Many of us have issues that we’ve been dealing with for a long time, and we’ve gotten used to them, to the extent that we don’t even notice them or pay attention to them on a regular basis.  As a practicing physician I see many patients who tell me they are fine and healthy, but when questioned admit to having headaches and migraines, joint or back pain, heartburn, skin rashes, or diarrhea among other things.  These things are not healthy, we’ve just gotten used to having them, and often take them for granted as “normal”.

Therefore it’s important to back up and take an inventory of your health and disease before you begin the ECD, so you can truly get a sense of how much benefit you’ve received from doing it.

I recommend creating an inventory of your health and disease.  Below I have provided you with a template that lets you rate your general health and well-being.  Answer each of the following categories from 1-10, with 1 being lowest/worst and 10 being highest/best, and answer yes or no to the sub-questions.  If you have specific issues you can add descriptions or notes afterward.

1. Sleep 1 – 10
2. Are you waking up feeling rested?
3. Energy 1 – 10
4. Do you have any energy crashes throughout the day?
5. Digestion 1 – 10
6. How often are you having a bowel movement? (1 per day, 1 per week, etc.)
7. Are you constipated?
8. Do you have diarrhea?
9. Gas or bloating?
10. Flatulence?
11. Mood 1 – 10
12. Anxiety?
13. Depression?
14. Menses (your period; for women only) 1 – 10
15. PMS?
16. Painful period?
17. Musculo-Skeletal 1 – 10
18. Joint pain?
19. Muscle pain?
20. Back pain?
21. Skin 1 – 10
22. Rashes?
23. Overall sense of well-being 1 – 10

After having taken an inventory, set it aside in a safe place.  Once you finish the elimination portion of the diet, you’ll fill out a second copy of the above questions which you’ll compare to the first to help solidify the benefit you’ve seen from the ECD.

What are your thoughts?  Feel free to share them with us in the comments section below.

As a new parent, I found the book Under Pressure by Carl Honore to be a welcome slap in the face.  Luckily I haven’t had time to descend into the madness of hyper-parenting but I’ve already begun to hear the seductive siren song.  After all who doesn’t want their kids to be better, smarter, stronger, faster?  We all do, we all want the best for our children.   But we often lose sight of what our children actually want in favor of what we want for them.

Traveling around the world Honore shows time and again that kids don’t want hyper-parenting, and that despite our best efforts it does not help them succeed more or become better people.  It often backfires and has the opposite effect.  What kids want and need is: to feel safe and loved, they want our attention and time with no conditions attached, they need boundaries and limits, they need space to take risks and make mistakes, they need to spend time outdoors, they need to be ranked and measured less, they need healthy food, they need to aspire to something bigger than owning stuff and they need room to be themselves.

Honore argues for us to slow down, and adopt a saner view of childhood.   I could not agree more.  I highly, highly recommend this book for all parents.  We can do better by our children, but not through hyper-parenting.  I think the following quote from the last chapter of the book, sums things up nicely.

“Half a century ago, an influential English pediatrician called D.W. Winnicott argued that engineering the perfect childhood was impossible and that striving to do so was damaging both to the parent and to the child.  Instead, parents should aspire to meet their children’s needs most of the time and accept that they will mess up occasionally.  Do a ‘good enough’ job, said Winnicott, and most children will grow up fine.”

Do your children a favor, get this book, read this book.

What are your thoughts?  Share them with us in the comments section below.

The most recent information collected by the US National Poison Data System which is the annual report of the American Association of Poison Control Centers, showed there were 0 deaths caused by any dietary supplements in the United States in 2008 (the latest year with complete information available).  Various data suggests that half of Americans take dietary supplements, which amounts to somewhere around 56 billion doses of supplements in a year.  Of those 56 billion doses, there were NO (zip, zero, zilch, nada) deaths from the best available data we have.

Compare that to deaths from pharmaceutical drugs, which are well regulated and much safer than supplements, and then tell me how dangerous supplements are again.

You can download the Annual Report of the American Association of Poison Control Centers for free here.

