2012-02-08

Dr.Phinney's Atkins++ (advances_in_ketogenic_diet)

2011.12.8: news.co.med#Dr.Phinney/atkins++:
Steve Phinney, MD` New Atkins for a New You:
. the amount of science expertise that you
and Dr's Westman, Volek, and Phinney have
is actually deeper than Dr. Atkins?
That’s correct.  Science.  Modern science.
And we think we’ve brought current medical science.
But what Dr. Atkins brought to the diet was, in a way,
similar to what a Lakota or Kiowa grandmother
brought to this.
Dr. Atkins treated thousands of patients on this diet.
And he had an excellent empiric body of observation;
he basically evolved a diet that worked well
for the purposes of his time,
to help people easily and healthfully lose weight.
[12.8: how Dr.Atkins is like a traditional grandmother?:
. at first I thought he meant to belittle atkins
in order to rationalize his new book:
Steve Phinney, MD`New Atkins for a New You.
but then noticed the idea was fitting in 2 ways:
# one link in a chain:
. Atkins had been just one of many jumpstarts
for the low-carb high-fat dieting style;
like the proverbial grandmother,
he was just passing on a tradition,
not creating one .
# grandma spoils the child:
. Atkins was going a little bit overboard on
letting the kids have their fun:
granted, he was publishing real science on dieting,
and proving how deluded we've been about carb's;
he also sold his diet as minimally invasive
even when that implied getting too much protein,
and getting unhealthy fats (ones that came from
corn-fed animals, not the Inuit fare). ]
What we’ve done with The New Atkins for the New You
is move beyond there.
I’ve brought some key learning from indigenous diets.
And the use and selection of fats.
Drs. Volek and Westman have added their
clinical and research expertise,
particularly concerning metabolic syndrome,
type 2 diabetes, and high blood pressure.
[. like the Zone diet, it's a life style not a weight loss phase ]
to allow people to remain healthy and functional .
[12.9:
. he implies that atkins' wasn't sustainable;
he's referring to the unsustainable induction phase
of Atkins' quite sustainable entire program .]

Pemmican and High fat diets:
The Atkins diet has been the bulls-eye for
critics of low-carb, high-fat diets,
saying it’s unbalanced, so it must be dangerous.
. what's really interesting is, looking at human history,
our ancestors before the advent of agriculture
had a low carb diet.
. there are a lot of assumptions that
hunter-gatherers ate a lot of fruit and vegetables,
and that’s how they balanced their diet.
But it appears in many places
(for example here where the buffalo roamed)
that those cultures evolved around
highly successful hunting skills,
with a minimization of gathering
(and in some cases a complete avoidance of ).
The Great Plains natives ate mostly buffalo
and in many cases nothing but the buffalo
( 20% to 25% of energy from protein
and 75% to 80% as fat ).
. however many ate berries too;
it was kept in a separate bag .

. in order to use a large buffalo kill,
they would produce pemmican:
. dry most of meat, 
sew sacks out of the hide
(rawhide skin on the inside),
stuff pounded dried meat into the sacks,
take hot buffalo fat and pour it in
to fill in all the air spaces around the meat.
. after sewing the sack closed,
the squeezed out all air to kill any bacteria
with the heat of the melted fat .
transported and stored anywhere from six months to five years
. killed in the fall or early winter,
an animal provided a lot of fat.

. Arctic Explorer Vilhjalmur Stefansson,
lived among the Inuit, and then in 1928
he was monitored while on an Inuit diet,
to show that some meat diets
(his was 15% protein and 85% fat)
had enough Vitamin C to prevent scurvy .
. meat certainly doesn't provide 50mg per day
but maybe your needs are reduced on low carb .
.  Jeff Volek at the University of Connecticut,
demonstrated that when people on a mixed diet
are switched to a low carbohydrate diet,
their level of inflammation goes down
(as does oxidative stress, and presumably
the need for vitamin C).

Why do we need fiber?
People think fiber is needed for the bulk
that will speed transition time;
in fact, we need fiber only if our diet is
not ketogenic (producing short-chain fats).
. bacteria in fecal matter break down fiber
and produce very short chain sat'fats,
-- three and four carbons long --
and this feeds the cells lining the colon.
. when you’re on a 20-gram-carb diet,
you start producing short-chains yourself,
and, unlike glucose and triglycerides
these ketones pass easily to the colon
via a membrane's active transport .

