Is calorie-counting bad for health?
Opportunity Cost is a tool from economics. It holds that we should only choose a course of action after including the costs of not having made the alternative choice. For example, driving the shorter, potholed, route might have a 1 in 10 chance of causing a puncture, while the longer route will double fuel consumption.
In healthcare, and in nutrition especially, opportunity cost is especially relevant. By drawing so much attention to whether we eat more (or less) calories, we are prioritizing focus on a starchy or sugary ingredient and neglecting the far more relevant (for modern times) goal of achieving a nutritionally adequate diet.
This has historical and political reasons - read Australian Gyorgy Scrinis's book Nutritionism for a greater understanding. But it also has modern consequences. People facing weight gain may fall into the trap of focussing on calories, starving themselves of real foods in favour of something 'Lite' with little or no nutritional value. It takes a lot of nutritionally futile 'lite' foods to fill you.
Even health professionals emphasize calories while neglecting to promote a nutritionally adequate diet. How many patients are prescribed medication without even a cursory evaluation of whether they are eating a nutritionally adequate diet - one that meets the Recommended Daily Allowances (RDAs).
What's the alternative? It requires education. And effort. But we could rate foods, especially processed or packaged foods, in terms of their nutritional value. Some foods may be protein-rich, some mineral-rich. Others may be able to boast vitamins and anti-oxidants in their natural form. They could even carry an ecological rating.
It's not that calories aren't relevant, but rather that they're the wrong priority. Most of us eat too many calories (see Lauren Manning's 2008 graph above), but only a few of us eat a nutritionally adequate diet. The opportunity cost of calorie-counting is too high.
Spring is here. Time to overcome Christmas lethargy
Fight your Schweinehund!
Spring has a special feel. The year is taking shape but we can still just about recall our New Year's resolutions…
Many of us started the year resolved to sort out our diet. Or joined a gym. But maybe the daily grind has eroded the enthusiasm. Spring is another chance to rekindle the fire.
The things that motivated January's ambitions - think pasty inflamed skin and scalp, inflated midriff, achy joints, blocked or runny nose, muddled brains - are still there but the worst of all is lethargy. Beware your innere Schweinehund...
The domestic pig came into being in the 18th century. Before that, in Central Europe, hunters for wild boar used packs of specially trained hounds – the appropriately named Schweinehund. These wilful and ferocious dogs were notoriously difficult to control. In time, der innere Schweinehund came to signify the powerful inner lethargic force that pulls us off track and away from doing what we want and ought to.
Lethargy is also central to depression, or the ‘black dog’. It is like being an extra in someone else’s film instead of donning the director’s cap yourself.
You can only master your innere Schweinehund through practice - by recognizing when he seeks to drag you off course - and by consciously pulling the other way.
Things the Schweinehund might whisper in your ear:
- You can just as easily start tomorrow.
- You don't have a drink problem. You're sociable.
- You're still thinner than Pat
- That sugar will give you energy
- Smoothies are one of your five-a-day
- Yes, you're intolerant to cow's milk, but it didn't specifically mention cheese
- You can't fight bad genes.
- If the doctor didn't find a problem, it's not your job to find one.
7 Tips for taming your Inner Schweinehund this Spring
TIP 1. Set real goals and rewards
By all means measure your progress, weekly, in terms of symptoms, kilos, steps and inches, but don’t ignore any Elephants in the Room. Check if your self-harming-food intake is really a comfort drug to vent dissatisfaction at some other problem. Or boredom. If so, identify what you can do about it.
Consider filling the void with different thoughts and deeds that might make you happier. Look outwards (not just the online world). Build achievements instead.
Good things will complement your nutritional and exercise goals and make the New You into a rounded person rather than a fad-chaser. Food-wise, why not try to introduce two wild foods from your neighbourhood into your diet?