What are your thoughts?  Share them with us in the comments below.

Ask anyone about saturated fat and they will tell you that it will clog your arteries and give you a heart attack or a stroke, or that it will make you diabetic.  In fact, it does none of these things.

Two articles have recently been published that lend proof to these (perhaps) shocking words.

The first:

Am J Clin Nutr. 2010 Mar;91(3):535-46. Epub 2010 Jan 13. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.  Siri-Tarino PW, Sun Q, Hu FB, Krauss RM.

And the study concluded:  “A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD [heart attack] or CVD [stroke].”

The second:

Am J Clin Nutr. 2010 Mar;91(3):502-9. Epub 2010 Jan 20.  Saturated fat, carbohydrate, and cardiovascular disease.  Siri-Tarino PW, Sun Q, Hu FB, Krauss RM.

The study concluded: “In summary, although substitution of dietary polyunsaturated fat for saturated fat has been shown to lower CVD risk, there are few epidemiologic or clinical trial data to support a benefit of replacing saturated fat with carbohydrate. Furthermore, particularly given the differential effects of dietary saturated fats and carbohydrates on concentrations of larger and smaller LDL particles, respectively, dietary efforts to improve the increasing burden of CVD risk associated with atherogenic dyslipidemia should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity.”

Which is a complicated way of saying that replacing saturated fat in the diet with more carbohydrate, which is what virtually all mainstream nutrition advice suggests you do, causes MORE build-up in the arteries (and a higher risk of heart attack and stroke).  Instead, the authors of the study suggest that refined carbohydrates (such as sugar and flour) should be limited.

New meta-analysis

But wait! You might say.  Didn’t I just hear about a new study just come out the other day saying that replacing saturated fat with seed oils (polyunsaturated fat) lowers the risk of heart disease?

This study:

Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials  Dariush Mozaffarian, Renata Micha, Sarah Wallace.

Doesn’t this suggest we’d be healthier if we replaced the saturated fat in my diet with vegetable oils?  Stephan Guyenet, PhD at Wholehealthsource.blogspot.com has done a very nice analysis of this study (which I’ve posted below), suggesting it’s fundamentally flawed, and you’d be better off ignoring it.  If you have not ready Stephen’s Whole Health Source blog, and this sort of thing interests you, you owe it to yourself to get over there.  He has a wealth of posts on a variety of health and nutrition related issues

Rebuttal by Stephen Guyenet

March 23, 2010

New Review of Controlled Trials Replacing Saturated fat with Industrial Seed Oils

Readers Stanley and JBG just informed me of a new review paper by Dr. Dariush Mozaffarian and colleagues. Dr. Mozaffarian is one of the Harvard epidemiologists responsible for the Nurse’s Health study. The authors claim that overall, the controlled trials show that replacing saturated fat with polyunsaturated fat from industrial seed oils, but not carbohydrate or monounsaturated fat (as in olive oil), slightly reduces the risk of having a heart attack:

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs [how do you like the acronyms?]. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

Looking at the studies they included in their analysis (and at those they excluded), it looks like they did a very nice job cherry picking. For example:

• They included the Finnish Mental Hospital trial, which is a terrible trial for a number of reasons. It wasn’t randomized, appropriately controlled or even semi-blinded*. Thus, it doesn’t fit the authors’ stated inclusion criteria, but they included it in their analysis anyway**. Besides, the magnitude of the result has never been replicated by better trials, not even close.
• They included two trials that changed more than just the proportion of SFA to PUFA. For example, the Oslo Diet-heart trial replaced animal fat with seed oils, but also increased fruit, nut, vegetable and fish intake, while reducing trans fat margarine intake! The STARS trial increased both omega-6 and omega-3, reduced processed food intake, and increased fruit and vegetable intake! These obviously aren’t controlled trials isolating the issue of dietary fat substitution. If you subtract the four inappropriate trials from their analysis, which is half the studies they analyzed, the result disappears. Those four just happened to show the largest reduction in heart attack mortality…
• They excluded the Rose et al. corn oil trial and the Sydney Diet-heart trial. Both found a large increase in total mortality from replacing animal fat with seed oils, and the Rose trial found a large increase in heart attack deaths (the Sydney trial didn’t report CHD deaths, but Dr. Mozaffarian et al. stated in their paper that they contacted authors to obtain unpublished results. Why didn’t they contact the authors of this study?).

