Calling out Grandma & Grandpa

First, let’s just get it out of the way. My bad for not writing more. I knew it had been a while, but when I logged in and saw October 27 was my last post I admit I’m a bit embarrassed. So, mea culpa with no decent excuses.

As many know, I’m huge fan of Seth Godin. Two of his recent posts, “But that’s not what I meant” and “What posterity has done for us” remind me, however, that there is still a need for writing and speaking out. And so, I’m back and pointing my finger at you, grandparents.

Back when I had a mother in law, one of her favorite phrases was to shake her head in semi-mock disbelief at whatever was going on and say “It’s not a world that I ever made”. At the time I thought it a comic phrase, but now I recognize as something different. It’s a way to shrug off responsibility, because, in truth, it IS a world that you all made. And now I see most of you trying to pass the buck. But I’m calling you out. Time to own up, take some responsibility and start fixing things.

Back in the day, there was smoking and it was a thing. Everyone did it, all the time. Even doctors said it was OK, for a while. And then, slowly, so very slowly, things began to change. In the early 1950s reports started to emerge that smoking was linked to lung cancer. But it wasn’t until 1964 that The Surgeon General issued the first governmental warning about smoking and lung cancer. And thus began decades of “debate” over the merits of smoking. But you’re all old enough to remember that, when the truth finally came out, there really wasn’t much of a debate. It was a bunch of entrenched, old money tobacco companies and executives trying to preserve their income. And they did it not by giving you facts, but by trying to introduce doubt about the facts that existed. “Doubt is our product” as the infamous memo said. And, for quite a while, it worked. It took 24 years to get cigarettes banned on airplanes and 34 years before the huge tobacco settlement that we all remember. While smoking is still a thing, it’s now a small thing and because we all recognize that it’s incredibly bad for you, we tax the hell out of it to offset the costs to the rest of us.

So what’s that got to do with anything? It should be obvious, but obviously it’s not. There are 3 developing crises that are all linked together; the rise of chronic diseases (like diabetes), obesity, and global climate change. And, like the 1964 Surgeon General’s report, the evidence is out there and mounting that these are real, are costly, are devastating, and threaten not just our health and well being, but our very planet. And just like in the 50’s and 60’s, the lobbyists for big agriculture, big food, and oil are engaged in a giant game of obfuscation and denial. And you, senior citizens, have done nothing. You are supposed to be our cultural memory. You are supposed to be our old and wise companions that help steer us away from mistakes we’ve made in the past. And you’re supposed to be cantankerous enough to tell it like it is.

As Seth Godin said:

I’ve never met anyone who honestly felt that they would have been better off living at the beginning of any century other than this one.

And our job is to build the foundations necessary for our great grandchildren to feel the same way about the world they’re born in.

It’s only fair, isn’t it?

And yet, your silence is deafening and damning. For all of the news that your generation watches and all of the newspapers that you read, are you really not learning anything? Let me review just a couple of facts. These are not opinions (aka the “alternative facts” our President favors), but peer-reviewed, data driven facts. (By the way, for you less internet savvy readers, anything blue and underlined can be “clicked” on to go to the source).

So, to my senior citizen readers, remember when McDonald’s was first a big thing? What did you eat there? A hamburger and fries with a drink was a meal. Now it’s called a Happy Meal and it’s for children and they get a plastic toy with it. You’ve undoubtedly bought one for someone. Under your watch and with your participation, the consumption of meat, including poultry and seafood, has risen dramatically over the last 60 years. Not surprisingly, given what we know now, so has the obesity rate, the diabetes rate, the cancer rate, the inflammatory disease rate, and all of the chronic diseases we know so well. And, in large part due to the ever increasing needs to supply (at great profit) all of that meat, dairy and eggs to you, we’re raising the temperature of our planet. The polar ice caps are melting. The giant glaciers on Greenland are melting. Glacier National Park has almost no glaciers. The (at the time) mythical “Northwest Passage” that Henry Hudson so diligently sought, but could never find (i.e. the waterway over Canada to link the Atlantic and Arctic Oceans) is now a reality, at least in the summer months.

Yes, there are “doubts” about all of these things. But if you spend just a few moments digging, you’ll find that available data doesn’t create any doubt, it’s just people creating doubt. Because doubt is their product. And it sells. And it makes such an awful lot of money.

I can already hear my father moaning that The Wall Street Journal says that Climate Change is just a computer model and you can make computer models tell you whatever you want. <insert eye roll here>. That is the classic argument of the doubt creators. Here’s a lovely short YouTube video of the guy who makes “the satellite temperature” data sets. You know, the data that people like Ted Cruz love to say are “the best data we’ve got” and “they don’t show warming”. And in the video, the man who makes the graphs that Mr. Cruz uses, will tell you that: 1) the data is created by using a model (apparently if the model tells you what you want to hear it’s OK, but if it tells you what you don’t want to hear it’s not OK), 2) the data is incorrectly used and 3) the data is just one bit of information in an ocean of information that all point to the same thing.

So, grandparents, what do I want you to do? Quit passing the buck. Be open to learning something new (and perhaps complicated) because you have the time to do so. And then teach your children, your grandchildren, and your great grandchildren how to avoid the mistakes made in the past. How to recognize the charlatans and merchants of doubt for what they are. Just get involved and do your part. I believe you have much to teach and much to give.



Let’s Talk About Microbes

I know that a lot of you have expressed interest in the upcoming flu shot discussion, but I feel the need to do a little background work before launching into that particular discussion. As many of you know, I don’t generally decide that something so pervasive as flu shots is goofy without giving it some real thought first. And it’s hard to put down in a paragraph or two all of the thinking I’ve done about flu shots. Besides, microbes have become really interesting. So, a little background first.

