We are not all the same.

Cont'd from Everyone is Different.

Lyle (McDonald) brought the following study to my attention to illustrate that "We are not all the same":- Some Metabolic Changes Induced by Low Carbohydrate Diets. On a very-low-carb diet, one subject’s total cholesterol rose to 12.9mmol/L (500mg/dL in US units). The others didn't.
See also LDL cholesterol goes sky high on fatty diet.

I posted the study in various blogs to make the above point. Here are some of the replies I got:-
"Lyle? Lyle McDonald? Is that where you got that study, Nigel?" and... "I’m usually a pretty polite guy, Nigel. But based on this quote from the beginning of the study you mentioned, the people who wrote this study were a bunch of f**kwads, and really don’t deserve our attention. It’s a hatchet job."
"That was a weird study (1967) what I could make of it." and... "The men did all the stages but the women only did 3 stages of the diet."
"The fats were mostly omega-6 PUFA 13-35 grams worth..."
"The report you cite is so old and out of date that it makes me cry..."

My point was well & truly missed. I got the distinct impression that people thought I was criticising very-low-carb, high-fat diets. I wasn't. The simple fact is that there is no "One True Diet" that suits absolutely everybody. In the olden days everywhere & in poor countries nowadays, people that ate/eat the wrong diet for their body died/die young. Nowadays in rich countries, they get put on drugs e.g. oral hypoglycaemics (to lower blood glucose) & hypolipidaemics (to lower blood cholesterol/triglycerides).

Please note that omega-6 PUFAs tend to lower serum cholesterol rather than raise it, as per Figure. 1 below from Individual fatty acid effects on plasma lipids and lipoproteins: human studies.

However, don't rush off and eat shed-loads of omega-6 PUFA (e.g. corn oil) in the mistaken belief that it will make you live any longer.

Cont'd on Everyone is Different, Part 2.

Things that make you go pink.

Strenuous exercise. Alcohol. High-dose Niacin. All of these things make you go pink. All of these things are also good for your heart & circulation. As I mentioned in Red, red wine and very sharp pointy things, one glass of red wine significantly lowered my blood pressure in less than 10 minutes, probably by making my arteries dilate (which made me go pink) and by reducing my mental stress which lowered my stress hormone levels.

According to JBS2 guidelines (which I don't fully agree with), CVD risk factor increases with increasing blood pressure. It also increases with increasing TC:HDL ratio. What increases HDL? Things that make you go pink. What we now need is a study showing the effects of blushing on the risk factors for CVD!

Natural & synthetic disaccharides.

As mentioned in Carbohydrates: Dogs' Doodads or Spawn of Satan?, there are three common disaccharides, sucrose (table sugar), lactose (milk sugar) and maltose (beer sugar). These all contain a molecule of glucose linked by a glycosidic bond to molecules of fructose, galactose and glucose respectively. In our bodies, our guts contain the enzymes sucrase, lactase & maltase which hydrolyse the glycosidic bond breaking the disaccharides into their constituent monosaccharides. People who lack any of these enzymes are unable to break the disaccharide into monosaccharides. As disaccharides are not absorbed, they pass along the gut until they reach the colon, where colonic bacteria ferment the disaccharides into short-chain fatty acids and gas. This increases ammonia levels in the colon which attracts water. End result: Lots of gas, soft poo and the excretion of ammonia (nitrogenous waste).

There's a synthetic disaccharide called lactulose, which is a disaccharide of fructose and galactose. As our bodies don't contain the enzyme lactulase, lactulose is fermented, producing lots of gas & soft poo. I thought I'd post about this as I'm taking lactulose to prevent the constipation caused by high dose Co-Codamol, the pain-killer I'm on while my 4-inch scar heals. It works!

An interesting but otherwise useless fact: The artificial sweetener sucralose that's made from & is about 600 times sweeter than sugar has the chemical name 1,6-Dichloro-1,6-dideoxy-β-D-fructofuranosyl-4-chloro-4-deoxy-α-D-galactopyranoside (I'm nerdy enough to know that by heart!). Sucralose has a structure like lactulose rather than sucrose, which has the chemical name β-D-fructofuranosyl-(2→1)-α-D-glucopyranoside. As the amount of sucralose used is about one 600th that of sucrose, it doesn't cause the above effects.