. there are reports that the Inuit had a higher
incidence of stroke?
We didn’t do modern epidemiological studies
until about 50 years ago. But it would appear,
when medical missionaries went among the Inuit,
living on their indigenous diet,
they rarely reported cases of cancer,
even though people lived into their sixth or seventh decade.
Well documented.   Heart disease, heart attack,
was rare or unknown.
And we know that the omega-3 fats
that the peoples got from cold water ocean fish,
protect and reduce the risk of heart attack.
[but fishoils do increase the risk of fatal stroke .]

. Volek has done studies with non-indigenous foods,
that is our current market foods
and putting people on low-carbohydrate foods,
in his case, the Atkins diet,
and demonstrates that
when you take people off of carbohydrates
and put them on a properly balanced,
that is moderate protein, relatively high fat diet.
then inflammation biomarkers go down markedly .
-- reducing risk of heart attack .
and the definitive Jupiter study,
clearly demonstrates that when you reduce
not cholesterol  but inflammation,
then this directly and rapidly results in
a reduction of heart attack risk.
. that’s C-Reactive Protein, among other things.
C-Reactive protein, Interleukin 6.  V-Cam I Cam.
So yes, there may be some side effects of the low carb diet
in terms of vascular health of the brain.
Loren Cordain comments:
CSU scientist and author of The Paleo Diet,
Loren Cordain responds to U-C Davis Scientist
and co-author of the New Atkins,
Steve Phinney’s discussion on Pemmican.

This interview includes Loren’s opinion that saturated fats
DO increase plaque in the arteries.
However, Loren says, this only becomes very hazardous
when saturated fats are eaten in combination with
grains, beans, dairy, high-sugar foods or other foods
that tend to increase inflammation.
Cordain says the combination of saturated fats
and inflammatory foods such as grains
is a deadly formula for a heart attack.
ref#1: Artery Plaque in Pre-Westernized Inuit:
The paleopathology of the cardiovascular system.
. Paleopathology, the study of disease in ancient remains,
adds the dimension of time to our study of health and disease.
The oldest preserved heart is from a mummified rabbit
of the Pleistocene epoch, over 20, 000 years old.
Cardiovascular disease has been identified in
human mummies from Alaska and Egypt,
covering a time span ranging from
approximately 3,000 to 300 years ago.
An experimental study suggests that the potential exists for
identifying in mummified remains a wide range of
cardiovascular pathologic conditions .
The antiquity and ubiquity of arteriosclerotic heart disease
is considered in terms of pathogenesis.
ref#2: saturated fat is atherogenic:
Myocardial infarction in a large colony of nonhuman primates with coronary artery atherosclerosis.
. while butter was atherogenic;
[plaque forming -> myocardial infarction]
what kills you is the rupture of the plaque.
. lard had the same effect as butter when mixed with
carb's (40%calories are fat);
peanut oil (omega-6+?) was thrombogenic . [clot forming]
I’m on record stating that saturated fats are
not uni-dimensionally responsible for cardiovascular disease.
They represent a risk factor.
And the risk factor of saturated fats can be small.
I don’t believe stearic acid (18-O) is atherogenic
in the context of a Paleolithic diet;
nor is high 12-O or 14-O atherogenic;
because, they occur in such small concentrations.
Palmitic acid is atherogenic.
And there’s not an experiment in humans or animals or tissue
to show that it doesn’t down regulate the LDL receptor.
This is a point that is never addressed in Gary Taubes’s book
or Eric Westman’s articles, or Ron Krauss.
You need to address the down regulation of the LDL receptor.

We awarded the Nobel Prize in medicine to Brown and Goldstein
for saying that Palmitic acid down regulates the LDL receptor.
That controls the flux of oxidized LDL in and out of the intima.
. in contrast to the Inuit, we have a pro-inflammatory diet.
If you took these 1600 year old Inuit women
and fed them bread along with their high fat diet,
I would be almost certain that you would see myocardial infarctions.

We believe that wheat upregulates metalloproteinases.
It upregulates metalloproteinase 2 and metalloproteinase 9.
If you look at the final dissolution of that fibrous plaque,
what causes that fibrous plaque to rupture
– it’s made out of collagen and smooth muscle and cholesterol.
What causes it to rupture is metalloproteinases.
They up-regulate and degrade the collagen,
and when the fibrous cap breaks,
that is the event that kills you.