I mentioned Ed Yong’s book “I Contain Multitudes” just a little bit ago. I can’t overemphasize how important and fascinating this book is to me. Here’s why: it isn’t often that a book makes you reconsider your fundamental understanding of how the world works. Honestly, it usually seems to happen with really good science fiction. I’m thinking in particular of “Altered Carbon” by Richard K. Morgan, but I think a couple of the Neal Stephenson books work that way too (“Snow Crash”, “Diamond Age”, “Seven Eves”). So to find that truly paradigm shifting experience in a book of non-fiction is extraordinary made even more so because it’s true.

Let me paraphrase a bit from the beginning of Ed Yong’s book. The concept of the entire history of planet earth expressed as a 12 month time line. It’s a way to illustrate the enormity of geologic time as opposed to our puny concept of time, where time spent on hold with Comcast can seem like an epoch. A couple of highlights from the year:

  • January 1 @ midnight: the earth coalesces from matter in space
  • March 4: the oldest rocks we know of form
  • March 20: algae arrive on the scene
  • July 17: the first cells with nuclei arrive (this would be microbes)
  • November 18: the first basic organisms start to form, including plants
  • December 1: the first insects
  • December 2: the first amphibians
  • December 5: the first reptiles
  • December 13: the first dinosaurs
  • December 14: the first mammals
  • December 22: the first flowering plants
  • December 31 @11:02 pm, just 58 minutes to midnight and the first direct human ancestor makes an appearance.
  • December 31 @11:59 pm: the Revolutionary War

As you can see from this simple illustration, not much seems to have happened in the first 11 months. But, don’t miss that July 17 entry of the first microbes. In this way of looking at the evolution of all animal life on earth, we came on the scene almost 6 months after the microbes. Or, to put it differently, we evolved in an environment that had been completely occupied by microbes for a very, very long time. As mammals, we are Johnny come latelys. As hominids, we are the late coming party crashers, arriving, literally, in the last hour. More to the point, we evolved in the world of microbes.

When I did my medical training (medical school in the late 1980s, surgery training 89–97) I was inducted into the entrenched belief system that the only good “bug” is a dead “bug”. Microbes cause pestilence and disease and are to be eradicated. Almost all of the significant medical advances had involved conquering diseases caused by microbes and this was all the proof anyone needed to know that microbes were nothing but trouble. We didn’t even call them microbes, we called them “germs” in a classic example of demonization. Our medical distrust of microbes spread to the general public and germophobia ran rampant as hand sanitizers and antimicrobial soaps popped up like unwanted mushrooms in a damp field. This may have reached it pinnacle when I saw a dispenser for antimicrobial wipes at a gas pump. I’m not sure I can imagine a much more inhospitable environment for microbes than a gasoline pump handle, but there they were. (As a complete aside, it has always bothered me that we talked about “normal flora” when we talked about microbes that lived in & on our bodies, but we microbes that are pathogens are generically called “germs” and most doctors call them bugs. I should have know this internal inconsistency hid a lot of misinformation!)

Fortunately, not everyone was buying the hype. There were intrepid researchers out there who took a more broad look at microbes and have slowly begun to put together a much more nuanced picture of how we interact with them and the important roles microbes play in everything from planetary health to our day to day health. Not just in disease states, but the ways we co-exist with these partners that have been present long long before multicellular organisms ever existed on planet Earth.

As some of you know, I’ve prattled on a bit about the “gut micro biome” in several posts. Worry not, I will be writing about this for years to come as new and fascinating things come to light. But for those who are wondering if there’s really any practical use to all of this ridiculous micro biome thing, let me close with a little talk about Clostridium difficile colitis. Known as C. diff. colitis in the medical world, this is a disease that is a significant problem that is occasionally fatal and costs us untold millions of dollars to diagnose and poorly treat. And it’s a micro biome problem through and through.

Most people who get C. diff. colitis get it after exposure to antibiotics. That is, they are given antibiotics to treat some problem (whether the antibiotics were a good idea or not in the first place is not the point of this particular discussion, but, as you’ll see, it’s an increasingly germane discussion) and, as a result of the antibiotics, they develop abdominal pain, cramping and diarrhea. Particular to C. diff colitis is a smell, which is hard to forget once you’ve experienced it and is virtually diagnostic. Severe cases can develop breakdown of the lining of the colon (large intestine) which allows bacteria access to the blood stream and can be fatal. Suffice to say, it’s not a problem to be taken lightly. So what happens? How does a dose or two of antibiotic cause such havoc? The answer is that we have trillions of bacteria living in our intestines. All mammals do. These bacteria live in a fairly balanced relationship with our body and immune system and play some pretty important roles. One of the many species residing there is C. diff. But C. diff is resistant to most of the antibiotics you might receive. So as you take antibiotic tablets for that sinus infection, upper respiratory infection, urinary tract infection, etc. the antibiotic can also kill off a large number of the bacteria in your large intestine. As the other bacteria disappear, C. diff has an opportunity to reproduce and take over a bigger role in the gut and, if conditions are right, it will do so. Doctors call this an “opportunistic infection”.

So what’s the treatment for C. diff colitis, a disease caused by the use of antibiotics? Why, more antibiotics, of course! This time specific (and expensive) antibiotics that are generally active in killing off the C. diff as well as the rest of your gut bacteria with the hope that, if you clear everything out, what grows back *should* be more or less normal. It’s like treating your house fire with a couple of cans of gasoline. No wonder some physicians describe this sort of therapy as “flaming the landscape”. In retrospect, probably the most remarkable thing of all is that it has worked more often than not. But it doesn’t always work and some very unfortunate people are left with a chronic C. diff infection that is very hard to shake.

