The World Turned Upside Down: The Second Low-Carbohydrate Revolution (41 page)

Ancel Keys auf Naxos

The idea of a Mediterranean diet
derives,
in some way, from Ancel
Keys's Seven Countries study. He discovered that the two countries with
the
highest consumption of fat, had the lowest incidence of cardiovascular
disease
(Crete) and the highest (Finland), and he attributed this to the type
of fat,
olive oil for Crete and animal fat for Finland.  It was later
pointed out
that there were large differences in CVD between different areas of
Finland
that had the same diet. This information was ignored by Keys
who was also
a pioneer in this approach to conflicting data. As mentioned
in Chapter 3,
there was the additional problem that Keys collected data on Crete
during Lent.
Further revelations described in "Big Fat Surprise" suggest that the
Seven
Countries Study and the fruit of that poisoned tree were largely the
triumph of
Keys's imagination over reality
[11]
.

Kokoretsi.

Leopold Bloom ate with relish
the inner organs of
beasts and fowls. He liked thick giblet soup, nutty gizzards, a stuffed
roast
heart, liver slices fried with crust crumbs, fried hencod's roes. Most
of all
he liked grilled mutton kidneys which gave to his palate a fine tang of
faintly
scented urine.

– James Joyce,
Ulysses
.

Along with Greek Barbecue, it is
traditional at Easter to serve
 kokoretsi
,
which is
made from the internal organs of the lamb. Liver, spleen, heart, glands
are
threaded onto skewers along with  the fatty membrane from the
lamb
intestines. When the skewer is full, the lamb intestines are wrapped
around the
whole creation. It is then barbecued over low heat for about 3-5 hours.

One of the regrettable aspects of the
decline in food in the
United States is the general disappearance of organ meats. The Paleo
movement,
however, may help with this. 

Organ meats were once very popular;
the
quotation above is
probably the second most widely quoted passage from James Joyce's
Ulysses
.
Because of
various ethnic influences, organ meats were probably more popular in
New York
than in America (which begins somewhere in New
Jersey). Entries on the
internet, including
Jimmy Moore's
confrontation with beef
tongue
 are, to me, quite remarkable in
that (corned, as in
corned beef), tongue was once a staple of my diet. 

When I was in grade school, there
were
many weeks where I would
bring tongue sandwiches on Silvercup bread for lunch every
day. 
Silvercup, made in Queens was the New York version of Wonder Bread. The
Silvercup sign is still a fixture of the New York landscape – it is now
the
site of Silvercup Studios, the major film and television production
company
that kept the name when it bought the building in 1983 after the baking
company
folded. (You name the TV show, it was probably produced at Silvercup).

Of course, everybody draws the line
somewhere. Although I used to
eat with my friends at
Puglia
,
the Little Italy restaurant that specialized in whole sheep's head, I
passed on
this delicacy mostly because of the eyeballs.  Also, although
you gotta'
love the euphemism "Rocky Mountain Oysters," bull testicles don't do it
for me,
at least if I know for sure in advance. (I don't really mind, in
retrospect, if
the folk-myths about the tacos that I ate outside the bullring in
Mexico City
were really true).

Digression on the
etymology of food words.

Whether it is the steak itself or the
cook
whose back is turned
in Tournedos, it is generally difficult to find the etymology of food
words,
although some are obvious. The conversion of Welsh Rabbit to Welsh
Rarebit is
surely an attempt to be more politically correct and avoid Welsh
profiling. One
disagreement that I remember from when I was in college is now settled.
There
were many ideas about the origin of the word pumpernickel. 
One of my
favorites was that Napoleon had said that it was "
pain pour Nicole
"
(his horse). Great but not
true. It is now agreed that it comes from the German,
pampern
,
to fart and
Nickel
meaning goblin,
along the lines of Saint Nick for Santa Claus.  So
pumpernickel means
Devil's Fart presumably due to the effect of the unprocessed grain that
gives
it its earthy quality.  Which reminds me of the ADA's take on
fiber that I
quoted in one of my blogposts: "it is important that you increase your
fiber
intake gradually, to prevent stomach irritation, and that you increase
your
intake of water and other liquids, to prevent constipation." 
Foods with
fiber "have a wealth of nutrition, containing many important vitamins
and
minerals." In fact, fiber "may contain nutrients that haven't even been
discovered yet!" (their exclamation point).

In Brooklyn, the Mediterranean diet
means
Italian sausage,
largely from Southern Italy.  I had always assumed that
Soppresata
(pronounced,
as in Naples, without the final vowel) was so-called because it was
super-saturated with fat, but since first writing this in a blogpost,
my
Italian friends have suggested that it comes from Sop-pressata, that is
"pressed on," but this is also unconfirmed.  There are many
varieties but supposedly the best is from Calabria.  For
something like
this, with so many varieties which each cook is sure is the best, there
is no
exact recipe, but you can get started with this from
About.com
Italian Food
.

6.6
pounds
(3 kg) of pork meat – a combination of loin and other lean cuts

1
pound
(500 g) lard (a block of fat)

1
pound
(500 g) pork side, the cut used to make bacon

Salt, pepper

Cloves,
garlic and herbs (rosemary, lemon peel, parsley, etc.)

