It’s not just the lives of individuals who eat crap (which is most of the country, frankly, even though they have no idea how toxic what they are eating is).  It’s the happiness and achievement potential of today’s youth.  It’s the emperor with no clothes at the center of the healthcare debate.  And it’s a lynchpin for economic recovery and sustainability.

Watch the premiere, and spread the word…

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I’m a 42-year-old woman, 5′1″, and 113 lbs.. I work out 3x/wk. (cardio and weight training) and walk an average of 4 miles/day. Like Rafe, I am a Nutritarian — my diet is made up primarily of vegetables, fruits, nuts, seeds, beans, and whole grains. I eat no processed foods, no sugar other than what occurs naturally in fruit, no added salt, and fewer than 10% of my calories from animal products. I eat eggs 2x/wk, salmon 1x/week, red meat 1x/month, and dairy not at all. I use almost no processed oils (I prefer to water-saute or steam my vegetables) and eat ~80% of my food raw. Recent blood work assures me that I am the healthiest that I have ever been in my life, and my general sense of well-being confirms this. I have only two minor issues:

Firstly, though I am not the least bit worried about my weight, I am concerned with my fat distribution — too much of it is abdominal, which is the most unhealthy place to accumulate body fat. Secondly, after eating this way uneventfully for 18 months, I’ve recently started experiencing intense cravings, particularly for fruit. I consulted with Dr. Joel Fuhrman (author of Eat To Live) to see if he had any advice. His recommendation? Add more healthy fats to my diet (specifically, 1.5 oz. of nuts and seeds, in addition to the flax seeds and avocado that I already eat). To offset this, I need to eliminate ~400 calories from my daily intake. Since I’d been eating 8-9 servings of fruit per day, he suggested cutting back to 3-4. We’re going to reevaluate things in 3 months.

I bought a scale to weigh the nuts/seeds, and started using Fitday to track my calories. Because I tend toward the OCD end of the spectrum, I started weighing and tracking everything down to the ounce. [An interesting side note: if you buy a bag of Earthbound Farm Romaine Hearts expecting it to contain the 12 oz. of romaine that it advertises, think again. For the last 10 days, mine have contained anywhere from 14 oz. to 23 oz. of romaine, with the average bag having 20 oz.]

Fitday tracks not only calories, but also nutrient intake. At any time, you can pull up a graph showing how adequately you’re meeting your RDA of more than 20 vitamins and minerals. On my ~1700 calories a day regimen, I tend to go into dinner with ~600 calories to spare. I now find myself checking to see whether I’m short on any particular nutrient, then modify dinner/dessert accordingly. [Selenium is almost always lacking, as is zinc. I fix that with a brazil nut every other day (literally, one brazil nut has 150% of the daily RDA of selenium) and some pumpkin seeds. When calcium is short, I eat bok choi.] Even within the bounds of my nutritarian lifestyle, I am making some very deliberate food choices.

So what does a typical day look like for me?

Breakfast:
Steelcut oatmeal with fruit and nuts – or - a blended salad
[Kim's Blended Salad: 18 oz. romaine, 1.5 cups frozen spinach, 1/4 haas avocado (37g), 1 tbsp ground flax seed]
Apple or 2 kiwi

Lunch:
Huge, colorful salad (mixed greens, red chard, purple cabbage, yellow peppers, tomatoes, carrots, sunflower seeds)
Quinoa and nut loaf – or – steamed brussels sprouts, broccoli, cauliflower
Banana or melon; 2 squares (11g) dark chocolate (80% or higher)

Dinner:
Vegetable bean soup (includes split peas, carrots, onions, zucchini, kale, cashews, celery, mushrooms)
Baked curried sweet potato with lightly toasted pumpkin seeds
Mixed berries

On blended salad days, that’s roughly 3 lbs. of raw vegetables, another 3/4 lb. of cooked vegetables, plus a variety of fruits, healthy fats, beans and whole grains.