Enter new thinking and a miracle cure. If you take a big step back from the germs as enemies way of thinking and instead think about the colon as an ecology, interesting things start to happen. In the setting of C. diff, the fundamental problem is not that C. diff is there, it has always  been there. The problem is that the other bacteria, that usually keep C. diff in check, are gone. So, can anyone think of a way you might replace the other bacteria that people with C. diff colitis are missing? Or, to reframe the problem in a different language, how could you restore the normal micro biome of the gut? The pretty cheap answer to this conundrum is to transplant a normal micro biome back into the disease colon. Where could you find normal micro biome to transplant? Sorry to say, if you hadn’t already seen this coming, but that’s pretty much what the feces from a healthy person is. So the answer, it turns out, is fecal transplantation. It works, it’s cheap, and it treats the problem in a way that those mired in old “germs are our enemy” thinking have a hard time accepting. Imagine the thought of transplanting trillions of active microbes into a diseased colon and hoping it will cure the problem.

It turns out that it works so well that there is now a preparation for instilling into the colon of people with C. diff colitis. It is a mixture of the bacteria found in a normal, healthy colon grown in the lab and capsulized for easy delivery. The best part? It’s called RePOOPulate. I shit you not. Read about it here.


Zone 2 Training – part 2

In the last post, I talked about what the various heart rate zones are, how they are most simply calculated, and then talked about why it is important. I want to recap the last point because it is so critical. When endurance athletes talk about Zone 3 and Zone 4, they often refer to them as the grey zones. This is not to say that there isn’t a time or place for work in Zone 3 or Zone 4, but if you’re going to venture there you should have a really good reason for doing so, otherwise the time you are spending exercising will burn calories, but will not do a lot for improving your fitness or, in technical terms, your aerobic threshold. I know this seems ridiculous, but if you’re a runner, ask yourself, when was the last time you made a significant gain in your running times? If the answer is “a long time” or “I don’t remember” I’m sorry to tell you that all those hours and miles you’ve put in haven’t been as beneficial as they might have been. On the other hand, they were not for naught and they have taught you excellent habits of discipline. Now let’s make them really pay off.

Step One: find your zone

I showed you the super simplistic calculation for HR Zones in the last post. If you don’t want to delve further, use that calculation. There are several other ways to calculate your Zone 2, including the Karvonen Formula, the Maffetone formula and the Friel formula. If you’re interested, drop me a note and I’ll gladly explain further. Or, if you’re so inclined, I put together an Excel spreadsheet that calculates them for you. This is a link to the spreadsheet. Personally, I like the Karvonen Formula, which uses your age to calculate your maximum heart rate, as before, but then also takes into account your resting heart rate. I like it because it seems to be a way of taking your existing fitness into account (assuming your existing fitness is loosely marked by your resting heart rate, but I’m OK with making that assumption). The Friel formula is probably the most precise as it is a percentage of your actually Lactate Threshold (the point where you go from exercising aerobically to anaerobically) but unless you have access to a physiology lab you’re going to have to guess your Lactate Threshold. Using the various methods, the upper limit of my Zone 2 is somewhere between 126 and 144 beats per minute. For simplicity sake, I’ve chosen 135 as my number. Could I do better? Maybe, but it is’t the lowest or the highest and it seems to correlate pretty closely to my rating of perceived effort (RPE). For those on a beta blocker medication, which keeps the heat rate artificially slowed, all of the Zone 2 calculations in the world won’t really work. In that case, learn the RPE scale and use it!

Step Two: get a heart rate monitor

None of this really works without a heart rate monitor of some sort, unless you’re just going to go with the RPE scale. If you’re a data nerd like me, you’ll need a heart rate monitor. Most of new Garmins, including the smaller ones, have heart rate monitors built in. The newer Fitbits have HRM (heart rate monitors), the Apple Watch has HRM, and you can even go “old school” and get a chest HRM. If you’re going that route, look at Tickr! a newer chest strap HRM that links by both ANT+ and Bluetooth technology, so it links to most anything (including most newer treadmills) and, oddly, is on sale at Amazon today.

Step Three: slow down!

Go ahead, go do a work out. Go for a run. But as soon as you reach your Zone 2 maximum heart rate, you have to slow down. In fact, you’ll probably have to slow down to a walk until your heart rate comes down. Eventually, you’ll find a pace you can keep for a while, but your heart rate is going to go up again, virtually guaranteed and you’ll have to slow down and walk.

Personal Experience: I was just starting up running after a lengthy time off (infectious mononucleosis) so I know that my aerobic conditioning was off. But, when I started Zone 2 I was back running 4 miles or so at a 9:30–10:00 minute/mile pace and feeling pretty good about it. My first run with Zone 2 I knew would be slow, so I slowed the treadmill down to 5.5 (about 11 minutes/mile). I made it about 10 minutes before I hit my Zone 2 threshold and had to slow down and walk. I spent an hour on the treadmill and managed to just get over 4 miles in, so I averaged about 4.0 for the hour, which is a brisk walking pace. But I’ve varied my workout between running, rowing, stationary cycling and elliptical, all keeping at Zone 2 threshold and within 3 weeks I’m covering 5 miles in the hour. More importantly, I’m running for an hour and feeling really good after. No terrible muscle aches, no cramps and no feelings like I’m physically spent. I anticipate being able to run for the entire 60 minutes soon and then starting the get the pace back up to at least 10 minutes a mile if not better.

OK, you are probably thinking, what a slug. But consider this in a different light. If you could run a 10 minute mile pace in Zone 2 and do a marathon, you’d run the entire race in about 4 and half hours and walk away ready to run the next day. I don’t know many runners who can do that.  Imagine, then, what might happen if you did this Zone 2 training not for a couple of months, but a year. Imagine getting to the point that your current “race pace” could be done in Zone 2, so that come race day you could run the first half in Zone 2 and then push yourself a little for the second half. You might walk away with a significant improvement in both your time and your ability to run the next day!

