Nutritional Fallacies

Nutritional Fallacies
The complexity of metabolism makes it a fertile ground for many misconceptions. I have advocated for more than thirty years that diet-induced inflammation makes you fat and keeps you fat as well as increasing the likelihood of developing chronic disease and accelerating the rate of aging.  Unfortunately, this is a difficult concept to convey to the general public. What people want to hear is that there is some dietary villain that only needs to be banished from the diet that will magically reverse our growing epidemics of obesity and diabetes yet doesn’t require much thinking or commitment on their part, especially relative to any thought of calorie restriction. They are looking for some magic formula that allows them to eat as much food as possible and never gain weight. So, let me outline some of the usual suspects of this flawed thinking.

If It is Too Good to Be True, Then It Probably Is
In an effort to maintain wellness (usually defined by most people as not yet having enough organ damage to require chronic medication to manage its symptoms), we often jump from one popular dietary panacea to another to better manage our weight, try to stay well, or at least better manage an existing chronic disease. We love to hear things in the media that give us a license to indulge and ignore the scientific research that we know is probably true but is not to our liking. Here are some of the likely myths you will find.

Fat is bad
Since obesity is really defined by the accumulation of excess body fat, then simply following a dietary program based on the concept that “if no fat touches your lips, no fat will reach your hips” would make perfect sense. However, not all fats are bad.  Some are pro-inflammatory, others non-inflammatory, and the still others are pro-resolution fats.  Excess omega-6 fatty acids and palmitic acid which are the real culprits because of their inflammatory consequences.  Monounsaturated fats are non-inflammatory and omega-3 fatty acids are pro-resolution fats. Therefore, taking much of the omega-6 and saturated fatty acids out of the diet and replacing them with monounsaturated fat and omega-3 fatty acids makes good sense.

Unfortunately, this “fat is bad” thinking has usually been interpreted as a scorched earth policy that also removes monounsaturated fats such as oleic acid that are non-inflammatory and the omega-3 fatty acids that are necessary to generate the hormones needed for the resolution of cellular inflammation. Furthermore, since proteins contain fat, they are also usually restricted on a typical low-fat diet.  As a result, you’ll feel less satiated because the hormones PYY and GLP-1 are not released in high enough amounts by the gut as the protein content of the meal decreases. These low-fat, low-protein, and high-carbohydrate diets remain consumer-friendly (who doesn’t like bread, rice, and pasta), but often result in hormonal disasters especially if the carbohydrates are rich in high-glycemic load grains and starches. The industrialized food giants were able to seize upon this “fat is bad” trend to churn a wide number of fat-free foods in the early 1980s that contributed greatly to the beginnings of our current obesity and diabetes epidemics because they had a high-glycemic response that contributed to constant hunger as well as being deficient in fermentable fiber and polyphenols. The result was not only excess calorie consumption caused by increased hunger, but also a corresponding decrease in gut health which is one of the causes of gut-induced inflammation that leads to obesity and early development of chronic disease.

Carbohydrates are bad
The carbohydrate-insulin theory states carbohydrates make you fat because they increase insulin levels, whereas fat, especially saturated fat, doesn’t. This has led to the vigorous advocacy of ketogenic diets that supposedly gives you a “metabolic advantage” so you can eat more calories and lose weight. It is true that radically reducing carbohydrates in the diet will rapidly deplete the glycogen stores in your liver needed to help maintain blood glucose levels. However, it takes a lot of bound water to hydrate that stored liver glycogen. So, as liver glycogen levels rapidly decrease, this bound water is also released. As a result, on a ketogenic diet you rapidly lose retained water via urination and see a rapid weight loss on the scale. However, losing stored water is different than losing stored body fat. When researchers compared a high-fat ketogenic diet to a high-carbohydrate diet containing an equal number of calories, there was no difference in the fat loss between the two diets.

It is also stated that ketogenic diets provide a “metabolic advantage”, so you can theoretically eat more calories and lose weight.  Yet when carefully controlled experiments published in 2006 comparing the Zone Diet to a high-fat ketogenic diet, demonstrated there was no “metabolic advantage” of ketogenic diet compared to the Zone Diet.  However, the high-fat ketogenic diet dramatically increases cellular inflammation compared to the Zone Diet in only six weeks. Other publications using the same subjects also demonstrated that a high-fat ketogenic diet also induces greater fatigue upon mild exercise and causes accelerated loss of calcium potentially leading to bone loss.  Both of these adverse metabolic consequence were observed as earlier as two weeks after starting a high-fat ketogenic diet.