This is my average daily nutritional intake since I started tracking:

1. One can be 95% vegan and still get enough protein
2. One can eat NO dairy and still get enough calcium
3. One cannot, however, get enough B12 from a mostly vegan diet
4. Vitamin D is extremely difficult to get from food sources.
5. If I take a multi, I should look for one without Vitamin A

Perhaps most strikingly, even with a diet so rich in nutrient-dense foods and a bit of ‘gaming’ my meals to meet my RDA, I am just scraping by on 2 of my nutritional needs, and am actually short on 2 others. [I am excluding B12 and D from the tally because I don't expect to be able to meet those needs nutritionally.] I have been taking a B12 supplement ever since I made the shift to a largely vegan diet, and I take a D supplement in the fall and winter when sunlight is inadequate. I believe that these two supplements are unavoidable unless I change latitudes and eat more animal protein.

But what about a multivitamin? Should I be taking one? Should you?

I certainly should. This food tracking exercise is almost over — I now have a pretty good feel for what 1.5 oz. of nuts looks like, so the scale can go away. I also find that by eating when I’m hungry and stopping when I’m satisfied, I naturally gravitate towards my appropriate caloric range. And while I may have been hitting my RDA numbers for the last 10 days, I fear that when I no longer have the Fitday graphs keeping me vigilant, I will likely come up short on some nutrients on a regular basis.

Should you take a multivitamin? That depends. For one thing, you’re probably bigger than I am, and are likely to be consuming closer to 2000-2500 calories per day. Those extra calories can go a long way toward meeting ones RDA of everything. The real question is: How healthy is your diet? Are you eating a lot of fruits, vegetables, good fats, beans and whole grains? If not, your first priority should be to add more of these foods to your diet. [And while you're at Whole Foods scoring some kale? Pick up a multivitamin, too.] If you’re a fellow nutritarian eating anything close to a vegan diet, you may be able to skip the multi, but you definitely need B12.

One way to be certain of your needs is to track your food for a week. It’s an informative experience. (And you don’t need to be so exacting about it. Fitday and other websites like it offer many options for telling it what you ate and how much — no scale is necessary. If you need to track food on the go, there are iPhone apps for this as well.) If you’re game, it would be interesting to know how you’d rate your diet before you start tracking, then see how well your estimate matches reality. You might just end up as surprised as I was.

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3. Egyptian Mummies Yield Ancient Secrets of Good Journalism

The opening line of the article is “CT scans of Egyptian mummies… show evidence of… hardening of the arteries, which is normally thought of as a disease caused by modern lifestyles….”  One of the researching cardiologist draws this conclusion: “Perhaps atherosclerosis is part of being human.”

The LA Times reporter covering the story (Thomas Maugh) rightly points out at the end, “The high-status Egyptians ate a diet high in meat from cattle, ducks and geese, all fatty.”  Which of course entirely negates the hypothesis of heart disease being part of the natural human condition.

It’s clear why the researchers — both cardiologists — would want ancient evidence to support the notion that heart disease is normal.  But the fact is that the preponderance of evidence around the world in epidemiology as well as cardiology indicates that diet and lifestyle are largely responsible.  Don’t trust me, just start digging around for yourself, it’s not hard to find the data.

Okay, so researchers are trying to get their work into the mainstream, what’s new?  Any thinking person can see through their faulty logic, right?  Not according to all the research on behavioral psychology.  That’s why I’m mostly disappointed in the reporting as opposed to the research.

Maugh and the LA Times bit so hard on this succulent morsel of pseudo-science that the net result is false information which is damaging to public health.  Had Maugh flipped his article upside down and lead with his commentary at the bottom, he would have come much closer to serving the public good with the dark leafy vegetables of truth.

hat tip: @DannyHorowitz

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If you ask a cardiologist it’s clear that they believe unequivocally that statins work, mostly because they see what statins to do blood cholesterol levels.  But remember, cholesterol numbers in and of themselves do not matter.  They are a proxy variable for cardiovascular health.  Plaque buildup matters.  At one time blood cholesterol numbers were the only non-invasive indicator we had of plaque buildup, but that’s not true anymore.  However, drug companies are highly incentivized to prove that statins improve health.  So they fund lots of studies.

Notwithstanding the systemic bias when there are profit motives and publication motives, we can turn to these studies and see if statins actually work.  The best way to remove bias is to look at large-scale meta-analyses, like this one.  If you simply read the conclusion you see “statin use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events.”  However, if you decode the numbers you see that “significant” means that, for example, at age 65 you improve your changes of dying within the next four years from 8% down to 7% [hat tip to Kevin for helping me decode the numbers].  Now, is that really significant?