Give up your preconceived notions!

I’ll admit that committing to Zone 2 training is a bit of a leap of faith. But after reading Rich Roll’s account, doing a good bit of research on it and now trying it in my own training, I’m a full fledged convert. So if you think it might be interesting, but know in your heart that you have to run to exhaustion to improve your running capacity, I will ask you to reconsider sometime next year. Because I’m a complete Zone 2 convert and I’m going to run a half-marathon next spring and my firm belief is that: 1) I’ll break my previous PR by at least 5 minutes while 2) feeling better during and after the race than I’ve felt for any previous race. And if I’m right and I’m making serious improvements in my running at age 54 and at least 5 years since I made any other gains, I defy you to come up with a better explanation that just better training through science and understanding.


Zone 2 Training – Part 1

heart-rate-zonesI picked up this concept in Rich Roll’s book “Finding Ultra”. The concept was not completely new to me, but Rich Roll had a way of describing it that made it seem new, which is kind of magical. For those of you who are unfamiliar with the concept, I’ll spend a little time going through the background and basics, then explain why you should care. Finally, a little practical advice that I’ve come up with while trying to use Zone 2 training.

What are Zones?

Zones are heart rate zones. This is a range of heart rates that are a rough indicator of how strenuous the physical activity you are doing is at any given time. Most people talk about 5 heart rate zones:

Zone 1: Very Light, at the end of a work out you feel guilty that you haven’t worked hard enough – walking on a treadmill at a speed that seems easy.

Zone 2: Light, you should be able to converse with someone while working out. Converse, as in speak in sentences, not one or two word grunts – walking or running at a speed that seems easy at first, but over time requires more effort.

Zone 3: Moderate, your heart rate is getting a bit higher, your breath a little faster, you can talk a little, but definitely not hold a conversation – probably where you now spend a lot of time in your work out life

Zone 4: Hard, heart rate higher, breathing faster, this is a sustainable pace, but just. You’re pushing yourself now

Zone 5: Maximm, you’ve pushed your pace to it’s limit and can’t sustain this for very long at all.  For me, I have always thought of this as the place where I “lose my breathing” and have to walk for a moment to get things back on track. A big hill at the end of a workout where you’ve already pushed yourself a bit.

Each of these zones has a heart rate range associated with it and these ranges change with both your age and physical fitness. The most simplistic calculations go something like this: 220 – your age = your maximum heart rate (MHR). Zone 1 is 50–60% of MHR, Zone 2 60–70%, Zone 3 70–80%, Zone 4 80–90% and Zone 5 90–100%. This is pretty much what a LifeFitness machine at a gym will do if you tell it you want to do a “fat burning” workout (Zone 2) or an “aerobic” workout (Zone 3). For me, at age 54, my MHR is 220-54 or 166. Zone 1 is then up to 100, Zone 2 is up to 116, Zone 3 up to 133, etc.

Why do Zones matter?

Unfortunately, most of us grew up with the ridiculous “no pain, no gain” mantra of working out and we just can’t shake it. When it comes to cardiovascular fitness, however, nothing could be further from the truth. I get it that most of us are not looking to do marathons, ironman triathlons, ultra marathons, or more. But it seems like we are looking to “get fit”. So take a moment and ask yourself (because I’m guessing you have never really done it before) what does that mean to you? Is getting fit having bigger muscles, less weight, just feeling better in your skin, or actually increasing your capacity for exercise? Obviously, if you’re into weight lifting, it’s bigger muscles, but I would argue that for everyone else the answer should be increasing your capacity for exercise. This is what would let you exercise more efficiently, for your body to improve it’s ability to use energy to do physical work and would, as a consequence, likely result in some body reshaping and weight loss as well as improving your times. So, for almost everyone who is interested in fitness, I think you should seriously consider thinking about how you go about increasing your capacity for exercise or, in more technical terms, increasing your aerobic capacity.

Chances are that you, like me, have been doing it wrong.

This was my revelation from Rich Roll. I, like almost everyone, have been doing it completely wrong. I’ve been running seriously for 8 or 9 years. I’ve run 9 half-marathons (13.1 miles), so I’m not completely new to the running scene. I have an MD degree and am interested in exercise and physiology (how the body works) and I thought I had a good handle on what I was doing. And yet, despite my efforts over the last years, I had a miserable year in 2016 with running and haven’t really made any significant improvements in my times over the last several years. Why? Because I was doing it all wrong.

When you are exercising and you let your heart rate wander up into Zone 3 and Zone 4, you lose the benefit of actually improving your aerobic capacity. Yes, you work your body harder, but you don’t actually make your body more fit. The only way to do that is to exercise in Zone 2. Exercising at this reduced effort forces your body to adapt to the stress the exercise puts on your body. The adaptation is the thing you’re doing all that work for in the first place. It makes your body add blood vessels to deliver more oxygen and fuel to muscle cells and the muscle cells add a lot of mitochondria, the little power plants that convert oxygen and fuel into work. By adding mitochondria to the cells and growing a richer network of blood vessels to support the muscles, you get more work out of the same effort. It turns out that elite athletes, like Rich Roll, spend 80–90% of their exercise time working out in Zone 2. So why aren’t you?