If your intake of carbohydrates is too low, then brain function becomes compromised. Even under conditions of complete starvation, blood sugar levels in humans never drop below 65 mg/dL (90 mg/dL is considered a normal glucose level). This is because glucose is the primary fuel used by the mitochondria in the brain to generate the tremendous amount of ATP needed to maintain cognitive function. Therefore, to maintain minimal glucose levels in the blood, the body increases cortisol production to breakdown muscle mass into glucose (i.e. neo-glucogenesis). Unfortunately, the increased cortisol secreted in this process also depresses the immune system and increases fat storage by promoting insulin resistance.  It is insulin resistance, not insulin per se, that makes you fat and keeps you fat.

Finally, advocates of high-fat ketogenic diets tend to forget that carbohydrates don’t cause constantly elevated levels of insulin because insulin levels rapidly rise and fall with blood glucose levels unless you have insulin resistance. What actually causes insulin levels to remain elevated in the blood all the time is insulin resistance, and that is ultimately caused by cellular inflammation.

Fructose is bad
This theory came from the observation that the rise in obesity coincided with an increase in fructose content due to the introduction of high-fructose corn syrup as a sweetener in the American diet. It is true that fructose is more reactive than glucose, thus at unnaturally high (i.e. supra-physiological) levels, fructose can cause increased oxidative stress leading to increased fat formation in the liver. What hurts this hypothesis is that the use of high-fructose corn syrup in the United States peaked in 1999 and has been declining ever since, whereas obesity has not.  Furthermore, recent animal and human studies show that when equivalent levels of fructose and glucose are provided, there is no difference between the two carbohydrates on any metabolic functions, let alone fat accumulation in the liver. Recent research also indicates that at normal levels of fructose consumption, the microbes in the small intestine will metabolize most of the fructose before it ever enters the body and possibly reach the liver. Also overlooked is the role of polyphenols in preventing oxidative stress. This is why an apple (rich in both fructose and polyphenols) is good for you, and excess amounts of high-fructose corn syrup (as well as table sugar) is not. Finally, humans don’t absorb fructose from the small intestine efficiently unless it is in the presence of glucose that co-transports fructose into the blood via a glucose transporter located on the walls of the small intestine. It doesn’t matter if it is high-fructose corn syrup (55 percent fructose/45 percent glucose) or table sugar or sucrose (50 percent fructose/50 percent glucose), these usual suspects will provide the necessary glucose to aid the entry of fructose into the blood. So, simply stated only use either table sugar or high-fructose corn syrup with great moderation.

One reason we are consuming less fructose since 1999 is because we are consuming more artificial sweeteners.  Unfortunately, recent research indicates that the most commonly used artificial sweeteners disturb the bacterial composition in the gut resulting in a condition called metabolic endotoxemia, which increases inflammation. This helps explains why artificially sweetened soda consumption appears to increase hunger and weight gain.  And if you eat more calories, you will gain weight even if your fructose consumption is decreased.

It should also be noted that fructose (especially in the form of fructose polymers) is one of the best fermentable sources of energy for the gut microbes to increase the production of short chain fatty acids critical for gut health.

