills than in people who got a placebo.

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Teach Doctors Nutrition, Then Let Them Practice Medicine

The major causes of death and disability in the United States today are diet-related diseases. As I explain in my book Where Do Gorillas Get Their Protein?, you can prevent heart attacks and many cancers by eating a low-fat, purely plant-based (vegan) diet. That same diet can also prevent and even cure some serious autoimmune diseases, such as rheumatoid arthritis. Yet doctors are not being taught about diet. Instead, they learn how to use medications and surgery to treat diet-related diseases. To avoid paying for those expensive treatments, insurance companies are putting restrictions on what kind of care they will cover.

Often, insurance companies refuse to pay for an expensive treatment until the doctor has proved that all of the cheaper treatments have failed to help that patient. This policy is called “fail first” or step therapy. Unfortunately, a patient with a serious condition could die or end up permanently disabled unless the right treatment is used right away. As a result, doctors have been spending more and more of their time in negotiations with insurance company clerks. Tragically, those clerks often end up making the treatment decisions, even though they are not qualified to practice medicine and have never even met the patient. To solve this problem, we must give doctors better training in nutrition, and then let the doctors, rather than insurance company clerks, practice medicine.

Step therapy is a perversion of a good medical idea called stepped care. Stepped care is the idea that patients with a less urgent or less serious case should get treatment of a lower intensity, at least at first. For many illnesses, it makes sense to start with a less-intensive treatment (such as a change in diet) rather than using a more-intensive treatment (such as medication). Even if medication is needed, it may make sense to start with a cheap generic medication with a well-established safety profile, rather than using an expensive new drug whose long-term safety is unknown. Yet even if doctors are using the stepped care model, they do not need to start with the bottom step. They can jump to a middle step or even the top step in serious cases.

In stepped care, the doctor and the patient make the medical decisions. But in “fail first” or step therapy, the bean-counters at the insurance company make the medical decisions. By requiring “fail first,” insurance companies ensure that a lot of patients will have treatment that fails. In contrast, doctors want to pick the therapy that is most likely to succeed.

Since so many deadly and disabling diseases are caused by an overly rich diet, dietary management should be the first step in managing them. Dietary therapy itself can follow a stepped care approach. For arthritis patients, the first step in dietary management is a low-fat vegan (purely plant-based) diet. Animal proteins and fatty foods promote arthritis. If the animal proteins enter the bloodstream before they are broken down into individual amino acids, they can provoke the immune system to make antibodies. Since the animal proteins resemble human proteins, those antibodies can then attack the person’s own tissue. Diets that are high in fat and cholesterol make this problem worse by damaging the lining of the intestine, making it leak. (Some of the medications used to treat arthritis pain also damage the intestine.)

If a low-fat vegan diet does not provide adequate relief within a few weeks, the patient can also eliminate the gluten-containing grains (wheat, rye, and barley). If problems persist, the patient can be taught how to follow a formal elimination diet, which excludes the other plant-source foods that are known to cause problems in some patients (e.g., corn, soy, strawberries, citrus fruits). After the patient feels better, plant-source foods can be carefully reintroduced, one at a time, to identify the foods that were causing problems.

In severe cases, such as a flare of rheumatoid arthritis, the doctor may want to start with a therapeutic fast, which is the top step in dietary management. A therapeutic fast involves taking nothing but water by mouth for days to weeks, in a setting of complete rest. This is the ultimate elimination diet. By eating nothing at all, the patient avoids all possible dietary triggers of disease. A therapeutic fast also causes hormonal changes that stop runaway inflammation. After the fast, foods should be reintroduced carefully, one at a time. Therapeutic fasting should be done only under medical supervision. It is powerful medicine against the diseases of overnutrition, such as type 2 diabetes and hypertension (see chapter 9 of my book Thin Diabetes, Fat Diabetes: Prevent Type 1, Cure Type 2). It has long been known to be a safe and effective treatment for a flare of rheumatoid arthritis.

Insurance companies develop policies to boost their own profits, not to protect their subscribers from getting the wrong treatment. There is a better way to control healthcare spending, while improving public health. Give doctors basic training in nutrition. Teach them how to use diet rather than drugs to solve diet-related problems. Then, let the doctor decide what other kinds of treatment his or her patient needs, even if that treatment is expensive. Let the doctors, not the accountants, practice medicine.

Start Giving Vitamin C to Septic Patients Now!