Don't forget to reward yourself. Rewards should be defined in advance – whether a trip to the cinema or a new handbag – and only paid out after the good behaviour. Rewards should preferably be public - tell your colleagues or use social media so that you can’t cheat. And try not to reward yourself with bad stuff (e.g. sugar or drink).
TIP 2. Enlist support
Two heads are better than one. Most of us perform better with some form of feedback. You might hire a professional life- or health-coach (would it cost more than what you are doing instead?). Or enlist a friend. Perhaps your local pharmacy would be willing to monitor your progress on a weekly or fortnightly basis. A growing minority of pharmacies are moving towards a total health approach. It can't harm to ask.
TIP 3. Write a health or action plan diary
Your diary will become a series of snapshots of that small snowball you roll and roll and gradually grow until it becomes unstoppable!
Progress tends to come in fits and starts - not a straight line – so don’t be disheartened if there are bad weeks. What matters is momentum.
TIP 4. Don't just give up things. Replace them.
Two common excuses for relapsing to a poor diet are ‘there’s nothing left to eat’ or ‘replacement foods are too expensive’. Neither stands up to scrutiny. Supermarkets are the size of football pitches - there is enough to choose from. While the cost argument has some validity, the German discount supermarkets have done us a service. They have given us greater equality of access to basic healthy foods (49c/39p for a bag of fresh vegetables!).
Most individual foods are nutritionally incomplete; they lack something. Add colour and variety to the mix so your body can scavenge what it needs. Eat as many colours weekly as possible.
TIP 5. Make your own Survival Recipe Book
Build up a small selection of recipes based on easily stored, less perishable, foods and always keep the ingredients in stock. It might involve mixing a bag of pre-cooked wholegrain rice with some tinned salmon and garnishing with tomato and beetroot and other vegetables or fruit from the fridge. Not perfect, but much better than a takeaway.
TIP 6. Exercise
Recent research has shown that our hunter-gatherer ancestors - who had less regular access to the likes of milk and calcium-rich crops - had far stronger bones (and teeth). It’s not all about food. Exercise builds bone density. It also challenges and hones your body’s stem cell repair mechanisms. There are cheap (pedometer, stopwatch) and sophisticated smart gadgets to help you track your progress.
TIP 7. Sleep
TV and smart phones bring a world of information to you. But don’t let any inanimate gadget rob you of the detox and immune-boosting effects of a proper night’s sleep. Tiredness in turn prompts food cravings. A rested mind is a clear mind.
"That sounds like an awful lot of work" says your inner Schweinehund... Don't let it win!
Nutricentric's Peter Conry gave a talk entitled 'Bordering on Healthy' at the College of Naturopathic Medicine Open Day in Belfast on December 4th, 2014. The following is an extract.
Allergies: Honecker’s Revenge?
Erich Honecker embraced Leonid Brezhnev and Mikhael Gorbachev to underscore Eastern Bloc solidarity. East German wags liked to ‘quote’ Brezhnev: ‘Comrade Erich? Terrible politician, but boy can he kiss!’
He oversaw construction of the Berlin Wall and East Germany’s shoot-to-kill border policy. He also ran the DDR until, in 1989, the ‘winds of change’ swept him from power. He died in Chile in 1994.
Despite his bad press, Honecker’s regime played an unheralded role in our understanding of allergy and asthma.
I worked in West Germany in the 1980s, before what Germans call the ‘Wende’. I even knew an Ossi (East German) who’d escaped over the Wall. Solitary, almost like someone catapulted forward in time, he felt more comfortable amongst migrants from less affluent countries, like me. My (West-) German friends, by contrast, were comfortable, brand conscious, broad-minded, well-travelled and ecologically aware.
In 1990, quite suddenly, Germany reunited. West German business and academics streamed into the East; the former to tempt 16 million virgin consumers, the latter to document, study and publish.
Erika von Mutius, a researching paediatrician at the University of Munich, set out to catalogue the impact of partition on childrens’ health, especially in the still polluted cities of the East.