Red, red wine and very sharp pointy things.

Suffice it to say that I've been feeling a bit stressed recently, what with all the hoo-ha over my mum's nursing home etc. Today, I'm going to be prodded & cut open with very sharp pointy things as I'm having a right inguinal hernia repaired with polypropylene mesh.

Last Wednesday, I attended the pre-op' assessment and failed with a BP of 154/100. I explained that I had a very important meeting with Social Services on my mind and it was causing me much stress so I was told to get a re-test at my local surgery on Friday. As the meeting on Thursday didn't go quite as I'd hoped (case closed), my BP on Friday was 160/100. My GP upped my Amias dose from 8mg/day to 12mg/day and told me to get a re-test on Monday. I had to get my diastolic reading (the lower of the two numbers) below 90 or my op' would not take place today.

On Monday morning I tested my BP at home using my £9.99 Lloyds Pharmacy automatic BP meter (which usually gives the same reading as my GP's sphygmomanometer) and the lowest reading I could get was 135/99. Uh-oh! Desperate times call for desperate measures.

I hardly ever drink alcohol, but I had a bottle of Blossom Hill Californian Red in the cupboard for *ahem* special occasions, so I had a 250mL glass of it on an empty stomach. Woo-hoo! It went straight to my head and I felt slightly flushed. Ten minutes later, I was in the doctor's surgery having my BP tested. It was 140/86. Result! I told my GP what I'd done and he was O.K. with it. So, red wine for the win!

Before you all rush off and get hammered, here's an article from the Harvard School of Public Health about Alcohol: Balancing Risks and Benefits. The article used to contain a graph but it's been edited-out in the latest version. Luckily, I had a copy of it on my hard disk which I shall upload here.

As women have smaller livers than men, the cirrhosis graph shoots up faster for women as alcohol consumption increases beyond 1 drink per day.

The problem with "Wholegrain" cereals etc.

As I mentioned in Carbohydrates: Dogs' Doodads or Spawn of Satan?, some breakfast cereals turn into blood glucose faster than table sugar (half glucose bonded with half fructose) even though they're "Wholegrain" cereals.

A whole (i.e. intact) grain consists of a protective outer shell (a.k.a. bran) and innards consisting of starchy/proteiny endosperm and nutritious germ. See Cereal germ.

To turn a grain into a breakfast cereal, it's milled into dust, mixed with water to form a paste and the paste is extruded through holes into whatever shape the manufacturer desires. Technically, everything that was in the whole grain is in the finished product. However, the form and function have completely changed. Here are a couple of analogies.

1) I want to sell my car. I take it to a scrap-yard and have it shredded into tiny pieces. All of the tiny pieces are put in a skip, which is delivered to my driveway. I place a sign on the skip stating "Whole Mazda MX-5 for sale. Enquire within. £5,000 O.N.O.". What would you offer for my "Whole Car"?

2) An insane person gives me £5,000 (in £50 notes) for my "Whole Car". As I'm on a roll, I take the notes and put them through a cross-cut shredder which turns them into thousands of 2mm x 2mm pieces. I empty the pieces into an attaché case. Who will accept my attaché case full of "Whole £50 notes" as payment for their second-hand car? Any more insane people out there?

Roller-milling grains into fine dust does four things.

1) It exposes the starchy endosperm.

2) It greatly increases the surface area to volume ratio of the grain, resulting in faster digestion and absorption. Surface area to volume ratio is inversely proportional to particle size. If 3mm grains are roller-milled into 0.1mm particles, the surface area to volume ratio is 30 times bigger. See Particle size, satiety and the glycaemic response. Therefore, "wholegrain" breads made from roller-milled flours are as bad as white breads, in terms of glucose and insulin response. Choose wholemeal breads made from stone-ground flours, as the particle size is bigger.

3) It makes the finished product much more likely to stick to your teeth, resulting in the rapid formation of plaque that damages your teeth and gums.

4) It makes the finished product more energy-dense.

