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Health and Fitness Q&A with Kevin

Posted by Rafe Furst in Health, Interventions, Science on February 18th, 2009 | View Comments

Whenever I have a question about health matters that is too complex for an MD or academic researcher to get right, I ask Kevin. Nobody I know has a better combination of broad-based current knowledge of the primary literature, plus a whole-system view and understanding of compex dynamics, plus the practical will and experience in living by (and updating) his conclusions. Here are some questions I had for Kevin recently and his answers.

Rafe: Do the BPA results (such as they are) cause you concern? Do you still use your Nalgene bottle? Would you let your infant or child drink from a plastic bottle or sippy-cup?

Kevin: I am somewhat but not overly concerned about BPA. We have eliminated BPA-containing beverage containers from _daily_ use. However, I have not swapped out the emergency Nalgene bottles. I would let my infant or child drink from a BPA cup if we were over at a friend's house (i.e., I wouldn't grill the friend on their BPA posture), but I would throw away my own BPA containing cups.

Rafe: I just learned that Celebrex is supposed to have all the anti-inflammatory power and none of the gastrointestinal issues. True?

Kevin: All of the Cox-2 inhibitors make the claim about no gastrointestinal issues. When I looked at the data a couple of years ago, the difference in incidence was actually not that great in the general population. Moreover, the Cox-2's have a higher incidence of cardiac side effects (while Cox-1's are actually cardioprotective on average). Avoid the Cox-2's unless you have known high gastrointestinal sensitivity to the Cox-1's (or you have a history or unusual risk of gastric ulcers, of course). If you're worried about taking high dose, post injury Cox-1's, take bismuth subsalicylate (e.g., Pepto Bismol, but I prefer the generic chewables) at the same time. It has a prophylactic effect.

Rafe: When working out, do you increase your protein intake, either generally, or in relation to your workouts? If so, does it matter what form the protein takes?

Kevin: In general, I recommend getting 20% of your calories from protein, period, full stop. When you work out, your caloric intake goes up and takes care of additional protein requirements. It's best to get protein from your regular diet, but if you need to supplement, here's my view. Egg protein can increase the sulfurousness of your gas passing, but I seemed to tolerate it well back when I had to supplement (because my caloric requirements were so high). Soy is cardioprotective (though mildly estrogenic). So most people should go with soy.

kevindick

I have no training in medicine or biology. My undergrad and grad degrees are in economics and mathematical modeling, with some specialization in quantitative models of risk and decision making.

I picked up the health/medicine hobby as a matter of personal necessity. The psych literature on judgment and decision making that I studied in grad school showed pretty convincingly that clinicians typically fail to adopt evidence-based treatment plans, let alone ones based on a rational assessment of risks.

So whenever I had even a minor clinical issue, I found myself looking up the primary literature, assessing the risk-reward and making my own decisions. Over the years, I've built up a modest library of knowledge and skills in doing this.

As for unfermented vs fermented soy, there is no conclusive evidence as Daniel points out. The evidence is somewhat suggestive that high doses of unfermented soy may be bad. Actually, I think the potential thyroid effects are the most concerning. Though if we're only talking 1 or 2 servings a day, I wouldn't worry about it if you have normal thyroid function.

But like I said, best to diversify your food portfolio. If you already use soy milk and eat tofu, avoid other unfermented soy products. Of course, if you already have a diet high in soy, try to focus on consuming more of other pulses.
Daniel

While the presence of phytoestrogens is alarming, there does not appear to be significant evidence to date supporting negative effects on men. (i.e. Testosterone, semen, and sperm, are not significantly affected.) As data piles up over the coming years hopefully we will learn more.
Colin Cooley

Kevin,
Regarding soy foods, do you recommend fermented soy products like tempeh over non-fermented? I've actually tried to cut down on my soy intake (eg gone with almond milk rather than soy milk lately) for various reasons, but recently I have been on a tempeh kick (as a recommendation, topping some nori with tempeh is a great post run/exercise snack). Also, and I know you're only discussing this superficially above, but it seems as if you're not concerned about the effects of trypsin inhibitors and phytoestrogens in soy. I understand there is concern about the effect the former has on digestion and latter has on male fertility. Is this possibly where fermented soys are better?

Finally, as a suggestion, it would be great to know a bit about your professional/personal background in addition to Rafe's vouching. It may be elsewhere on this site and I'm just missing but it would be great to know where your expertise lies as I take advice here.

best,
Colin
kevindick

A vegan should be very concerned with getting complete protein. But I don't think foods need to be grouped together as longs as we're talking mid-to-upper socioeconomic status (and let's face it, being vegan is pretty much a luxury).

Vegans get plenty of grains so they primarily need to focus on getting enough soy and other pulses.
Daniel

How concerned should a vegan be with getting "complete protein"? Should certain foods be grouped together?
kevindick

(1) No, only a few. All polycarbonates and some PVCs use BPA. So look at the recycling code. Polycarbonate is included in 7 and PVC is 3. Everything else should be BPA free. Note that Nalgene has released a line of BPA-free, polycarbonate-like bottles called "Everyday". Google for "BPA free products" if you want a full list of safe items. The BPA leeching process is incredibly sensitive to temperature. So be more careful with hot beverage containers.

(2) Currently, all over-the-counter NSAIDs (e.g, aspirin, ibuprofen, naproxen, ketoprofen) are Cox-1. Almost all of the oral prescription NSAIDs that aren't simply larger doses of OTC NSAIDs (only Celebrex is still on the market at the moment I believe, but there are others under trials) are Cox-2.

(3) As long as you have normal kidney function, you couldn't get too much protein without trying very hard (e.g., limiting your diet to only meat and/or protein supplements). Getting enough is another matter. I recommend at least 1 meat-focused meal per day on average. For vegetarians, I would recommend being more careful and actually counting your protein grams. Barring that, go for at least 1 full serving of soy and 1 full serving of pulses (beans, lentils, peas, etc.) per day per 100lbs of body weight. But that's a _very_ coarse rule of thumb.

(4) There are potential problems with too much soy in infants. It is also one of the most allergenic foods. However, in healthy adults without soy allergies, my estimations is that soy foods (as opposed to soy isoflavone supplements) consumed in moderation are unlikely to cause problems. However, you should always diversify your food portfolio where possible.
rafefurst

Some followups:

1) Do most all plastic containers/bottles have BPA? If not, how do you know which ones do? I'm concerned about tupperware and such. Does it matter whether the container is heated, cooled, microwaved, in sunlight, etc in terms of the leeching process? Should I be concerned about my metal or glass containers with plastic lids? What do you think of Innate products?

2) Which non-steroidal anti-inflammatory brands are Cox-1 vs. Cox-2 vs. neither? It's hard to sort this out via Google or Wikipedia.

3) Practically speaking how do you know you are getting 20% of your calories from protein? If you are not eating a lot of meat, fish, poultry or dairy, what's the right approach? Can you get too much protein (either in general or of a particular sort)? How long before and after an intense workout do you ingest, or does that matter?

4) Since soy seems to be the go-to substitute in "healthy" vegan foods, is there a danger of getting lopsided? E.g. soy creamer in my coffee, tofu and tempeh as the only substitutes for meat, poultry or fish, edamame as the go to snack each day, and then whatever other concentrated soy I get from products that I'm barely aware of.