She compared Eastern blackspots, like Leipzig, with her home city, Munich. Her findings? Despite high allergen exposure, and huge pollution, the East had almost 50% less hay fever and allergic sensitisation. Asthma was similarly reduced.
It wasn't that pollution had no impact – the East had more chronic bronchitis – but von Mutius’ data turned the prevailing belief – that pollution was to blame for the West’s allergy epidemic – on its head.
Soon, she linked her results to the emerging hygiene hypothesis. This postulates that modern lifestyles are so hygienic, and housing so hermetically sealed, that the immune system doesn't get its proper training during early childhood. It is this – not the level of exposure to allergic triggers – that leads to a hypersensitive immune response.
She postulated, and proved, that farm-children - exposed to airborne bacterial diversity - develop fewer allergies. She also studied a US Amish community - Swiss/German-descended farmers who live a 19th century lifestyle. Allied to low prevalence of hay fever and wheeze, none of the studied Amish children were using corticosteroid asthma inhalers!
Von Mutius’ work group continues to add new proofs, linking reduced allergy risk to, variously, early attendance at crèches, being part of a larger family, suffering measles as a child, receiving no antibiotics or paracetamol during the first year of life, and drinking unpasteurized farm milk.
Persuasive as this body of research is, it's not the whole story. People with those protective factors can still develop allergies.
The rest of the story
In 1980s Frankfurt, my neighbours and I could indulge our predilection for Milka-Schokolade, Cornettos, Wendy burgers, cakes and sugar-smothered breakfast cereals. Barely 50 miles away, East Germans couldn't. Instead, many carried a ‘Perhaps-Bag’ (a lightweight loose nylon shopping net) in their pockets, as in ‘Perhaps’ there’ll be a treat – like bananas – in the State shop today'. And perhaps there'd be some left when you reached the front of the queue.
After reunification, who could blame East Germans for wanting all the treasures they’d only ever spied on pirated West-TV signals?
It is tragic that diet wasn’t assessed during those pioneering East-West studies. However, we can indirectly track what happened after. By 1991, 10% of children in the former East had become overweight (versus 15% in the West). By 2000, the Eastern figure jumped to 17.5% - closer to the West’s 22%. Obesity rose faster still.
In parallel, the hay fever prevalence grew from 2.3% of Eastern children in 1991 to 5% in 2006. Allergic sensitization (IgE) also grew, from 19% to 26%. It would have been worse still if Eastern mothers hadn’t continued to smoke less than in the West.
For perspective, Ireland is more affected by both allergy and asthma than Germany. We should clearly – at HSE level and as health professionals – be doing much more to encourage patients to adopt a real-food diet and a more rugged lifestyle.
But if your suffer, and if the hay fever season aggravates your condition - 90% of asthmatics suffer from allergic rhinitis - there are a few things that may help
Reduce exposure to reduce symptoms?
Lifestyle aside, allergic reactions require sensitization and exposure. The first determines if you react, the second whether there’s anything to react to.
In some Asian countries, like Japan, sufferers wear face masks during pollen season. This isn't yet culturally acceptable in the West, but some exposures can be reduced.
While allergy is traditionally divided into Seasonal (SAR: hay fever due to pollens) and Perennial (PAR: dust mites, mould, cat & dog dander), they are not separate conditions.
Germany’s experience shows that a hyper-reactive immune system is more relevant than the type of allergen. Accordingly, most allergy sufferers have elements of SAR and PAR. One worsens the other. A perennial allergy to dust mites elicits chronic low-grade inflammation, which in turn makes nasal passages and eyes more likely to become inflamed when exposed to other, less avoidable allergens, like the major seasonal culprit, grass pollen.
Interesting research fact: Rainfall, paradoxically, tends to initially increase allergen exposure by smashing pollen corns to pieces!