The authors claim, based on their analysis, that replacing 5% of calories as saturated fat with polyunsaturated fat would reduce the risk of having a heart attack by 10%. Take a minute to think about the implications of that statement. For the average American, that means cutting saturated fat nearly in half to 6% of energy, which is a real challenge if you want to have a semblance of a normal diet. It also means nearly doubling PUFA intake, which will come mostly from seed oils if you follow the authors’ advice.

So basically, even if the authors’ conclusion were correct, you overhaul your whole diet and replace natural foods with bland unnatural foods, and…? You reduce your 10-year risk of having a heart attack from 10 percent to 9 percent. Without affecting your overall risk of dying! The paper states that the interventions didn’t affect overall mortality at all. That’s what they’re talking about here. Sign me up!

* Autopsies were not conducted in a blinded manner. Physicians knew which hospital the cadavers came from, because autopsies were done on-site. There is some confusion about this point because the second paper states that physicians interpreted the autopsy reports in a blinded manner. But that doesn’t make it blinded, since the autopsies weren’t blinded. The patients were also not blinded, so the study overall was highly susceptible to bias.

** They refer to it as “cluster randomized”. I don’t know if that term accurately applies to the Finnish trial or not. The investigators definitely didn’t randomize the individual patients: whichever hospital a person was being treated in, that’s the food he/she ate. There were only two hospitals, so “cluster randomization” in this case would just refer to deciding which hospital got the intervention first. Can this accurately be called randomized?

Bottom line:

If you want to care for your heart and health, forgot about saturated fat and concentrate on reducing refined carbohydrates (sugar and flour; the ‘crack’ of our food supply).

Other resources

Have a hard time swallowing that saturated fat could possibly be healthy?  Don’t take my word for it, check out the following resources.  If you read these resources and still feel unconvinced that saturated fat is the problem, I’ll eat a stick of margarine!

• Good Calories, Bad Calories – THE book.  It’s thick and quite a read, but if you want to understand the past 100 years of nutrition science and how the whole idea that saturated fat is bad for you got started, you owe it to yourself to read this book
• Great Cholesterol Con by Malcolm Kendrick – Cholesterol is also NOT bad for you.  This is a very readable, user friendly book written by a British medical doctor (MD).  Highly recommended

And a trio of great blogs

• Whole Health Source Blog – Stephen Guyenet, PhD’s blog.  Highly recommended
• High Fat Nutrition Blog – by Petro Dobromylskyj a British vet.  Quite technical, but Peter does a fantastic job of analyzing studies and revealing what they truly show.
• Michael Eades Blog – very readable blog by Michael Eades, MD a long time proponent of a carbohydate controlled eating style.  Some fantastic gems in the archives.

The first step here is getting a handle on what you regularly eat.  Let me use myself as an example.  Before the ECD we ate fairly well; a low wheat diet without much added sugar.

A typical day looked something like this for me:

• Breakfast:  A smoothie made in my blender (3 raw eggs, ½ cup of whole milk unflavored yogurt, ½ cup of frozen blueberries, stevia to taste, added water to thin the consistency)
• Snack:  None
• Lunch:  Salad greens with roast chicken, peppers, avocado, and grated parmesan cheese.  Dressing typically either balsamic vinegar and olive oil or a prepared garlic-parmesan dressing.
• Snack:  An apple, or a piece of cheese.  Sometimes both.   Often a small handful of dark chocolate chips.
• Dinner:  A protein portion (chicken, protein, beef, fish) and a side of vegetables topped with butter, a sweet potato a couple of times per week.  A side salad with bleu cheese crumbles, balsamic and olive oil.
• Snack:  A coconut ice cream bar
• Fluids:  Mostly water, green tea, glass of kombucha with a few ounces of pomegranate juice added.