It sounds almost too good to be true. Dr. Paul Marik, the Chief of Pulmonary and Critical Care Medicine at Eastern Virginia Medical School, in Norfolk, Virginia, has found that a cocktail of intravenous vitamin C and corticosteroids, along with a little bit of thiamine, may be a cure for sepsis, which is a major cause of death. (Sepsis killed Patty Duke and Muhammad Ali.) Many physicians are skeptical of Marik’s claim, for two reasons. First, they have heard a lot of nonsense about vitamin C over the years. Second, they have been trained to wait for the results of a double-blind randomized controlled trial before they make any change in how they practice medicine. As a result, they may be slow to adopt Marik’s protocol. But if they hesitate, they will miss the chance to save lives. Physicians have nothing to lose by trying the Marik’s protocol. Patients have everything to lose if their physician hesitates.

Marik’s breakthrough came in January of 2016, as he struggled to save the life of a 48-year-old woman suffering from overwhelming sepsis. He had recently read that vitamin C might be a useful treatment for sepsis. He recalled that steroids, which are commonly used for treating sepsis, might work well in concert with vitamin C. So he ordered that the patient be given a combination of steroids and vitamin C intravenously. Within hours, she started to recover. Two days later, she was well enough to leave the intensive care unit. Then, Marik and his colleagues used the same treatment on two more patients who seemed destined to die of sepsis. Those patients also recovered. At that point, Marik and his team adopted the combination therapy as standard practice. They eventually added a small dose of thiamine to the protocol, because sepsis patients are also often deficient in thiamine. Since then, they have not seen a single patient die of sepsis. (However, some did die of the underlying disease that led to sepsis.)

Marik’s claims have been supported by an adequately powered clinical study. However, that study was retrospective. It compared 47 consecutive septic patients treated with his protocol to 47 septic patients who had been treated before his institution began using the protocol. Only 4 of the 47 patients treated with the vitamin C protocol died, as compared with 19 of the 47 patients in the control group (P<.001). Most importantly, none of the patients in the treatment group developed progressive organ failure. That finding suggests that the treatment is effective against the sepsis, in particular.

Marik’s claim makes biological sense. In 2012, Wilson and Wu explained the mechanisms by which vitamin C could improve microvascular function in sepsis patients. They explained that the vitamin C would have to be given intravenously to provide adequate ascorbate concentrations in plasma and tissue. In 2015, Carr et al pointed out that septic patients present with hypovitaminosis C and explained that the enzymes that are involved in the synthesis of norepinephrine and vasopressin require vitamin C as a cofactor for optimal activity.

Some methodological purists may quibble about the supposed “flaws” of the design of Marik’s study. They may insist on a prospective, randomized, placebo-controlled study before they adopt the vitamin C protocol. Yet such a study would violate a basic principle of medical research ethics. Researchers are not supposed to assign patients with a serious illness to different treatment arms unless there is real uncertainty about which of the treatments would be better. This principle is called clinical equipoise. Yet there is no real uncertainty. The probability that the results of the retrospective study were due to random chance are less than one in a thousand. Nor was there any reason to suspect that the differences in outcome were due to any confounding variables. Nor are there any serious safety concerns about adding vitamin C and some thiamine to the commonly used corticosteroid treatment for sepsis.

Regulatory agencies typically require drug companies to do double-blind, randomized controlled trials to support a new drug application. Yet there are some exceptions. For example, the Food and Drug Administration approved lepirudin (Refludan®) for anticoagulation in patients with heparin-induced thrombocytopenia on the basis of a clinical trial that used historical controls, rather than assigning patients to a placebo treatment that would have threatened life and limb.

So we now know that a vitamin C, which is a cheap, easily available product with a long history of safe use, is probably the key to the successful treatment of a major cause of death. The medical profession will be judged by how fast or how slowly it acts on this information.

Photo by Unhindered by Talent



Is the Alkaline Diet Good for Your Health?

The proponents of the Alkaline Diet are urging you to eat the right foods, but for the wrong reasons. The Alkaline Diet is based on the idea that you should eat foods that have an alkalinizing (pH-raising) effect on the body, while avoiding foods that have an acidifying (pH-lowering) effect on the body. The proponents of the Alkaline Diet often make claims that are clearly nonsense. For example, some of them claim that the diet will cause your blood pH to rise to 8.5, thus killing cancer cells while allowing ordinary cells to survive. That is clearly false. On the other hand, some detractors of the Alkaline Diet also say some things that are false. Some of them are simply against vegan diets, for ideological reasons. Others fail to grasp how an acidic food, such as lemon juice, could end up having a net alkalinizing effect on the body, as I’ll explain below.

If you eat the kind of diet that the promoters of the Alkaline Diet recommend, your health will almost certainly improve. The foods that have the strongest acidifying effect on the body come from animals: dairy foods, meats, fish, and eggs. Grains and beans have only a small acidifying effect. In contrast, nearly all fruits and vegetables have a net alkalinizing effect. For this reason, people who avoid the most acidifying foods will end up eating a vegan diet, including lots of fruit and vegetables.