Identifying dust mite sufferers is not hard. They often have year-long bed-related early morning nasal or wheeze symptoms - which improve during the day. Dust mite exposure can then be reduced by mite-proof mattresses and bed covers. You’d use covers on the parent’s and – unless brand new - child’s bed. You can combine spraying (e.g. the Mitex herbal mite repellent), wooden or lino flooring, an air filter and, for children, hot-washable toys. Mites are nowadays also common on the TV couch, so use hot-washable covers or throws there too.
What else can you do?
First line OTC treatments include Antihistamines, Decongestants, Sodium Chromoglycate and OTC Corticosteroid Nasal Sprays. Here are some tweaks for sufferers who ‘have tried everything’:
- Nasal Rinsing: Best known for treating chronic congestion, sinus rinses can also eliminate allergens and other irritants from the nasal passages.
- Saline Air Purifiers: A salt-based air purifier, or saline pipe, can create a breathing-sanctuary at home or work
- Buteyko breathing: This is essentially a training in nasal breathing (instead of mouth-breathing). While it seems counter-intuitive to seek to breathe through a nose that is often blocked, and to do so with less breaths, once learned it does usually help reduce breathing distress.
- New Pollen Filter: Your car engine has an air filter. So does the passenger area – often located behind your windscreen wipers. You can replace it for under €30.
- Probiotics: Probiotics can help dampen the inflammation related to hay fever and reduce symptoms
- Oral desensitization: These oral treatments provoke formation of IgG antibodies which bind more quickly to the grass pollen proteins than IgE, reducing the IgE allergic reaction.
- Hayband: The acupressure-based elbow button works remarkably well for a proportion of sufferers
- Erika von Mutius "Environmental Microorganisms and Lung Health", Annals of the American Thoracic Society, Vol. 11, No. Supplement 1 (2014), pp. S13-S15.
- Moises Velasquez-Manof: ‘An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases’
- Ciprandi G, Cirillo I. ‘Monosensitization and polysensitization in allergic rhinitis’ Eur J Intern Med. 2011 Dec;22(6): e75-9.
- Eva U.B. Kibele ‘Regional Mortality Differences in Germany’ Springer, 1 Oct 2012
- Behrendt H, Tomczok J et al. ‘Timothy grass (Phleum pratense L.) pollen as allergen carriers and initiators of an allergic response’. Int Arch Allergy Immunol. 1999 Feb-Apr;118(2-4):414-8.
- Schäppi GF1, Taylor PE et al ‘Concentrations of major grass group 5 allergens in pollen grains and atmospheric particles: implications for hay fever and allergic asthma sufferers sensitized to grass pollen allergens’. Clin Exp Allergy. 1999 May;29(5):633-41.
Are we living longer but sicker?
In September 2013, Leinster played the Ospreys at the RDS in a bruising early-season RaboDirect rugby match. On the same campus, 100 metres away, Your Health Show 2013 kicked off.
I was giving a talk entitled "I told you I was sick" drawing together studies and experience from around the world that show affluent nations suffer far greater levels of troublesome auto-immune conditions. You know the type I mean - nuisance conditions that curtail freedom, activity and maybe even lifespan (by making other bad things happen more easily).
The list is long but includes asthma, arthritic conditions, Hashimoto's Thyroiditis (under-active thyroid), coeliac, food intolerance and even hay fever.
A popular theory - the hygiene hypothesis - blames our greater hygiene levels and sanitized indoor environments. There is data to support the argument that children growing up with greater exposure to bacterial endotoxin - for example on traditional working farms - have a less 'nervous' immune system.
In other words greater bacterial exposure makes the immune system more practiced, comfortable and at ease; and less likely to over-react to things that aren't really threats - such as our own cells or everyday foods or plants.
But that's only part of the story.
Parallel to improvements in hygiene came the biggest change in food habits since humans inhabited these parts. We used to eat a seasonally varied (albeit precarious) diet of meats, crops, forage vegetables and fruits. We now generally consume at least one synthetic food with every meal.