If my cardiologist told me I needed to take statins and I said “prove it” and he produced that study above, I would absolutely not take them.  For one, there are known deleterious side effects (which could possibly account for the small overall mortality risk decrease).  For another, the average length of followup was only 4 years, whereas I am told that I am to take these drugs indefinitely.  How do I know that the long-term side-effects won’t overrun the long-term benefits sometime after the four year mark and thus increase my overall mortality risk?

On the other hand, some small scale studies done by well-respected physicians indicates that you can reverse even advanced heart disease, as measured by the number of cardiac events (i.e. what really matters) through diet and exercise alone.

You can object all you want to the statistical significance of small scale studies.  The real issue is, given the evidence, what would YOU do if you were diagnosed with heart disease or were at high risk of heart disease as measured by your cholesterol numbers?

Since I’m not such a candidate, I made a friendly wager with a good friend of mine about a year ago who is.  He has been under a physician’s care for years because he has abnormally bad cholesterol numbers, and it runs in his family.  His doctors told him that he couldn’t control it with diet and that statins are the only way to go.  Problem is, he has a hard time tolerating statins (i.e. deleterious side effects).  Despite being on various statins, his numbers had barely budged.  The wager was designed to test the hypothesis that through dietary changes and exercise he could improve his numbers, a proposition that he claimed was impossible because he’d changed his diet in the past but it didn’t work.  My claim was that he was misinformed about what he was supposed to be eating and what he was not.  He got some advice from another friend who knows the literature.  Here is the result:

Been on about an 80%ish vegan diet, taking 2 meds (that I’ve taken before to little effect) that are pretty mild as far as lipid management,my cholesterol on a recent test came back lower than it’s ever been:

total chol = 165, hdl = 40, ldl = 110, triglyc = 80

my LDL level was 270 less than a year ago, and my total chol was 350.

Still kind of stunned, and I expect the results are at least somewhat anomalous, but even if they prove to be outliers to my normalized levels it will represent a bigger improvement than I could have ever had taking super-dosage statins.

Here’s my challenge to the medical establishment: produce a meta-analysis of statins that shows absolute age-adjusted mortality rate decrease of greater than 10% over 20 years.*

In the mean time, I’ll be eating healthy, exercising regularly, and making money from people who want to take the same bet as my friend.

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1. Over-concentration: Just because a little bit of something is harmless or even healthy for you, doesn’t mean that large quantities are better.  Often times it’s worse for you, and even toxic.  While supplements are an extreme example of this — consider Vitamin D toxicity, which is something that only happens if you get it in supplement form — processed foods in general can take a food which is a net positive and turn it into a net negative.  So, whereas whole oranges you can eat quite a bit of and improve your health, drinking lots of orange juice is bad for you (the sugar content badness outweighs the micronutrient goodness).
2. The missing 99.99%: There are tens of thousands of phytochemicals and other micronutrients in whole vegetables and fruits.  So if you are eating a significant portion of your daily food intake in the form of processed foods, think of all the health-promoting biochemicals you are not getting.  Furthermore, you were evolved to eat the entire package (i.e. the whole food), and if you are eating processed foods you are only getting a handful (less than 0.01%) of these things that are good for you.  As Mark Bittman says, “It’s not the beta-carotene, it’s the carrot.”  The point is not that you need every single phytochemical every day but rather you don’t which ones you don’t need and which ones you do in what combination, etc.  And neither does anyone else.  So the rational strategy is to eat a variety of unprocessed foods to cover your bases.

Here is Bittman’s TED talk, which is well worth watching:

Click here to view the embedded video.

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A person who [eats for health] is called a nutritarian, and understands that food has powerful disease–protecting and therapeutic effects and seeks to consume a broad array of micronutrients via their food choices. It is not sufficient to merely avoid fats. It is not sufficient for the diet to have a low glycemic index. It is not sufficient for the diet to be low in animal products. It is not sufficient for the diet to be mostly raw food. A truly healthy diet must be micronutrient rich and the micronutrient richness must be adjusted to meet individual needs. The foods with the highest micronutrient per calorie scores are green vegetables, colorful vegetables, and fresh fruits. For optimal health and to combat disease, it is necessary to consume enough of these foods.

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If you’ve listened to this the whole way through (which you should), I’m curious as to how it will affect your habits, if at all.  And why?

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