A vegan diet is great for your health, as long as you don’t eat too much fat (from oils, nuts, or avocadoes) or too much refined sugar (empty calories) and as long as you take a vitamin B12 supplement. A low-fat vegan diet provides plenty of fiber and carbohydrate. It provides no cholesterol or animal protein. As a result, a low-fat vegan diet will stabilize your blood sugar, help you lose weight, and reduce your risk of heart attack, stroke, and many cancers and autoimmune diseases. Yet even if you are eating a lot of alkalinizing fruits and vegetables, your blood pH will not change. It will stay at almost exactly 7.4, unless you get really sick. Nevertheless, the alkalinizing effect of a vegan diet does provide a few benefits: a decrease in the risk of gout, kidney stones, and osteoporosis.

The Alkaline Diet has come under fire from skeptics who point out (correctly) that this diet does not really alter the pH of your blood. Unfortunately, many of these skeptics are unaware of (or in denial about) the health benefits of a low-fat vegan diet. Some of them even fail to understand how an acidic food like lemon juice (pH of 2.0 to 3.0) could have a net alkalinizing effect on the body.

All foods are mixtures of organic and inorganic compounds. If you burn a piece of food in a laboratory, most of the organic compounds will be oxidized to form carbon dioxide and water. After the food is completely burned, you will be left with an ash that contains inorganic compounds. The ash will contain some important cations (pronounced cat-eye-ons), including the alkaline metals (sodium and potassium) and alkaline earth metals (calcium and magnesium), and some important anions, including sulfates and phosphates. If you dissolve that ash in water, the pH of the water could go up or down. If the ash is richer in the alkaline metals and alkaline earth metals than in sulfates and phosphates, the pH of the water will go up (alkalinizing effect). If the ash is richer in sulfates and phosphates than in the alkaline and alkaline earth metals, the pH of the water will go down (acidifying effect).

When you metabolize your food, you burn up most of the organic compounds, including many (but not all) of the organic acids. You will be left with an alkaline or acidic ash, plus the organic acids that your body cannot metabolize. These acidic and alkaline byproducts of metabolism will circulate in your bloodstream until they are lost in your urine. In the meantime, they will seem to have little or no effect on the pH of your blood. Instead, they will mainly affect the pH of your urine. You can make a reasonably accurate prediction of how much of an effect a serving of any food will have on the pH of urine by measuring the amounts of protein (a source of sulfur), phosphorus, calcium, potassium, and magnesium that are in the food and plugging the results into an equation.

The pH of your blood must stay at almost exactly 7.4 (slightly alkaline) all the time, or you will die. To keep the blood pH at 7.4, the body has an elaborate system of buffers. The main buffer is derived from carbon dioxide. The body uses an enzyme called carbonic anhydrase to speed up the conversion of carbon dioxide and water to carbonic acid (H2CO3) and vice versa. Carbonic acid is a weak acid, which means that when it is dissolved in water, only a small percentage of its molecules get pulled apart into hydrogen ions (H+) and the acid’s conjugate base (bicarbonate, HCO3). An even smaller percentage of the bicarbonate ions get pulled apart into H+ and carbonate ions (CO3–2).

The pH of an aqueous solution is a measure of the concentration of H+ ions. In pure water, the H+ concentration is about 1 ten millionth of a mole per liter, or 1 × 10–7 M, which is a pH of 7 (the negative of the base-10 logarithm of the H+ concentration). If you added enough acid to make the H+ concentration go up to one millionth of a mole per liter (1 × 10–6 M), the pH would go down to 6. In other words, more H+ means lower pH. (That explains why sea water is becoming more acidic as the amount of carbon dioxide in the atmosphere rises!) In contrast, when the concentration of H+ in an aqueous solution goes down, the pH of the solution goes up.

The conjugate bases of a weak acid (e.g., bicarbonate and carbonate ions) are unstable. When they meet up with a hydrogen ion in solution, they are likely to react with it. Thus, a carbonate ion is likely to bond with an H+, to become a bicarbonate ion. A bicarbonate ion is likely to bond with an H+, to become carbonic acid. If the carbonic acid content of the solution rises, more of the carbonic acid gets converted back to carbon dioxide and water. The carbon dioxide can then be lost to the atmosphere.

When you mix a weak acid with its conjugate base, such as mixing carbonic acid with sodium bicarbonate, you get a pH buffer. If you add a little bit of acid to blood, the bicarbonate and carbonate ions will immediately bind most of the incoming hydrogen ions. Thus, the number of hydrogen ions in the solution will go up very little (i.e., the pH will not drop by much). The ability of a solution to take in acids or alkalis without changing its pH is called the buffer capacity.