And that's before considering the relentless rise in sugar consumption which has shifted our inner environment - our probiotic microrganisms - and stretched our body's detoxification abilities.
Or the change in sleep habits, which alter our natural circadian hormonal rhythms and makes us more likely to consume junk foods.
On balance, I believe that Food (aided and abetted by the other stressors) is the Elephant in the Waiting Room. Remarkably, it is largely ignored by medical and pharmaceutical education.
But it is only through the accumulation of multiple bad habits that we have come to our current pretty pass. I liken it to the Broken Windows theory of Crime, whereby not repairing the first window broken by vandals invites further vandalism. Eventually the building itself is destroyed.
Medicines can tweak some of the regulatory mechanisms and delay the inevitable. They may even change what we ultimately die from. But, as problems accumulate, adding medicines - rather than fixing and reversing problems - becomes less effective and brings problems of its own.
Health expenditure tends to focus on serious cases - even though prevention amongst the moderately at-risk ultimately saves more lives - and costs.
As the name suggests, Nutricentric Healthcare is biased towards this goal of repair, reversal, or at least delay of the march of ill health.
If medication is routinely the first answer, it's because the wrong question is being asked.
Instead, the first question should be: 'Can I try to reverse or fix the problem?
There are so many health conditions affected by diet and lifestyle that no website can do them justice. I have started with those conditions that are more patently food-related. Food is nowadays, for most people, subject to choice, and therefore correctable. I have gradually added other closely-related aspects, such as fertility and allergy.
The general approach is to diagnose, then design and follow a personal diet and lifestyle change plan for a given period. And to see how far that takes you. That's often very far indeed.
Is there a reason why men delay medical treatment?
While working in China, I visited teaching hospitals that had a stem cell ward. At the time, scientists quoted in the European and US press usually ridiculed the idea that natural stem cells from umbilical cords could have beneficial effects. And yet I saw results that were sometimes stunning - I also learned the limitations of treatment.
This sensitized me to the role of stem cells in health, aging and repair. The Chinese researchers already had years of clinical experience when they told me the stem cells treatments didn't work as they were largely portrayed - as cloned replacement cells.
Instead they stayed in the recipient's body for a while then die off. While present, these young stem cells secrete cytokine messenger chemicals which in turn re-activate the body's own stem cells, for a while. This can often dramatically accelerate repair of sometimes serious injuries or damage from chronic disease.
However, they don't make chronic diseases go away, Progressive diseases like Ataxias or Motor Neurone Disease would likely return months or years later to claim back the ground gained.
Activation of stem cells is a curious thing. A small child, still growing, has very active stem cells. Children repair and grow quickly. As we age, our stem cells slow down. When they go into resting mode they are known as senescent. But regular challenge, for example through exercise, can keeps stem cells active.
In other words, the constant micro-damage of sport keeps the body's repair systems fit.
I play soccer. I've broken (others have broken for me) legs, fingers, toes, ribs. I've been concussed, cut, and shorn off metres of skin from slide-tackle burns. And, as a result, I heal fairly quickly. I think this experience may be a large part of why many men are reluctant to seek medical help.
Could it be that the regular experience of rapid healing makes us men assume that our body, left to its own devices - will fix things on its own?
That's my theory. However, it doesn't make this male behaviour wise. The body uses symptoms to tell us there is a problem. We should still be asking: What is it? Why did it happen?
We need to act - for the sake of the children
Without change, problems just accumulate. To my eyes, the most poignant legacy of Ireland's Celtic Tiger years is not the ghost estates, it's the overweight children.
On November 19th, 2013, at the meeting of the American Heart Association, Grant Tomkinson PhD (of the University of South Australia's School of Health Sciences) presented results from his ten year review of athletic performance amongst children from 28 countries. The data spanned the period 1964 to 2010 and showed that the current generation are slower - they take one and a half minutes more to run a mile - and 15% less fit. Much of the difference is down to obesity.