We believe elements in the Western diet,
including Wheat and corn and grain and legumes*
and high glycemic load carbohydrates,
these upregulate the enzymes that
directly cause the rupture of the fibrous cap.
*: [being in the paleo camp,
he's not giving beans a fair study ? ...]
Loren Cordain Replies to Steve Phinney:
Steve’s comments and follow-up are logical
and I have read that paper by Jeff Volek.
So, I guess we are in agreement that 16:0 [Palmitic sat'fat]
downregulates the LDL receptor
and that low carbohydrate diets reduce circulating 16:0,
which in turn would reduce the risk for CHD.
However, the paleo pathology paper by Zimmerman
clearly shows atherosclerosis in the coronary arteries
of adult Inuit eating their tradition diet,
centuries prior to westernization.
My point was that these Inuit likely
never suffered fatal myocardial infarcts,
as the fibrous cap covering the atherosclerotic lesion
likely would have never ruptured via the
necessary upregulation of MMPs (metalloproteinases)
from chronic low level inflammation.
High 16:0 intake combined with the typical western diet
(refined CHO, wheat, vegetable oils, dairy, saponins, etc)
elicits chronic low level inflammation
via a number of mechanisms including
increased intestinal permeability which leads to endotoxemia
(leakage of lipopolysachharide (LPS) from
resident gram negative gut bacteria into circulation).
LPS binds toll like receptor 4 on leukocytes
and antigen presenting cells to upregulate
numerous inflammatory cytokines.
Loren Cordain, Ph.D., Professor
Department of Health and Exercise Science
Colorado State University
Fort Collins, CO 80523
Tel: (970) 491-7436
Fax: (970) 491-0445
mailto:lcordain@cahs.colostate.edu
http://www.thepaleodiet.com
Phinney replies to Loren Cordain:
On the topic of saturated fat,
I might respond to Professor Cordain’s concerns
by pointing out that
keto-adapted individuals fed a high fat diet
actually experience a reduction in the proportion of
palmitate (16:0) in their serum triglycerides.
Jeff Volek has done two human studies
(one published, one submitted)
that demonstrate this,
and Craig Warden (PhD, UC Davis) has done
two mouse studies that confirm this observation
in tissue triglycerides as well.
These studies indicate that the body’s adaptation
to a low carb diet
(let’s say less than 10% of energy)
includes a shift in metabolism
that  preferentially oxidizes 16:0.
So then the question is,
if it’s been made into CO2 and water,
how can it harm you?
And as for pemmican, my point* is that
it was a reserve food,
and only used in intervals when
fresh meat was unavailable.
*(see Steve Phinney’s discussion of Pemmican)
But the fact that it could sustain people
for months at a time
is often ignored or denigrated.
Clearly the many hunting cultures of North America
had complex and varying dietary practices,
involving which parts of which animals
were consumed, and by whom.
Among the hunters of caribou, moose, elk and bison,
it was common to break open the long bones
to eat the marrow – a source of minerals
from the trabecular bone as well as fat.
And the Inuit were reported by Stefansson
to enjoy gnawing seal ribs
back from their cartilagenous insertion at the sternum
towards the dorsal end where they were heavily calcified
-again a source of marrow fat and bone mineral.
And finally, I think the topic of low carb diets and vitamin C
is pretty much academic – literally.
In ‘The New Atkins’,
we advise people to eat 3-5 servings of vegetables
and/or berry fruit daily, and for the sake of “insurance’,
a daily multivitamin as well.
The academic question is,
before they had year-round access to fruits and vegetables,
how could hunting cultures maintain health and function?
And this is where our emerging understanding
of the role of oxidative stress and inflammation
stemming from dietary carbohydrate intake
offers a fascinating hypothesis, if not valuable insight.
2011.12.9: web
more comments to the pemmican post:
homemade pemmican turns out to be missing vit'C:
The Zero Carb people at Zeroinginonhealth (ZIOH)
have always praised pemmican as the “perfect” food.
Pemmican is made from dried, raw meat
that is ground up and then mixed with fat.
They also believe that you can live on it “indefinitely”
as some explorer (Stefansson) claimed so in a book,
making this statement despite there being no evidence
that anybody has survived on pemmican-only
for any extended period of time .
[reference to http://pemmi-pucks-inc.squarespace.com/
how-i-make-my-pemmi-pucks/:
. he uses bison, but it might not be as healthy
as what natives accessed,
plus he slow-cooked and then double cooked the fat,
which may have destroyed too much c .]
On the western/northern prairies
where the Lakota etc made Pemmican
there are a huge amount of berries available in the fall.
In bushier areas are late raspberries, closer to the mountains
and on burned out areas there are blueberries
and all across the prairies in bison territory
there are Pemmican berries. AKA saskatoon berries.
. the reason they were called pemmican berries
is that was what the whitemen saw the natives
putting into pemmican.
These are available in late fall,
and often throughout the winter
– they stay on the trees and get a little dry but are edible.
Rosehips are also widely available
and excellent sources of Vit C.
I don’t believe raspberry/strawberry
or other wetter berries were used
but I am pretty sure Pemmican berries,
blue berries and rosehips were used .
Garold Spire Jr M.D. February 6, 2011
Allow me to add that
the choke cherries are first pounded seed and all,
apparently to obtain the nutrition in the almond like pit,
then pressed into cakes and dried.
There is virtually no moisture in them.
Berry picking is done by the women.
Please refer to Lewis and Clarke’s journal
to see the reference to
Native Americans eating the dried berry cakes.
It is a long tradition here on the
Northern Cheyenne Reservation.
I’m certain it resolves several metabolic issues
with pemmican only diets.
January 21, 2011 at 8:03 am:
The use of dried berries with pemmican
but not necessarily in pemmican,
I believe is essential since the
citric acid cycle intermediates of malic acid and citrate
that are present in the berries
allow metabolism of fat avoiding ketosis.
Here on the Northern Cheyenne Reservation
dried cakes of choke cherries are used
since June Berries are no longer found.
They are not mixed with pemmican.
Hawthorn, buffalo berries and wild plums are common here
and may have been used as well.
Dr. Spire
Dr.Phinney June 26, 2011 at 10:45 am
High protein diets were known to induce
illness, including nausea, fatigue, and diarrhea.
When the Karluk survivors awaited rescue
on Wrangel Island in 1913,
the Europeans in the party contended with each other
over the lean meat provided by their Inuit hunter.
Many of them suffered from swelling and joint pain,
and two died.
In contrast, the Inuit family of three in the party
remained healthy eating the fats that the others spurned.
With a kind nod to Dr. Spire,
not all states of ketosis are bad,
but neither are all forms of ketosis good.
A well-formulated ketogenic diet
results in blood ketone levels in the 1-5 millimolar range,
at which levels ketones provide a sustained
and effective fuel supply
to multiple organs including the brain.
Humans adapted to a well-formulated ketogenic diet
also experience a marked reduction in
inflammation biomarkers
(and presumably reduced oxidative stress as well).
Oxidative stress is important in the context of scurvy,
as the presumed metabolic role of ascorbate
is to regenerate reduced glutathione
to protect against free-radical damage.
Thus the reduced inflammation and oxidative stress
associated with a well-formulated ketogenic diet
could significantly reduce the metabolic need for ascorbate.