Gluten is bad
This theory states that gluten (the protein found in wheat products like bread, pizza and pasta, and certain grains such as rye and barley) causes inflammation that produces obesity as well as virtually every other chronic condition because of its negative impact on the gut. There are certain genetic markers that are necessary for an inflammatory response to gluten. Nearly forty percent of the American population has those genetic markers, but less than one percent of the population has a true gluten intolerance that leads to celiac disease. So why don’t the vast majority of those genetically susceptible people have celiac disease? The reason is that it depends on how healthy their gut is, and in particular the integrity of the mucus barrier that prevents any large protein fragment (defined as containing more than three amino acids) from getting close to the gut wall where it can cause an inflammatory response. This is why approximately one percent of any population will have an intolerance to any large protein fragments coming from products such as egg, casein, nuts, fish, etc.  Large protein fragments that can cause allergenic responses can’t reach the gut wall if there is a healthy mucus barrier. In addition, the permeability of the gut barrier itself is controlled by the balance of two proteins; occludin and zonulin.  As discussed earlier, occludin is the protein in the gut wall that maintains a tight gut barrier whereas zonulin is a protein that causes a leaky gut by increasing the permeability of the gut wall.  The synthesis of occludin can be stimulated by the presence of short-chain fatty acid by-products of the metabolism of fermentable fiber in the gut and its assembly into the gut wall is activated by AMP kinase stimulated by dietary polyphenols. While it is true that gluten increases zonulin synthesis, it does so only if gluten gets past the mucus barrier, the first line of protection for the gut wall as well as penetrating the barrier of the gut wall as well as your second line of protection before interacting with the immune cells behind the gut wall.  One of the key benefits of the Zone Pro-Resolution Nutrition system is to rebuild the mucus barrier and maintain a healthy gut wall by supplying adequate levels of fermentable fiber to activate mucus production by the goblet cells in the gut wall as well as activating AMP kinase to maintain a tight junction in the gut wall making it difficult for gluten or any other large protein fragments from reaching the immune cells in the gut.

Another unexpected cause of a leaky gut are high levels of eicosanoids, in particular, leukotrienes. That gives rise to not only a leaky gut, but also leaky blood vessels as well as a leaky brain. Over the past forty years, celiac disease and food allergies to proteins have significantly increased. At the same time, the intake of fermentable fiber has significantly decreased due largely to the increasing consumption of refined carbohydrates. This combination could very well lead to both a weakened mucus barrier as well as a more permeable gut wall (i.e., a leaky gut). Add to this a growing increase in the generation of eicosanoids such as leukotrienes, coming from the excess intake of omega-6 fatty acids and you have gut trouble. Gluten was simply caught in the crossfire of these two dietary trends.

Furthermore, individuals who have “gluten-sensitivity” are more likely to have sensitivity to FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides and Alcohol Products) also found in bread products. Carefully controlled studies have indicated that when “gluten-sensitive” individuals are put on a low FODMAP diet and then challenged with gluten, there are no adverse effects. It appears that FODMAPs may be the cause of “gluten-sensitivity,” not gluten per se. It should be noted that lactose is one of the FODMAPs, meaning if you have lactose-intolerance (as does 65 percent of the world’s population), then it is likely you will also have a FODMAP intolerance.

I agree that increased inflammation will definitely make you fat, but making gluten the cause of that inflammation is unsupported although it has created a multi-billion dollar “gluten-free” processed food industry similar to the rapid rise of the “fat-free” processed food industry in the 1980s.

Finally, the gluten-free products developed by the food industry for “gluten-sensitive” individuals are very low in fermentable fiber. Lack of fermentable fiber is a primary dietary reason for developing a leaky gut. In addition, these gluten-free products having a higher glycemic response than the wheat products they are replacing thus making you hungrier the more of them you eat. This is great news for the food manufacturers whose sagging sales of fat-free products are now being replaced by the growing sales of gluten-free products without missing a beat.

Dairy is bad
Another food group that has gotten a bad reputation is dairy, and many popular diets restrict ‘evil’ dairy products altogether.

It is true that about 65 percent of the world’s population is lactose-intolerant, but human breast milk is very rich in lactose, and is considered nature’s most perfect food. What gives? Human breast milk is recommended as the infant’s sole source of nutrition during the first four to six months of life. This makes sense since it’s rich in high-quality protein, omega-3 fatty acids (and resolvins), and unique sugar polymers needed to establish and maintain the ideal microbial composition in the gut for an infant. The down side is you’ll be hard pressed to find human breast milk in your local supermarket aisle, whereas you will find a massive selection of cow’s milk that also contains lactose. So, why is human breast milk good, but dairy milk is bad?  The answer is epigenetics.

All newborn children have the enzyme (lactase) in their gut that allows them to breakdown the disaccharide lactose found in human breast milk into two simple sugars (galactose and glucose) that can easily be absorbed. This is important because if the lactose makes its way to the colon, it is often the cause of gastric disturbances (i.e. lactose intolerance).