½ cup
grappa
(I think that you could also use brandy if you want)

The basic ideas is to remove all the
gristle, and chop it with
the lard and the pork side. About.com recommends a meat grinder but I
suspect
that the knife blade of a food processor is better.  Then,
wash the casing
well in vinegar, dry it thoroughly, and rub with a mixture of well
ground salt
and pepper. "Shake away the excess, fill the casing, pressing down so
as to
expel all air, close the casing, and tie the salami with string. Hang
for 2-3
days in a warm place, and then for a couple of months in a cool, dry,
drafty
spot and the
sopressata
is ready." At exactly what moment these simple,
natural ingredients turn
into processed red meat is unknown.

PART IV - THE WORLD
TURNED UPSIDE DOWN.

Chapter
25

The
second low-carb
revolution.

 The LEO Conference, held in
Gothenburg, celebrates
non-conformity in science. The 2008 meeting honored Uffe Ravnskov, the
arch
cholesterol skeptic
[22,
27]
.
Speakers before me quoted Max Planck as saying that if you really
wanted to
introduce a new idea in science, you had to wait for the old generation
to die
out. When I spoke
[113]
, I
suggested that, since I was
in that generation, we might want to do it a little sooner.

Coincidentally, it was in Sweden that
we saw one of the key
battles of the second low-carbohydrate revolution. Dr. Annika Dahlqvist
lives
in Njurunda, Sundsvall. She described, on her blog
[114]
,
how she discovered that a low-carbohydrate diet would help in her own
battle
with obesity and various health problems that included enteritis
(irritable
bowel syndrome or IBS), and gastritis, fibromyalgia, chronic fatigue
syndrome
and insomnia and snoring (the last two probably constitute the original
"double
whammy"). Recommending low-carbohydrate diets for her patients and
publicly
advertising her ideas drew a certain amount of media attention leading
to a run
in with the authorities. In November 2006, she lost her job at Njurunda
Medical
center. Ultimately exonerated in January 2008, the
National Board
of
medicine
found that a low-carbohydrate diet was "consistent with good clinical
practice." This was the likely prelude to the announcement in 2013 that
the SBU
(Swedish Council on Health Technology Assessment) endorsed
low-carbohydrate
diets for weight loss. The SBU is charged by the government
with assessing
health care treatments. While their statements were far from
enthusiastic, it
was one of a number of events in 2013 and 2014 that indicated the fall
of the
low-fat paradigm and greater or lesser acceptance of carbohydrate
restriction.

The changes go on as I write this. We
are still some
distance from "Yorktown" and there is very strong resistance from the
loyalists. The switch from demonizing fat to demonizing sugar is a
mixed
blessing; the same poor science is used to show how bad sugar is and
starch is
criticized only if it is "refined." Oddly, a major factor in the
revolution, is
the recognition that, after all these years, the statins are not
penicillin.
They may, in fact, do more harm then good in many people who have not
had a
cardiovascular event.

The big picture.

We are in the middle of a change in
scientific thinking and
one can anticipate a certain amount of chaos. For the individual
dieter,
however, the big picture is simple: if you have a weight problem, your
best bet
is to try a low-carbohydrate diet. Other dietary approaches may work
but they
don't have the backing of the science and they're less reliable. If you
have diabetes,
it is the first thing to try. More to the point, the high levels of
carbohydrate, indeed, the necessity for any significant level of
carbohydrate
at all,  recommended by the health agencies are wrong.

Many people discover this for
themselves – "I went to this
conference and they had a buffet and I really pigged out on lobster and
roast
beef all weekend but some how I didn't gain any weight." Nobody says
that about
the pasta buffet. The studies from Volek's lab described in
Chapter 9
are
classic and compelling but, in fact,
almost every comparison of diets in the scientific literature shows
that
low-carbohydrate diets are more effective for weight loss and most
other
metabolic disturbances. The rationale is that dietary carbohydrate is
the major
stimulus for secretion of insulin which is a generally anabolic
(building up)
hormone.
Chapter
14
explained how it is possible to
lose more weight calorie-for-calorie on a low-carb diet – the bottom
line is
that insulin slows the break down (lipolysis) of fat and if you come in
with
another meal before the system has had a chance to deal with stored
fat, it
will accumulate. Also, on a low-carbohydrate diet, for whatever
reasons, your
appetite goes down. Most people find it easier adhere to  a
carbohydrate-restricted diet than to any other.

The real plus for low-carbohydrate
diets is anecdotal: it
changes your interaction with food. For people with a weight problem,
every
meal is a battle. At every meal you're trying to make sure you don't
cross some
line of calories, fat, whatever. If you make a substantial cut in the
amount
of carbohydrates that you eat, even if you are not overly careful, even
if you
spend a couple of days at the conference buffet, you are unlikely to
gain any
weight. You lose a substantial part of your obsession with and anxiety
about
food.