We do know that Stefansson lived for a year
on a ketogenic diet;
Drs. McClellan, DuBois, Rupp, and Toscani
expressed surprise and grudging admiration
that he (and his fellow explorer-subject Andersen)
survived without any signs of scurvy or kidney problems
(3 papers: e.g., McClellan et al, JCI, 87:651-8, 1930).

Stefansson also published a paper in JAMA in 1917
describing his experience in the Arctic
in which some of his party spent the winter eating
carbohydrate-rich foods rather than hunting,
thus developing scurvy,
which was promptly cured by feeding them
fresh meat and fat without carbs (be it sugar, flour, or berries).
Quite likely it was this publication that prompted
much of the vilification of Stefansson .
This is obviously not a simple subject,
as there are lots of variables at play here.
Clearly a well-formulated ketogenic diet
can contain lots of vegetables
and even some berry fruit,
but there is also solid evidence
that a ketogenic diet  that does
not contain fruit or vegetables

need not cause scurvy.
Equally evident is that
a badly formulated diet,
particularly one high in protein
and low in fat,
can cause malaise,
gastro-intestinal upset,
and perhaps overt disease as well.
It was to deal with these issues
that Dr. Volek and I wrote
“The Art and Science of Low Carbohydrate Living”
to address some of the misunderstandings
and to better define a well-formulated
low carbohydrate diet.