Psoriatic Arthritis: Psoriasis is more than just skin rashes and plaques.

A complication of Psoriasis is Psoriatic arthritis. The picture below shows what can happen to the feet, toes & toenails. Mine are nowhere near that bad.

From https://en.wikipedia.org/wiki/Psoriatic_arthritis

From Signs and symptoms:
"Pain, swelling, or stiffness in one or more joints is commonly present in psoriatic arthritis.^[4] Psoriatic arthritis is inflammatory, and affected joints are generally red or warm to the touch.^[4] Asymmetrical oligoarthritis, defined as inflammation affecting one to four joints during the first six months of disease, is present in 70% of cases."

This is the form that I have, affecting my left shoulder, right hip & right knee, joints that have been damaged over the years. I recently reduced the pain and inflammation in these joints by doubling my intake of EPA & DHA by eating two cans/day of Tesco Mackerel in spicy sauce, instead of one. Unfortunately, the improvement didn't last, so I'm back to one can/day.  

EDIT: I'm back to two cans/day of https://www.tesco.com/groceries/en-GB/products/258574414 (the Mackerel changed to one with lower EPA & DHA content), and my mood is a bit better. I've also added 600mg/day of soluble Aspirin (dissolved in the Epsom Salts solution) as it's anti-inflammatory and my stomach can tolerate that dose.

Occasionally (when high temperatures make me feel ill), my hands & feet on the left side of my body swell, causing "sausage-fingers & sausage-toes". The reason why only the left side of my body's affected is because the heart pumps more to the left than to the right (according to my GP). One solution to this is to stop the heart from pumping so fast & hard when feeling ill by taking a β1 receptor antagonist (a.k.a. beta blocker) e.g. Atenolol. As I'm using Atenolol off-label, I get them on-line.

I completely suppressed my skin rashes and plaques since 2007, by supplementing with 5,000iu/day of Vitamin D3, ~3g/day of EPA & DHA from Sardines/Mackerel & ~400mg/day of Mg from ~4g/day of Epsom Salts spread out over my waking hours.

However, there's this (emphasis, mine):-
"Along with the above-noted pain and inflammation, there is extreme exhaustion that does not go away with adequate rest. The exhaustion may last for days or weeks without abatement."

I'm lucky in that the exhaustion isn't extreme, but it is significant and it coincides with high temperatures. Since I wrote this, I've lost 10kg and now feel slightly better in high temperatures. On the minus side, pub chairs are much less comfortable and Winter feels colder!

I'm Mackerel-powered, lol!

I was eating one can/day of Tesco Mackerel in Curry, Mexican, Thai Green & Sweet Chilli sauces:-

From https://www.tesco.com/groceries/product/search/default.aspx?searchBox=tesco%20mackerel&icid=tescohp_sws-1_tesco%20mackerel

Mackerel is very high in the long-chain omega 3 polyunsaturates EPA & DHA. It also has a strong flavour, so I get it in strongly-flavoured spicy sauces. It goes nicely with a can of Tesco Everyday Value Sweetcorn 325G

One Sunday night, I got home from the Ploughdium jam and felt hungry, so I had another can of Mackerel bringing the total to two cans that day.

The next day, I was walking to Short & Sweet coffee shop for my brunch, when I noticed that I'd lost something - the pain in my right hip! The second can had raised my intake of Mackerel-sourced omega-3 fats from an average of 3.5g to 7g! Omega-3 fats are anti-inflammatory.

I started eating two cans/day of Mackerel, to maintain the higher intake. Then I noticed my mood gradually rising...and rising...and rising.

I'm now permanently somewhat hyperthymic. See Omega-3 fatty acids and major depression: A primer for the mental health professional.

Rheumatoid Arthritis: It's the food!

I had an email query about Rheumatoid Arthritis, so off to PubMed I went.

From http://www.webmd.com/rheumatoid-arthritis/ss/slideshow-ra-overview

I found Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis.

"Fasting is an effective treatment for rheumatoid arthritis, but most patients relapse on reintroduction of food."
This suggests that rheumatoid arthritis (RA) is an ongoing process, triggered by something that's consumed.

"After an initial 7-10 day subtotal fast, they were put on an individually adjusted gluten-free vegan diet for 3.5 months. The food was then gradually changed to a lactovegetarian diet for the remainder of the study."
Are you thinking what I'm thinking? I'm thinking Gliadorphin-7, as per Wheat, Constipation, Ischaemic Heart Disease, Type 1 Diabetes, Schizophrenia and Autism.