Children and other mammals nourished by maternal milk are genetically programmed to lose the lactase enzyme activity with time. This is part of your epigenetic programming where certain genes are turned off with development. In children who become lactose-intolerant, the lactase activity is usually gone by age seven, whereas other mammals lose this enzyme activity in a much shorter period of time. The most likely reason is that it becomes very difficult for the maternal milk supply alone to provide the increased calorie needs for a growing infant or calf and therefore shutting down lactase production is a good way to force the growing child or calf to start using other food sources.

That all changed with the advent of dairy farming. For that very small number of humans (probably less than one percent) that continued to keep generating the lactase enzyme, they now had a survival advantage over those who didn’t because dairy milk could be used as a source of high-quality protein in times of famine and was also a relatively uncontaminated source of liquid.

Today about 35 percent of the world’s population is lactose-persistent.  For them, dairy products are an excellent source of high-quality protein for them.  On the other hand, the other 65 percent of the world’s population will have a difficult time consuming any dairy at all. Considering 10,000 years ago virtually no one maintained the continued expression of the gene for lactase-persistence, this is a dramatic increase of a particular gene pool. The development of lactose-tolerant individuals has become the best example of natural genetic selection in humans caused by a cultural change. In other words, dairy milk gave this otherwise small segment of the human population a significant survival advantage over everyone else.

One of the first applications of biotechnology some 6,000 years ago was to reduce the lactose levels in dairy products. This provided new protein sources for those individuals that were still genetically lactose-intolerant. Two of these early biotechnology products were yogurt and cheese. Yogurt was only a partial solution since the lactose concentration was still relatively high being reduced from about 5 percent lactose in whole milk to about 3-4 percent lactose in traditional yogurt. However, for many, that reduction was enough for them to tolerate the remaining lactose. Yogurt production uses live bacteria (i.e., probiotics) to partially reduce the lactose levels in yogurt by converting lactose into lactic acid thereby giving yogurt its bitter taste. On the other hand, cheese production was much more efficient in lactose removal from dairy milk. First, you remove much of the lactose by acidifying the milk.  This precipitates out the casein fraction (i.e. curds) of milk protein from much of the whey protein and lactose remaining in solution.  Then you treat the curds with rennet (a complex of enzymes isolated from the stomachs of ruminants like cows, sheep, and goats) to better digest the lactose completely to galactose and glucose instead of using probiotics as in the production of yogurt.  Then you age the cheese to ferment it even further to remove still more lactose.  This is why some hard cheeses are nearly lactose-free depending on the production method and extent of aging.

The production of yogurt and cheese that gave many humans (in particular those who did not maintain lactase production) a vastly improved survival advantage using a sustainable source of protein as a growing reliance was now being placed on farming instead of hunting for protein requirements. These individuals had a greater chance for survival because they had a more consistent and plentiful source of high-quality protein. The newest technology that can take this a step further is the development of lactose-free milk.  Using a similar enzyme technology compared to cheese making, it is possible to reduce the lactose level in dairy milk to zero. Most importantly, you don’t need to a have an epigenetic mutation (only 35 percent of humans have such a mutation) to enjoy these nutritional benefits of high-quality sustainable protein as long as you are consuming lactose-free dairy milk.  The same is true of food products such as shakes and bars made with lactose-free dairy proteins.         

Then there is another argument that dairy products cause cancer. A little common sense goes a long way to address that statement. People in northern Europe have little lactose intolerance and consume considerable amounts of dairy products with no decimation of their populations by cancer.

The cancer-promoting theory is based on the association of insulin-like growth factor 1 (IGF-1) with cancer. Dairy products do increase IGF-1, but so does intense exercise. IGF-1 is a hormone released from the liver in response to growth hormone secreted by the pituitary gland after intense exercise as discussed in my book, The Anti-Aging Zone. IGF-1 is structurally similar to insulin and is partially responsible for muscle growth. Furthermore, when you perform calorie-restriction studies in humans, their general health increase, but there is no change in their IGF-1 levels. So, something doesn’t make sense here. If there is a shred of potential for the idea that dairy has a connection to cancer, it’s because dairy protein, egg whites, and human breast milk are rich in the essential amino acid leucine. This is why they are termed high-quality proteins. Leucine is the only amino acid that can stimulate another gene transcription factor known as mTOR that is essential for muscle building.  mTOR is more strongly related to cancer than is IGF-1, but without stimulation of mTOR you lose muscle mass creating sarcopenia (i.e., loss of muscle) as you age.  Obviously neither cancer or frailty are desirable outcomes as both can lead to an earlier death.