I’m guessing that you, like me, haven’t been doing it because 1) you had no idea (this is relatively newish exercise physiology stuff), 2) you don’t know how to make it work and 3) you still kind of believe that your exercise has to be really hard to make any serious pay off. But, now you know and I’m going to tell you how to make it work and I’ll try and talk you down off the ledge for number 3, all in the next post….  🙂


Changing direction, a little

This morning I had a shower thought. You know, those little epiphanies that occur when you’re taking a shower. I admit, I also get them running sometimes, which is somewhere in the top 10 reasons I like to run, but that’s beside the point. I came across a little article here that explains that the non-linear thinking that leads to shower thoughts is a result of a mindless-repetitive task that allows your brain to go into idle mode, relaxation, and likely the time of day.

So, my shower thought was this. I have a lot to say. I think a lot about getting a post out, but don’t do it very much because I’ve made it a lot of work. I didn’t mean to make it a lot of work, I just did because that’s how I roll. When I put something out there, I want you to know that it’s something I’ve thought about, researched, and vetted. I want you to know that I’m not just making things up or passing along some quackery. So every post is extensively footnoted with links to the source article and this takes a lot of time. And, I’m guessing, that those few of you out there who read these posts either never noticed the links or, if you did, rarely followed them to read the source material. And this was my epiphany. To make this process much easier and fluid on my end, I’m not going to do that anymore.

Here’s my solemn promise to you, reader. If you ever want to know the source material for something I say (as long as it’s not blatantly opinion) please just ask in the comments. That way I can post the relevant links for you (and the world) to see, keeping my promise to only bring you fact and not fancy. But there’s so much cool stuff out there and I’m dying to share it with you. For just a glimpse of the things rattling around in my head here’s what I’ve been reading lately:

How Not to Die” by Michael Greger, MD & Gene Stone. Dr. Greger is the “host” of and I’m a huge fan. This is fact based nutrition at it’s best. The book is not an easy read, but it’s so jammed full of fun stuff that I need to share.

Finding Ultra” by Rich Roll. Rich is an interesting character and many of you know him from his very popular podcast. He’s an alcoholic (in remission) ultra man athlete. No, not the old TV show, the crazy double Iron Man race in Hawaii. 6.2 mile open ocean swim, 261.4 mile bike followed by a 52.4 mile run. I, personally, think Rich totally missed the mark on his comments on soy in the book (and I emailed him and told him so), but it’s an interesting read. If you want to skip the book, check out the podcast. He did a show with Melanie Joy a couple of months ago that was very nice.

I Contain Multitudes” by Ed Yong. I have written in the past about the amazing science and discoveries being made regarding the human gut microbiome, the ecosystem of bacteria that live within our guts. Ed Yong’s book is a grand tour of all the amazing and cool things that are happening in the science of microbes and microbiomes. I don’t say this lightly, but this is literally paradigm shifting stuff. Really, our entire understanding of we live with bacteria is changing.

Finally, it’s cold and flu season coming up (as I look at the lovely fall colors from my window as I write) and that means the insane pressure for flu shots is just ramping up. I will have a post early next week and will show you why you don’t really need one.




Confusion in the media

There is an article from August 11 in the New York Times by Gina Kolata called “We’re So Confused: The Problems With Food and Exercise Studies” that I feel I have to address. The gist of the article is that Food Science is inexact and there is conflicting scientific literature on many foods. The cornerstone of the article is a January 2013 article from The American Journal of Clinical Nutrition entitled “Is Everything We Eat Associated With Cancer? A Systematic Cookbook Review“. In this article, two physicians selected 50 common foods from random recipes in a cookbook and did a meta-analysis of the scientific literature on those foods and found conflicting results. Ms. Kolata uses this and a few quotes from other physicians and researchers to conclude that Food Science in inexact and conclusions should be, pardon the phrase, taken with a grain of salt.

The problem here is that this isn’t really the whole story. There are two fundamental flaws in this logic.

First, it’s not really true for all foods. I issue a challenge to anyone who can find me an article that says that beans cause cancer. Let me expand that and say I’m unable to find articles that link ANY commonly consumed plants that cause cancer. Yes, you may find the odd link that suggests that pesticides or other chemicals sprayed on the plants may be harmful, but none to suggest that the foods themselves are carcinogenic. Please, flood my inbox and show me the error of my ways and I promise I’ll post anything you can dig up.

Second, the bigger problem is the media and the disconnect between how science works and how we want it to work. Science is a process, a long and tedious search for clues as to how things work. But our brains are not wired for this sort of process. We want answers; we want a story. If you want insight into how our brains work, there is no better work than Daniel Kahneman’s “Thinking, Fast and Slow“. I know, it’s a big, hard book, but I promise it’s worth it. One of the recurrent themes of Kahneman’s work is that we always try to make a coherent story out of available facts, even if one does not exist. It’s the reason why you so often see headlines screaming the latest findings as if the story is told and the conclusions are in. But that’s not how science really works. Yes, every scientist (like every person) has a bias. Yes, they conduct research based upon those biases. But then they publish those findings, not (hopefully) because they believe their findings are necessarily THE TRUTH, but because we slowly discover the truth by retesting, again and again, until we decide that the original conclusion was correct or not. The problem, then, is the media, which takes every Food Science article and study as the gospel truth because it sells. I’m pretty sure not many people paid a lot of attention to the February 2016 article in the New York Times “Gravitation Waves Detected, Confirming Einstein’s Theory” which described how scientists recorded a sound that they believe proves the existence of gravitation waves, first described theoretically by Albert Einstein in 1915. It took 101 years to find data to substantiate the theory and the scientists conclude that more data is needed to confirm the finding. But because they are not claiming that gravitational waves cause cancer, or improve your health, there is not much media attention paid to this finding. There is no great story except the tedious research needed to weed out the truth.

Until we have sufficient evidence to actually back up the assertions made, we have to rely on imperfect science to guide us. I remind you of the best eating advice ever dispensed, 7 simple words:

“Eat food, not too much, mostly plants.” Food, of course, refers to vegetables, fruits, whole grains and even meats (if you choose), but not “edible food-like substances (i.e. high fructose corn syrup)”.