Rolled grains are grains that have been steamed (to cook and make them soft), then put through what's effectively a mangle. They're still intact, if somewhat flat. Puffed grains are grains that have been heated to make the water within boil. As steam takes up a much larger volume than water, the grains are inflated to a much larger size. They're still intact, if somewhat funky-looking!

Don't be conned by breakfast cereal labels. If they look like "O"s or Brillo pads or brake pads, they're not intact grains.

Oats are O.K. even when turned into oatmeal, probably due to their high beta-glucan content, which forms a wallpaper paste-like goo when wet. See Particle size of wheat, maize, and oat test meals: effects on plasma glucose and insulin responses and on the rate of starch digestion in vitro.

See also Anthony Colpo's The Wholegrain Scam.

The problem with Diabetes.

Referring to Blood Glucose, Insulin & Diabetes, a healthy person regulates his/her blood glucose level so that it doesn't go too high or too low.

Someone who has diabetes either has insufficient/no insulin secretion (type 1) or has insulin secretion but it's ineffective (type 2). People with type 1 diabetes have to inject various types of insulin and monitor their Blood Glucose (BG) with a BG meter. Here lies the problem. Consider the following analogy:-

Blood glucose control is like driving down a road cut into the side of a mountain. If you steer too far to the left (low blood glucose), you fall off the edge of the road and die. If you steer too far to the right (high blood glucose), you smash yourself against the side of the mountain and damage yourself. Injecting insulin/taking oral hypoglycaemic agents is like pulling on the steering wheel to the left. Eating sugary/starchy carbs is like pulling on the steering wheel to the right. Exercising is like pulling on the steering wheel to the left.

Not monitoring BG regularly is like driving down the above road with your eyes shut most of the time. You have no idea where you are on the road. Every time you monitor BG, you open your eyes.

A high-glycaemic load diet + high-medication regimen (e.g. ADA & Diabetes-UK) is like pulling on the steering wheel hard, which results in diabetics veering all over the road. As diabetics don't want to fall off the edge of the road and die, they steer too far to the right (high average blood glucose) and damage themselves due to glycation.

A low-glycaemic load diet + low-medication regimen (e.g. Bernstein, Christie, Ruhl, Cooksey, Shwarzbein etc) is like pulling on the steering wheel gently, which results in diabetics steering a reasonably straight course down the middle of the road. Regular BG monitoring allows rapid error-correction.

As low blood glucose is potentially fatal, that's why Studies show that a high average blood glucose level has lower mortality than a more normal average blood glucose level.

The problem with BMI.

According to my Body Mass Index, I'm just obese. The word "obese" conjures-up images of people with huge fat bellies waddling along. Sure I'm overweight as I love my food, but I don't have a huge fat belly and I don't waddle! The problem with BMI is that it's a simple calculation involving body mass and height.

BMI = body mass (in kg) divided by the square of height (in metres).

I will now demonstrate how two people with identical body compositions, waist measurements and heights can have different body masses (and thus BMIs). Consider the body as a cylinder with the legs as two inverted cones each having half the diameter of the body at the top (it keeps the maths relatively simple). I will ignore the arms & head!

Volume of a cylinder = Pi x Radius squared x Length.
Volume of a cone = 1/3 x Pi x Radius squared x Length.
Mass = Volume x Density.

Length of legs + body = 160cm.
Body diameter = 30cm.
Therefore, body radius = 15cm.
Leg diameter at top = 15cm.
Therefore, leg radius at top = 7.5cm.
Leg & body density = 1g/cubic centimetre.

I have 75cm long legs + 85cm long body.
She has 100cm long legs + 60cm long body.

My legs = 4420g each. My body = 60082g. My total body mass = 68922g = 69kg. My height = 1.6m.
∴ My BMI = 26.9

Her legs = 5900g each. Her body = 42411g. Her total body mass = 54211g = 54kg. Her height = 1.6m.
∴ Her BMI = 21.1

See the difference? 1cm of legs weighs much less than 1cm of body. People with long legs and a short body (e.g. women) have a significantly lower BMI than people with short legs and a long body (e.g. me). In addition, people with narrow builds and people with very little muscle have a significantly lower BMI than people with wide builds and people with a lot of muscle.