The carbonic acid/bicarbonate buffer system plays an important role in stabilizing the pH of your blood. If you hold your breath, carbon dioxide will start to build up in your blood. As a result, the pH of your blood will drop (respiratory acidosis). Your brain will notice this drop in pH and tell your respiratory system to breathe faster. As you blow off that extra carbon dioxide, your blood pH will rise back to a normal level. If you hyperventilate, you will cause the carbon dioxide levels in your blood to drop to abnormally low levels. As a result, your blood pH will go up. This effect is called respiratory alkalosis. If some process in your body is generating excess acid or alkali, your respiratory system will try to compensate by adjusting your respiratory rate, to adjust the amount of carbon dioxide in your blood. As a result, your blood pH may still stay close to 7.4, even if you have a serious problem with acid-base balance.

The kidneys also play a role in controlling the pH of the blood. If your blood pH drops too low, you will pass more H+ and less bicarbonate in your urine. As a result, your urine will become more acidic. If the pH of the blood rises too high, you will pass less H+ and more bicarbonate in your urine. As a result, your urine will become more alkaline. Because of these and other regulatory systems, the pH of your blood will stay remarkably steady at about 7.4 (slightly alkaline), as long as you are in reasonably good health. Meanwhile, the pH of your urine will change dramatically, depending on what you have been eating.

If you start eating the Alkaline Diet, your blood pH will not change much. However, your body’s ability to buffer an acid load will increase. This increase in buffering capacity explains why vegan diets are useful in the management of gout. Gout results when the blood becomes oversaturated with uric acid. Uric acid is produced when your body breaks down purines, which come from the breakdown of DNA and RNA. Tissue that is highly active metabolically (e.g., organ meats) is rich in purines. So is beer, because yeast is highly active metabolically. When the blood becomes oversaturated with uric acid from the digestion of purines, the uric acid starts to precipitate out as crystals in the joints (especially of the big toe) and the kidneys. The result is gouty arthritis and kidney stones.

Although many vegetables are also fairly rich sources of purines, vegetable foods do not seem to increase the risk of gout, probably because they raise the blood’s acid-buffering capacity. When the blood’s acid-buffering capacity is high, more of the uric acid can remain dissolved in the blood and urine. As a result, fewer urate crystals will form in the joints or in the urinary tract.

Not all kidney stones are made of urate crystals. Many kidney stones are made of calcium oxalate. Calcium oxalate kidney stones are also a common result of an acid-forming diet. When the ordinary buffering systems are not enough to keep the blood pH at 7.4, the body may borrow some calcium from the bones, to use as an antacid. However, the body must also keep the calcium levels in the blood within a narrow range, or the heart will stop. For this reason, the excess calcium is quickly lost in the urine. In the short run, this problem can lead to the formation of calcium oxalate kidney stones. In the long run, it can contribute to osteoporosis.

Osteoporosis is common only where people eat a highly acidifying high-protein diet. Taking calcium supplements may help to correct the metabolic acidosis in the short run, because of the calcium’s alkalinizing effect. But in the long run, the combination of an acid overload and a calcium overload (either from dairy foods or fish bones or from supplements) can undermine the body’s ability to regulate its calcium content. If the blood calcium levels are chronically high, the body may eventually lose the ability to conserve calcium. As a result, the calcium that has been borrowed from the bones is not effectively replaced. So instead of recommending calcium supplements, doctors should be urging patients to avoid eating animal foods and to eat more vegetables and fruit. Doctors should also urge patients to go outside and play: to get exercise and reasonable exposure to sunshine.

You can measure the effects of diet on urine pH within a matter of hours. But to see the effects of diet on health, you often must study a large number of people over a long period of time. For this reason, much of what we know about the effects of diet has been learned from epidemiologic studies. Some of these studies compare different populations at one point in time. Others focus on people who have migrated from one country to another. Still others track the same population over time. Each of these kinds of studies has its own strengths and weaknesses. For example, differences between countries could be due to confounding variables, such as genetic differences. Unfortunately, many “skeptics” dismiss all of these studies as “pseudoscience” because these epidemiologic studies do not follow the same methods as pharmaceutical research. Up until recently, “skeptics” who worked for the tobacco industry used the same kind of arguments to make people doubt that cigarette smoking causes lung cancer.

In other words, the proponents of the Alkaline Diet are urging you to eat a good diet, but for bad reasons. Meanwhile, the skeptics who debunk the Alkaline Diet are often trying to scare you away from eating a good diet, for equally bad reasons.

Photo by blumenbiene