Healthy fats?

olive-oil-and-olivesAbout two weeks ago I was looking for an interesting recipe for wheat berries. For those unfamiliar with wheat berries, it’s what is actually harvested from wheat. If you’re into it, you can buy wheat berries and grind them up in your coffee grinder (espresso setting) and make flour. They’re hard little nuggets that take forever to cook (at least an hour), but they have a nice, chewy texture, a nutty flavor and are, I think, an under used grain. After a bit of searching, I found a nice recipe for a wheat berry asian salad, if you’re interested, it can be found here. I made the salad as directed and it was, indeed, quite good. I added some marinated, baked tofu to the top and it was a winner, but I was a little worried about the amount of oil that the recipe has, 3 tablespoons of olive oil and 2 tablespoons of toasted sesame oil for 2 servings. Because I liked the flavor, I did some research on how to reduce the oil in the recipe and came up with the following substitution. I added 1 tablespoon of toasted sesame oil for flavor, then a 1/4 cup of sunflower nuts for additional flavor boost, then, in place of the 3 tablespoons of olive oil and the other tablespoon of sesame oil I used a quarter of a block of soft (non-GMO, of course!) tofu. The flavor was still great and I was rather pleased with the results. So pleased, in fact, that I went to the unusual step of returning to the web site and posting my substitutions for those who might be interested in reducing the fat content of the salad. To my surprise, the blogger responded to my comments:

Hi Matt, I’m glad you’ve been enjoying this salad. Keep in mind that 3 of the 5 tablespoons are extra virgin olive oil – unheated, raw and wonderfully healthy. No other oil has been as extensively studied as olive oil in terms of its health benefits. It’s been a core component of the Mediterranean diet for centuries. I always recommend being very choosy of the brand (buy locally pressed whenever possible) to make sure you’re getting a quality product.

If you look at the recipe, feel free to scroll down to the bottom of the page and read our exchange. But this got me to thinking about the her statement and the concept of “healthy fat”. Indeed, when I replied to that comment stating that there was a large body of evidence that shows limiting fat intake is a good goal, she responded:

Matt, there is a relatively small body of clinical research that suggests that healthy fats are bad. You’ve probably noticed that many of the doctors making these claims are citing the same few papers or their own clinical/anecdotal observations (e.g, Dr. Esselstyn). On the contrary, the greater body of research largely draws the opposite conclusions.

So, there it is again, “healthy fats”. Readers who have been reading this blog probably know that I have a semantic quibble with the application of “healthy” to foods. But I take it, from the use here, that there are people out there, and maybe a lot of them, that believe there is some distinct benefit to their health to be gained by eating certain fats, like olive oil. Let me dispel this myth.

There is no such thing as a healthy fat.

I would refer interested readers to this short video at looking at the effects of olive oil on arterial endothelial cell function. It turns out that olive oil, just like all fats, inhibits endothelial cells. Is that important? Yes. It is this inhibition of endothelial cell function that is the critical first step down the pathway to vascular disease including, but not limited to, cardiovascular disease.

But how about extra virgin olive oil? Isn’t that OK?

It’s better than most oils, but it’s an oil, just like all the other oils. There are a few compounds retained in EVOO, but they’re few and far between. The olives are “juiced” for their oil and some of the “healthy” qualities of the olive fruit are retained in that juice, but all of the water soluble goodness is then extracted, leaving only the fat behind. The only nutrients that are retained at this point (i.e. in the bottle) are those that are fat soluble. Thus, using olive oil is not comparable to eating olives.

But what about the Mediterranean diet?

The “traditional” Mediterranean diet is primarily plants and whole grain foods. Dipping your piece of white foccacia bread into olive oil, while tasty, is not a good practice nor is it part of a traditional Mediterranean diet. Having a large salad with veggies, olives, nuts, and lots of greens along with a reduced fat dressing along with some whole grain bread is clearly a more nutritious practice that will bestow benefits to your health.


Let’s talk about eggs.

When I was in Chicago I had a conversation about eggs. The question posed was simple: are eggs really so bad? It’s a legitimate question and one that I thought deserved more than a glib answer. So here it is.

tl/dr version: Yes

Longer version (not that long):

The reason that most people give for eating eggs, besides liking the taste, is that they’re a “good source of protein”. I won’t belabor the protein point at length as I have done so previously, but suffice to say that humans can thrive at much lower protein levels than advertised. Research has definitively shown that 5-10% of calories from protein is the optimal range and this can be amply provided by a diet of plants. Consumption of protein above that level increases a number of health risks including (but not limited to) heart disease, type II diabetes, cancer and kidney disease. The USDA caloric needs estimator suggests about 2400 calories per day for sedentary adult males (and face it, most people are sedentary). To put that in perspective, 10% of calories from protein means consumption of 240 calories of protein. At about 4 calories per gram, that’s 60 grams of protein per day. One large egg has about 6 grams of protein, or about 10% of your daily need, but no fiber (sadly lacking in almost everyone’s diet), 5 grams of fat and 167 mg of cholesterol. Since the optimal diet is also 10% of calories as fat, your daily fat requirement is only 27 grams, so a single egg provides 20% of your daily fat needs. There is no dietary need for cholesterol (your liver makes all that you need) and most studies of those at risk for heart disease and diabetes recommend 200 mg or less of cholesterol a day. If you eat a single egg, you’re more or less done.

The Physician’s Committee for Responsible Medicine (PCRM) has a nice fact sheet on eggs, which can be seen here. It nicely summarizes all of the health risks of egg consumption, including an increased risk of colon & rectal cancer, bladder cancer, diabetes, heart disease, gestational diabetes (for the pregnant women), and the ever present risk of salmonella.