Thanks to Wolfram Alpha for doing the calculations.

P.S. According to her BMI, this 5 year old girl is overweight.

*Biff!* *Thwack!* *Ker-Pow!*

The Internet is a great place for a virtual punch-up. Nobody gets physically hurt (feelings can get very hurt!) and the end result is often educational as well as entertaining. Such a punch-up has just occurred between Alan Aragon (who's in my blog list) and Robert H. Lustig, M.D. (whose video is linked to in An apple a day...) plus quite a few others, including me.

Alan's blog post The bitter truth about fructose alarmism has caused a bit of a stir in the nutritional blogosphere.

Dr Lustig pointed out that lots of people have watched his video. If only Alan had some videos. Oh, wait! He has. They're in Conversations with a bro: animated edition. Also, see Alan Aragon on Paleo Cream Puffs and Is_Fructose_causing_problems_and_is_pointing_this_out_Alarmism_.mp4

Enjoy!

A slight hitch, Part 2.

Continued from A slight hitch. It was on Friday February 13th 2009 that mum collapsed with a UTI and ended up in a nursing home after 3 weeks in hospital. As it had a 3-star CSCI (now CQC) rating, I thought that life would improve for her. Boy, was I wrong!

Due to me being depressed for about 6 months, I didn't deal with the endless litany of problems that mum's friend reported to me other than pass them on the the Home Manager for action. As there was no other nursing homes in the area that had a 3-star rating, both mum & I were stuck between a rock and a hard place.

Luckily, I broke out of the vicious circle of depression, crap diet, more depression, more crap diet etc. Then I saw the BBC documentary about Sir Gerry Robinson trying to "fix" dementia care homes. It wasn't just an eye-opener to Sir Gerry. It was an eye-opener to me, too. The programme showed me the difference between good nursing homes and crap nursing homes. Sadly, the nursing home that mum was in fell into the "crap" category, despite charging over £800 per week. I can't name names as I don't want to be sued.

I started to complain more vocally about the poor standard of care at mum's home but things weren't getting any better. One day, I bumped into the activities co-ordinator who was looking glum so I asked her what the matter was. She told me that she was leaving as she couldn't stand working there any more. I asked her what work she would be doing after leaving and she told me that she would be working as activities co-ordinator in a new nursing home that hadn't yet opened. I got the details off her and I was round there like a shot!

The upshot is that I am moving mum to the new nursing home when they are able to take her. In the meantime, I got the mobile number of an MD of the company that runs mum's current nursing home and complained to her. I had a meeting with the MD and two Operations managers and I thought that things would improve. Boy, was I wrong!

After yet more complaints from mum's friend and finding that the MD was on holiday, I reached the end of my tether and sent a complaint to the CQC, who contacted the Home Manager, who almost certainly contacted head office. I got an e-mail from the Senior Operations manager inviting me to another meeting, where I was metaphorically savaged for being "aggressive" and "intimidating" to staff at the nursing home. I am as aggressive and intimidating as a dead sheep! The next point will be of interest to anyone that has Power of Attorney.

Not a lot of people know this (myself included), but Enduring Power of Attorney gives you the authority to act on someone's behalf for property and financial affairs ONLY. I had no authority over mum's personal welfare and so all of the supplements that I had put her on to help her mental function were stopped pending investigation by an NHS dietician despite mum's GP O.K.'ing me to supply them.

The only way that I can have authority over mum's personal welfare is to become her Deputy, which means applying to the Court of Protection. COP1, COP1B, COP2, COP3 & COP4 are the relevant forms, plus COP44A as I would apply for fee exemption on the grounds of low income.

I also have to register my Enduring Power of Attorney with the Office of the Public Guardian, as mum's mental faculties are such that she can no longer make important decisions for herself. You need the Enduring Power of Attorney registration pack (ZIP 0.94MB).

I also contacted the Social Services Access Team to report mum as a vulnerable person at risk. There's going to be a "robust" meeting next week.

Continued on A slight hitch, Part 3.