Tomkinson suggests this doesn't augur well for these children's health as adults. And this is not idle speculation.
A 2007 Austrian study by Professor Martie Truschnig and her colleagues found that obese adolescents had significant food intolerances (measured by IgG antibodies). These in turn were closely linked to levels of CRP, a laboratory value used to measure inflammation in the body. More shocking, these children also had increased thickening of the intima media layer of their arteries, a sign of developing atherosclerosis and heart disease.
Sugar is a big part of these problems and is tough but important to challenge. A more recent Austrian study showed that weight reduction in such obese children significantly increases feelings of self-worth, and not surprisingly this was even more dramatic in girls than boys.
Sugar is, let’s not beat about the bush, a drug of addiction. It causes inflammation, but it also encourages our bodies to store fat. And excess weight is associated with more inflammation, which in turn is linked with most of the diseases of the modern Irish town-dweller.
Our foods are labelled but we are quite likely to trust the ads and not read the small print. I’m regularly shocked at the latest food product claiming health benefits while being smothered in sugar. Have a look at some of the so-called probiotic yoghurts or the zero-fat 'diet-friendly' produce on the supermarket health shelves.
I regularly work with former heroin users who have turned their lives around. They've made me more aware that sugar is one of the hardest drugs to kick. Animal studies have shown that the addictive potential of sugar exceeds cocaine.
You may have read recent reports about ground-breaking Danish studies which linked back pain flare-ups to bacterial infections.
The picture is actually a bit more complicated.
When repetitive infections flare-up, there are usually two important aspects:
- the infection. Bacteria, fungi and, especially, viruses are known to be able to hide in the body, often for years, avoiding active detection by the immune system
- the opportunity. Think of cold sores, shingles, candida/thrush, Lyme disease, H. pylori. It is often temporary failure of our immune defences that gives the infection its chance
I am optimistic the Danish research will lead to better treatment, maybe cure, of chronic back flare-ups, even if I don't accept that this will routinely involve antibiotic treatment. For me the take-home lesson frmo the study is the importance of cultivating a healthy immune system. Many of us harbour several possible infectious risks at any one time.
A healthy diet and healthy exercise are the best ways to maintain good health. And a key component is learning how to manage bad habits, like sugar overuse. And how to replace them with good things - like regular exercise. Or gardening. Or walking the neighbour's dog.
I've always loved the German phrase der innere Schweinehund. Translating, literally, as 'inner pig-dog' it is generally used to denote our inner wastrel.
It's that inner voice that is lazy, comfortable and ultimately self-destructive. It asks us to wallow in the moment, to accept our seemingly inevitable fate. Or our genes.
That innere Schweinehund is the biggest foe most of us will ever face.
How do we put it back in its kennel?
The answer is: Piece by piece. Properly and systematically. With outside help where needed. And not to give up when we fall off the horse.
Some may find redemption in sport, especially team sport. We mostly act differently when others are relying on us.
Another, more scientific, some might say geeky, approach is the Quantified Self movement. This consists of people who set themselves the challenge of regularly measuring things (such as what they eat or do) and tracking how they feel or perform as a result. And publishing the results. It's research on the self. A good description can be found here. Maybe the flesh is weak, but we can make our spirit come out on top. .
Our nutricentric prescription for most things is better food, better sleep, better exercise and, where necessary, better thinking. Sounds trite, I know, but it works!
And part of the better food portion of that prescription is the discipline to read food labels. At least once.
In the supermarket, take Coca-Cola as your benchmark. It contains 10.6 grams of sugar per 100g, or 10.6%. When you buy a treat or food just read that one figure, the percentage of sugar. Many seemingly healthy foods far exceed Coca-Cola for sugar content. Even juices, Even yoghurts. Even artisan foods. Even weight-watchers. Even sauces.