So, when you get past the health issues involved in eating eggs and decide that they maybe really are not that great for you, you have to factor in egg production, which is, in a word, horrifying. Obviously, chickens lay eggs. Some are taken for human consumption, the others grow and hatch chickens. Female chickens are obviously favored by the egg industry for because they make more eggs. As with most animals, about half of the chicken eggs that are hatched are female and half male. So what does the industry do with all the male chicks? The industry term is “chick culling“. Soon after hatching, they chicks are “sexed” (i.e. the sex is determined) and the male chicks are “culled” from the flock and killed, usually by dropping the living chicks into a large grinder. This is a link to a YouTube video showing the process. It’s not a bloody video, don’t worry, but it is pretty gross. As the Wikipedia page suggests, in India alone approximately 180,000,000 male chicks are culled per year. In the United States, approximately 40,000,000,000 (yes, that 40 billion) male chicks are culled each year. The egg industry recently announced that it will end the process of culling by 2020 in favor a technique for sexing the eggs before they hatch, but that still leaves 40 billion male eggs that need “disposal”.

Once the lucky females make it past the culling stage, their beaks are clipped short with a hot wire so they can’t do what chickens do, which is often peck each other to death (pecking order!) and packed into small cages where they’ll spend the rest of their relatively short life (1-2 years) laying eggs until they’re spent, then killed off.

And what happens to all those killed chickens, both the culled males and the non-productive females? Why they enrich our fertilizer and pet foods.


Chicago Vegan Fest

logo_LOGO-Chicago-Vegan-Festival-v3I wanted to share some thoughts about the Chicago Vegan Food & Drink Festival. As you probably recall, we hit the Phoenix fest pretty much by accident when in town for the half-marathon. Then we got out to Portland for their second annual fest and last weekend, with a lot of anticipation, it was off to Chicago for their festival.

After arriving and getting settled on Friday we met up with my younger son, who lives in Chicago, at The Chicago Diner for dinner. We went to the Halsted location. Parking was a nightmare. The food was good, but, I have to admit, I had a better faux Philly earlier in the week when Rick and I were doing taste tests on some of our recipes. A Philly with a faux cheese sauce just isn’t up to snuff, in my book. Throw some of that faux provolone in the skillet and let the whole thing turn into a cheezy, gooey mass, that’s the way to do it! The Cuban was interesting, but I’m not sure I loved the fried yucca chips as an exchange for ham nor the peperoncini in exchange for a good pickle. Maybe I’m just being too picky? We also sampled the quinoa chili and, while interesting, it was the jalepeño corn fritter that got the most attention. And don’t even get me started on the Mac & Teeze™. I think my thoughts about faux Mac and Cheese are pretty well known. Suffice to say it went uneaten. I don’t want to leave you with the impression that I didn’t like The Chicago Diner or that I wouldn’t go back. I did like it and I would definitely go there when in Chicago, but it has become clear to me that the Midwest palate for plant-based eating is a bit different than the East or West Coasts. We have such a deeply ingrained meat and potatoes culture that getting people to consider going plant-based means you have to offer a palatable pathway to get them started. The Chicago Diner has been doing that for years; I just think it can be a little bit better.

The Chicago Vegan Food & Drink Festival was held in Grant Park. From the outset, the Chicago Festival had a very different vibe than the Phoenix or Portland Fests. The ticket price was much cheaper, which was a bonus, but there was nothing inexpensive after that. Whereas the Phoenix and Portland festivals had lots of things you could taste for free (including the amazing kombucha area in Portland), everything at the Chicago festival had a price and they were pretty steep. I admit that some of my issues with the Chicago festival had to do with the location and the vagaries of the weather, but it was a very hot, sunny day in Chicago and the festival was totally devoid of any shade, except around the extreme margins of the park, which took you well out of the festival itself. With 4 sides of tents and food trucks selling food and drinks, it would have greatly benefited from a large shaded area in the center. Also, the distribution of trash and recycling containers seemed random, almost guaranteeing that you’d walk around for some time with a handful of trash looking for a container. The tickets promised free drink tickets, but it turns out that was an 8 ounce cup of one of 5 local beers, which was totally inadequate for the heat of the day. Logistics aside, however, the overwhelming vibe of the Chicago Festival was one of commerce, which was a sharp contrast to Phoenix and Portland which had a very strong community feel. Portland was more like “we’re doing this cool things, come try them and hang out with us” and Chicago was “we have this food, come buy it”.

Speaking of food, we tried the Doomies faux Big Mac that has gotten so much attention. At a whopping $15, it should. Clearly designed to feed more than one, we fortunately had 5 people assembled to take on the burger. I would agree with the consensus that it was fresher and tastier than a real Big Mac, but the faux beef patties were far too large and the whole thing would benefit from a scaling back of the process. We also tried an alternate “bacon cheeseburger” and I have to say it was not as well done as I’d like. First, let’s talk about faux bacon (fācon, if you will). It’s mostly a giant nope. The only fake bacon that I’ve had that is reasonable is Claryn’s recipe for Vegan Bacon Bits on which is the best way to use up TVP that I’ve ever found. Artificial as hell, this recipe totally recreates Betty Crocker’s Bac-Os. Everything else I’ve tried has been a sad effort. Like with Mac & Cheese earlier, if the faux alternatives are awful, just quit. I get that people miss bacon, but time to move on. Faux cheese is a different story. There are some pretty decent alternatives out there, I’d recommend a trial of Chou brand to anyone who hasn’t tried it. I’ve also had some almond based ricotta that was amazing and I’ve made a salsa con queso that is very decent. So why would you use a terrible faux cheese on your bacon cheeseburger at a vegan fest? No good answer for that.