As you can see my standard diet was low in wheat and high in dairy.  Before you think I’m anywhere near perfect, we tended to eat out 1-2 times per week depending on the week.  This could range from relatively healthy food to pretty “junky” food like pizza, burritos, hamburgers, and ice cream cones.  I admit to a special fondness for donuts (about once per month; I highly recommend Top Pot donuts here in Seattle, if you’re going to eat a donut make it a good one) but I did draw the line at sodas, Twinkies, Slurpies, and potato chips.

So looking over my average day, it’s important to see what’s going to have to come out.  The biggest thing coming out for me are eggs for breakfast, and dairy in general.  It’s important to see what needs to come out and then even more importantly what is going to replace it.  Some people who aren’t prepared for an ECD do a kind of hunger strike for 2-3 days where they simply abstain from eating reactive foods but don’t put anything in its place.  This is a recipe for disaster.  One suggestion is to find two new foods to take the place of every food that is going to come out.  This may seem like a lot of work, but the effort you put in on the front end is going to make a huge amount of difference in the 3-4 weeks you are on the ECD.

I recommend you come up with 2 options for breakfast, 2-3 options for lunch, and 5-7 options for dinner, then plan to repeat these options for the 3-4 weeks of the ECD.  I used the Garden of Eating, a wonderful, highly recommended cookbook to plan out most of the recipes we’ll be using.

If at all possible, I highly recommend staying away from ‘faux’ foods.  That is, don’t replace milk with almond milk, cheese with a processed “no cheese” cheese, bread with rice bread, etc.  Simply removing the reactive foods will give you a huge boost in your health and well-being, but I recommend taking it a step farther, and at least for 3-4 weeks, purge fake food from your diet entirely.  I recommend you focus on: Meat, Fish, Fowl, Natural fats, Vegetables, Fruits & Nuts.

What are your thoughts?  Feel free to share them with us in the comments section below.

We’d love to have you join us.

This is not a pretty story, prepare yourself…

Excluding gluten from your diet unfortunately is much easier said than done however.

Here is how you go about it:

1. Remove bread, pasta, and baked goods.  Most people think this means they’ve gone gluten-free, sadly it doesn’t.
2. Then you must also a label reader.  Many prepared foods (in boxes, bags, or cans) contain gluten in them.  A list like this will help you keep an eye out for gluten containing ingredients.
3. Sadly, you’re still not done.  Next you must check your medications and supplements as many contain gluten as a filler ingredient.  If your supplements do not say they are free from gluten you must assume they contain it.
4. Do NOT buy from the bulk aisle of grocery stores (bummer).  They keep wheat flour at one end, and by pouring it into the bucket, and people scooping it out, it gets all over the other bins and food in the other bins.  You must assume these foods are contaminated with gluten.
5. Rice is often contaminated with gluten, so just switching to rice is often not sufficient.

Even more.  Depending on your sensitivity to gluten you must go further.

1. Unless the product says CERTIFIED gluten free, you cannot assume that it is gluten free.  McCann’s steel cut oats for example, a staple many health conscious folks buy, was shown to be contaminated with wheat.  This is not unusual, MANY foods either contain or are contaminated with wheat.  It is everywhere in our society!
2. If wheat and gluten are used in your household you should have a separate set of pans, plates, bowels, and utensils that are kept strictly gluten free.  Does this sound utterly ridiculous?  Yes it does.  It sounds obsessive, and it is, but it can be necessary.  Even the tiny bit of contamination on a cutting board used to cut bread, wiped off and then used to prepare a gluten-free meal has been shown to activate immune reactions to gluten.  It is THAT significant.

Here are a few cases given at the conference.