If you don't have a weight problem,
and you are in good
health, you may not have to change your diet. You may feel better with
fewer
carbohydrates in your diet but there is no ideal diet, no perfect diet
that we
evolved to eat. The paleo diet, based on what kinds of foods were
assumed to be
available as we evolved, is part of the current diet scene, but we
really
evolved to be adaptable to different nutritional environments. It is
good to
know that you don't have a biological need for any carbohydrate and
that the
opposite of lowering fat is not eating all the fat in sight. It might
well be,
as critics of low-carbohydrate diet say, that the recommended strategy
include
assurances that "you can eat all the fat that you want," but the
emphasis is
really on "want." Fat is filling. How much do you want? It is important
to
stress that the low-fat idea was not originally instituted to deal with
obesity
but rather to prevent heart disease (which it didn't) and  it
always had a
moralistic overtone. It was somebody's idea of what we should have been
eating
during the millenia in which haute cuisine evolved and the period in
which
people perfected sausages and other food in ethnic cuisines. The
low-fat idea
was the work of puritans. It gave rise to the obesity epidemic and the
fact
that many people did
not
get fat is only a testament to the adaptability of humans in dealing
with all
kinds of food.

"Suddenly last summer."
triumph of Low-carb

My blogpost hit it pretty well and I
repeat it here:

It was in July of 2012 that I
suddenly realized that we had
won, at least scientifically. It was now clear that we had a consistent
set of
scientific ideas that supported the importance of insulin signaling in
basic
biochemistry and cell biology and that there was a continuum with the
role of
dietary carbohydrate restriction in obesity, diabetes or for general
health.  The practical considerations, how much to eat of
this, how much to
eat of that, were still problematical but now we had the kernel of a
scientific
principle. In fact, it was not so much that we had the answer as that
we had
the right question.  In science, the question is frequently
more important
than the answer.  Of course, winning wasn't the original idea.
When my
colleagues and I got into this, about ten years ago, coming from basic
biochemistry, we hadn't anticipated that it would be such a battle,
that there
would be so much resistance to what we thought was normal scientific
practice.

Surprisingly, it was cancer studies
that showed us how it
all fit together.  The locale was the conference in
Washington, D.C.
called "
Metabolism,
Diet and Disease
."
 The first day of the conference would probably be more
accurately
described as Metabolism, Drugs and Cancers.  A surprising
thread in the
various talks – surprising to me – was the interaction between obesity
and
cancer.  Figure 26-1 shows how strong this is.

Figure
26-1
. Correlation of Obesity and Cancer Data
from the American
Institute for Cancer Research.

Less surprising, because of the
numerous studies, was the
effect of calorie restriction, the apparent basis for the connection
between
obesity and cancer: reducing calories has been shown to reliably
increase
longevity and to control cancer in animals. An additional thread was
that the
hormone insulin popped up as a major player in various experiments in
cancer.
The identification of downstream signaling elements – the compounds and
proteins that transmit the information about cell stimulation to the
interior
of the cell – were important results and, again, they frequently
pointed to the
components of insulin pathways and even to an association between
cancer and
diabetes. This was not new to me – outstanding experiments had pointed
the way
to the critical role for insulin and I always wondered why the
connection to
dietary carbohydrate was not made.  In any case, the second
day of the
conference included presentations on dietary carbohydrate restriction.
Although
not listed on the
organizing
committee
, Gary
Taubes had been one of the organizers and deserves credit for a program
with
both cancer people and low-carbohydrate people.

My colleague Dr. Eugene Fine
presented a poster at the
Washington conference.  Many conferences have poster sessions
in which
presenters pin typically 4 x 6 foot posters to easels and participants
can discuss
the subject matter with the presenter. Posters don't always have a big
impact
and we are grateful to Gary Taubes for making Gene's poster known to
the main
speakers. The work, now published in the journal
Nutrition
,
describes a
small study conducted with ten seriously ill cancer patients. 
The study
had the modest goal of showing that a ketogenic diet was a safe and
feasible
regimen and, in fact, the patients did well and six of ten had stable
disease
or partial remission. By itself, this study would usually been
considered only
a small step forward,  but, in fact, it was a key link in
tying together
the field of carbohydrate restriction and the field of cell signaling
in normal
and cancer cells.  An experiment such as this is difficult to
do – patients
need to have refused or failed chemotherapy, that is, for patients to
agree to
experimental nutrition approaches, they usually have exhausted the
traditional
regimens.  One way to look at the significance is that, given
what we know
about insulin and what we know about low-carbohydrate diets, the
experiment
should have been done twenty years ago. There were simply two lines of
thought
that had to be brought together.

Now in hindsight, it seems that
workers in carbohydrate
restriction should have paid more attention to downstream cell
signaling; we
thought that the role of insulin in system biochemistry made it clear
that
carbohydrate restriction was built on a solid foundation. The
resistance to the
idea seemed incomprehensible and parochial but this conference made it
clear
that there was more that was needed to make a consistent biological
story.  It became clear that there was a conceptual barrier to
acceptance
of carbohydrate restriction beyond the traditional resistance to
anything
associated with the Atkins diet. There was a mindset that prevented
adequate
synthesis of all the information.