On the positive side, we had two pretty fabulous desserts. One was a slice of cashew cream based key lime pie that won rave reviews. The other was an oatmeal cream cookie (two giant oatmeal cookies with vanilla “cream” between them) that was decidedly delicious, but probably had more calories than any 4 people should have in a day. Fortunately, we still had plenty of people to share it with. The sun and the heat conspired against us all; we found ourselves with waning appetites. Personally, I was disappointed that kombucha was no where to be found. I’ve developed quite a liking for that odd beverage since Portland.

One of the nice things about the festival was to meet some of my son’s friends. So here’s a shout out to Hector and Zach, both of whom seem to read my musings. I didn’t get a lot of time to talk to Hector, but I appreciated Zach’s input on the restaurant concept. Look for a post in the very near future on eggs to try to answer your question!

Driving back, we found the best kept secret in Wisconsin vegan dining. If you’re traveling I-90/I-94 take a quick detour through Wisconsin Dells (I know, right?) and stop at The Cheeze Factory restaurant. The entire menu of this delightful little spot is vegan friendly plant-based. Honestly, it was the best dining we had on the trip and I highly recommend the place.



Soy Epilogue: GMO Soy

Yesterday’s post about soy looked at the claims that soy is not good for you and then compared the claims to the science. The claims, as is often the case, were found lacking. But the post got long and I did want to spend a little time talking about genetically modified (GMO) soy because it’s an important part of the soy discussion.

I will admit that I’m not an expert on genetically modified crops, in fact, far from it. It was not a topic that I had given much consideration when I was working as a surgeon; after all, learning better and safer ways to do surgery seemed more pressing that what the farmers were planting. But as I learn more and more about genetically modified crops, I am definitely concerned that this is another example of corporate greed getting the better of common sense. For a well reasoned discussion of genetically engineered crops, I refer you to this article from the Union of Concerned Scientists.

Our old friend the USDA reports that about 90% of the soy beans grown in the U.S. are genetically modified. Moreover, almost all of that 90% are the same genetic modification called “Roundup Ready” from the Monsanto corporation. Monsanto, a multinational agrochemical and agrotech company is, of course, the maker of the ubiquitous herbicide Roundup, so frequently advertised for household use to rid your lawn and garden of those pesky weeds. But, as anyone who has used it around the house knows, the over spray from Roundup is an indiscriminate plant killer. Since American farmers use quite a bit of Roundup to prevent weeds, the folks at Monsanto came up with a plan to genetically modify some common crops so that they are resistant to Roundup, meaning that farmers could spray directly on the crops and kill the weeds, but the crop itself would not be affected. Sounds like a great plan; what could possibly go wrong?

Well, Roundup Ready soy turns out to be different than non-GMO soy in more ways than just being resistant to Roundup. This 2014 article from Food Science analyzes the compositional differences between organic, conventional, and GMO soy and came to the following conclusions (glyphosate is the active compound in Roundup, AMPA is what glyphosate breaks down into):


  • Glyphosate tolerant GM soybeans contain high residues of glyphosate and AMPA.
  • Soybeans from different agricultural practices differ in nutritional quality.
  • Organic soybeans showed a more healthy nutritional profile than other soybeans.
  • Organic soy contained more sugars, protein and zinc, but less fibre and omega-6.
  • This study rejects that GM soy is “substantially equivalent” to non-GM soybeans.

So, in a nutshell, Roundup Ready soy beans have less of what makes soy such a nutritionally balanced food in exchange for high residues of glyphosate and AMPA. A February 2016 article in Environmental Health entitled “Concerns over use of glyphosate-based herbicides and risks associated with exposures: a consensus statement” does a nice job covering the issues of glyphosate exposure and human health including, but not limited to, the fact that the World Health Organization has recently upgraded glyphosate to “probably carcinogenic to humans”. So this is not an insignificant point.

It’s pretty clear that the 10% of soybeans that are not GMO are clearly labelled and sold as such. Any trip to Whole Foods or a similar store will  show items like these tofu packages, both clearly marked as organic and non-GMO. organic_firmorganic-extra-firm-tofu So what happens to all that Roundup Ready soy? Where does the 90% go? Most of it is processed and goes into one of two products: soy meal, which is almost exclusively fed to livestock and oil, which is the primary ingredient in most “Vegetable Oils” you might buy at the supermarket. Wesson Vegetable Oil and Crisco Vegetable Oil are 100% soy, whereas Mazola Vegetable Oil is a soy/canola blend, with soy being the larger component. Fortunately, it appears that glyphosate is not soluble in oil, meaning that it concentrates in the soy meal and not the oil.

So what about all the glyphosate being fed to livestock? This 2012 article in Current Microbiology documents that glyphosate is toxic to some bacteria in the gut of chickens, but not to others, which has the significant potential to change the gut microbiome. And, you can be sure, if it can happen to chickens it can happen to cows, pigs, and people. The whole concept and understanding of the human gut microbiome is an exciting and rapidly evolving field of study. A PubMed search of “human gut microbiome review” will get you about 12oo papers written in the last 5 years. And while there may be opportunities to alter the microbiome in positive ways to help treat a wide spectrum of diseases that would seem to have no obvious connection to the gut, it seems equally clear that to have a probable human carcinogen (glyphosate) make changes through inadvertent absorption through the food chain introduced solely for the profit of agribusiness is not a good idea.

So, to slightly expand upon my recommendations for soy: minimally processed non-GMO soy is a nutritious compliment to a diet, whereas processed soy proteins and GMO soy should probably be avoided whenever possible. Soy oils are likely safe, from a glyphosate point of view, but remember that oil is a processed food that should be used in extreme moderation, if at all.