This is where the Zone Pro-Resolution Nutrition system comes to the rescue.  The gene transcription factor AMP kinase is stimulated by following the Zone Pro-Resolution Nutrition system (especially supplementation with adequate levels of polyphenol extracts) and will reduce the levels of mTOR by activating AMP kinase.  As a result, by following the Zone Pro-Resolution Nutrition system program you can maintain the correct intake of leucine needed to maintain muscle mass to prevent frailty as well as preventing any increase in mTOR. As usual in nutrition, it is matter of balance.

Lectins are Bad
Lectins are proteins used by plants to defend themselves against microbial invaders. Think of them as a sort of a stripped-down human immune system. The lectins bind to glycoprotein or glycolipid surface components of the potential microbial invaders and makes it difficult to penetrate into the interior of the plant cell. Commercially, isolated lectins are used to distinguish blood group types, so you don’t get the wrong red blood cell group type during a transfusion that could kill you. But there is a big difference between testing isolated blood for transfusions and eating plants that contain high levels of lectins. The primary plants that contain lectins are legumes, wheat (keeping in mind that gluten is not a lectin), and members of the nightshade family (peppers, tomatoes, eggplant, potato, and Goji berries). The contention that lectins create inflammation is only likely if the lectin reaches the gut wall and actually enters into the blood via a leaky gut to cause trouble. For most individuals, this means gaining weight and developing diabetes. Frankly, following the Zone Pro-Resolution Nutrition system will have a far greater effect on preventing weight gain and developing diabetes than trying to remove lectins from the diet. Lectins, like gluten and other proteins, are relatively harmless if you have a healthy gut. Furthermore, lectins are easily denatured by heat especially using a pressure cooker.  If you are concerned about lectins causing inflammation, then I would first rebuild the gut with a combination of omega-3 fatty acids, polyphenols, and fermentable fiber described earlier, before you consider avoiding the consumption of food products containing lectins which are the hallmarks of the Mediterranean diet.

Just as we are constantly reminded about the “evil” food ingredients that should be eliminated, there is a corresponding list of “good” ingredients coming from social media which we are constantly told that should be included our diet.

Alcohol is good
We are told that alcohol is good for the heart and therefore good for our health. This is great news for the alcoholic beverage industry, but not so true for the rest of us. Alcohol is a toxic substance. Furthermore, about one in seven who drink alcohol will ultimately develop a dependency on alcohol because it has the potential to hijack your dopamine reward system. The only benefit to drinking red wine is that it contains polyphenols.  Keep in mind that the key polyphenols in red wine are most likely delphinidins and this means drinking a lot of red wine to consume enough delphinidins see any significant health benefits.

Red wine is actually a poor man’s polyphenol delivery system just as alcoholic herbal tinctures were the primary drugs of the 19th century. Of course, a lot of people don’t like the strong taste of red wine and find white wine more pleasing. That is because white wine contains 10 times fewer polyphenols than red wine, but with the same amount of alcohol. Beer is even lower on the polyphenol delivery chart, and finally vodka brings up the rear, containing absolutely no polyphenols whatsoever.

But what about all the research that supports drinking? Most of that comes epidemiological studies, which means the conclusions are highly dependent on how the trial was organized. Furthermore, if it is a purely observational study, then it only suggests a possible intervention trial should be undertaken to see if the hypothesis has any true validity.

A recent analysis of all the epidemiology trials suggesting that alcohol may be beneficial for heart disease may be suspect since most of the studies included former drinkers who had stopped drinking in the “abstainer” group. If you drank alcohol in excess in the past, you are going to have to a lot of residual collateral damage. Since true alcohol abstainers are also included in that overall group, this dilutes the actual benefits of never consuming alcohol. If you are comparing everything to that “currently abstaining” group, then moderate drinking groups might look good in comparison. This is reinforced by a recent British study over a 30-year period strongly suggesting that any drinking at all will cause a shrinkage of the hippocampus in the brain. This makes sense since it is estimated that every alcoholic drink causes the death of about 10,000 nerve cells in the brain. Over thirty years, that can add up. Finally, a recent large-scale global study has indicated the optimal alcohol intake for decreasing all-cause mortality should be zero.