1. A young woman had been vomiting for two weeks anytime she ate food.  She was diagnosed with an eating disorder before seeking alternative care.  After an extensive workup it was found that the gluten in her chewing gum (the white powder that is used to keep the gum sticking to its wrapper) was causing the reaction.  She went completely gluten free and the vomiting stopped.
2. A young boy with autism was put on a gluten free, dairy free diet and had a remarkably positive reaction.  Three months later the boy put on lip balm and had a strong return of symptoms.  It was found the lip balm contained gluten (not listed anywhere on the label) and when he licked his lips the tiny bit he ingested was enough to trigger a return of symptoms.  After going back to the gluten free, dairy free diet his symptoms disappeared.
3. An older man with ulcerative colitis had the disease in remission using a gluten free diet.  Suddenly he started having 16 bowel movements per day.  After a workup it was found that he had started eating non-breaded roasted chicken at Kentucky Fried Chicken.  Some research found that although the chicken was unbreaded, it was marinated with soy sauce.  Soy sauces are made with wheat and do contain gluten.  When he discontinued the food and went back to a gluten free diet his symptoms disappeared.

Unfortunately, no good news for wheat and gluten.  Gluten, yes, it’s that bad.

More posts will be upcoming on gluten in the future.

What are your thoughts?  Have you tried a gluten free diet?  Share your thoughts in the comments section below.

When I think of a personal trainer, the stereotype of a big chain gym trainer comes to mind, the “buff” guy or gal who runs people semi-mindlessly through a circuit of gym machines (my apologies to all the quality personal trainers out there, I recognize this is a bad stereotype).   Ross doesn’t do anything like this.  I half expected to be told to do this exercise or machine and then do that one, but our session was completely different.  Ross started by getting a history of my physical injuries (thankfully few and far between) and then asking about my goals (continued pain free movement and the ability to continue to do all the activities of daily living like picking my son up and carrying groceries, etc.).  He then put me through a functional movement screen, which is a series of exercises designed to demonstrate your strengths and weaknesses.  We found, not unsurprisingly that I had poor hip mobilityand instability in my lumbar spine both secondary to sitting at a desk much of the day.  Ross then put me through a basic serious of exercises slowing them down, cutting the weight and focusing on good form.  It was honestly like yoga using weights.  At the end of the session the difference in my posture was easy to see in the mirror.

My goal is to connect with other practitioners who are not only good at what they do, but have a passion for it.  It can’t just be a job, it must be a calling.  After spending some time working and then chatting with Ross it’s clear to me how much he loves his work.  I felt, not only that I had gotten a workout (with its own benefits), but that I had actually done something even greater to improve my health by balancing out my posture.

If this sounds interesting to you, or you are looking for a personal trainer that focuses on bringing balance and symmetry back to your movement patterns and body, I highly recommend Ross.  He can be reached at (206) 790-5171 or ross@realhealthseattle.com.  He tells me his website www.realhealthseattle.com is being reworked and will be up in running in a few weeks.

And just to be clear, I have no financial relation with Ross whatsoever, and I get no compensation of any kind by making this post.

What are your thoughts?  Have you used a personal trainer?  We’d love to hear about it, share your thoughts in the comment section below.

Enter Business as Unusual by Anita Roddick, one of the founders of the Body Shop.

In this book she talks candidly about her experience from founding the Body Shop to making it a worldwide company.  How she never compromised her principles despite intense pressure within and without the company to stop “her silliness and get with the program”, that is, running a business with the bottom line as the only goal.  She talks about being a leader in cruelty-free cosmetics (no animal testing), recycling, encouraging others both within and outside the company to be politically active about causes they care about, and going straight to poor and underserved populations to improve their quality of life.

If you’ve resigned yourself to business as usual as exemplified by the Great Recession we’re going through, caused primarily by the myopic focus on the short-term bottom line and greed, this book is a refreshing breath of fresh air.  You can be successful, found and run a multi-million dollar international company with both principles and profits.  You do NOT have to compromise your principles in order to be successful.

If this topic is of interest to you, I highly recommend picking up Business as Unusual and giving it a read.

Have you read the book?  Have you struggled between principles and profits in your life?  Share your thoughts in the comments section below.

If my little blurb sounds interesting, I highly recommend you watch the movie.  I came away from it inspired and joyful, and will be adding it to my movie collection.

What are your thoughts?  Have you seen the movie?  Share them in the comments section below.