This suggests that RA is caused by peptide chains passing through loose "tight junctions" in the gut, triggering an (inappropriate) autoimmune response. For ways to improve gut integrity, see Cow's milk, Schizophrenia and Autism.

BCM-7 can be avoided by drinking A2 milk. Most cheeses are made from A1 milk, so should be avoided. Swiss cheeses like Gruyère and Emmental are probably made from A2 milk, so suck 'em and see.

To reduce inflammation in joints, consuming oily fish may help, as an adjunct to prescribed anti-inflammatory medications.

Continued on Fibromyalgia: It's the food, again! (probably).

How many working brain cells do researchers have? Part n+1

Once upon a time, I took the mickey out of some eejit researchers in How many working brain cells do researchers have? Guess what? I'm doing it again. A Facebook friend sent me a link to a worrying "new" study Omega-3 Supplements Linked To Prostate Cancer. Oh, dear. Things are looking bad for oily fish & fish oil supplements. Just a moment!

I did some digging on PubMed for the author and found this:- n-3 Fatty acids and prostate cancer risk. The main feature of wild oily fish & fish oil supplements is their high ratio of EPA & DHA (long-chain omega-3 fatty acids) to LA (a shorter-chain omega-6 fatty acid). It would therefore be logical to assess oily fish consumption and/or fish oil supplement intake by measuring the ratio of serum EPA:LA and/or DHA:LA and/or (EPA+DHA):LA.

What did Brasky TM, Crowe FL & Kristal AR actually do? According to the abstract, they measured only serum EPA, DHA & (EPA+DHA). They didn't measure serum LA. Therefore, if the subjects in the EPIC study ate a diet with a high omega-6 (n-6):omega-3 (n-3) ratio (i.e a Standard English Diet), subjects with a high serum n-3 level would have a very high serum n-6 level. As excessive levels of serum n-6 pufas are carcinogenic (see Completing the trine: Which are the safest fats?), it's not surprising that the study produced the results that it did.

There only one thing to do, in cases like this...

Because one palm just isn't enough!

EDIT: Here's a better analysis:- Fish Oil and your Prostate. It looks as though n-6 was measured, which makes my analysis wrong, but I'm keeping the double face-palm, as the full study is hidden behind a £30 pay-wall. Here's another good analysis:- Omega-3 Fats and Cancer.

Rigid diets & taking loadsa supplements to compensate for them.

I do not believe you want to be doing that!

This post was inspired by a recently-published study by Alan Aragon & Brad Schoenfeld, as bodybuilders are a group of people who often eat a rigid diet (some eat skinless chicken breasts, broccoli & brown rice for several meals each day).

See Nutrient timing revisited: is there a post-exercise anabolic window?
"Collectively, these data indicate an increased potential for dietary flexibility while maintaining the pursuit of optimal timing."

This post is also aimed at people who eat severely restricted diets in the (often mistaken) belief that something's making them ill.

People with type 1 diabetes who struggle to keep their blood glucose within reasonable limits (3 to 8mmol/L, or 24 to 144mg/dL) benefit from restricting their intake of high-GL carbohydrates, so this post is not aimed at them. See The problem with Diabetes.

People with type 2 diabetes who severely restrict their intake of carbohydrates must be in caloric deficit, otherwise the physiological insulin resistance caused by high serum NEFAs will mess up just about everything in their body if they are in caloric balance or caloric excess. I've read (so it could be false) that a certain non-skinny blogger who I'm in conflict with (who has type 2 diabetes and who eats a VLC diet) has heart problems and is taking medication(s) for high blood pressure. Hmmm.

People who suffer from gastrointestinal problems after eating gluten-containing foods, or mucus after eating casein-containing foods may have impaired gut integrity. See Gluten - more than just a pain in the guts?

Supplements that I consider of positive value are:-

Fish oils: If the diet is low in oily fish (tinned tuna is not an oily fish), there may be insufficient EPA & DHA (especially in men, children & post-menopausal women). Women of reproductive age can get away with taking flaxseed oil.

Magnesium: If the diet is low in veg/high in dairy, there may be too much Calcium relative to Magnesium.

Vitamin D3: If the lifestyle results in sun-avoidance, insufficiency in Vitamin D is highly likely.

Vitamin K2: If the diet is low in animal fats and/or fermented foods, insufficiency in Vitamin K2 is highly likely.

Supplements that I consider of negative value are:-

Vitamin A: If there's an insufficiency in Vitamin D, supplementing with Vitamin A/β-carotene may exacerbate it. As Vitamin D + Calcium may reduce cancer risk, supplementing with Vitamin A absent Vitamin D3 may increase cancer risk.

Vitamin E: If there's an insufficiency in γ-tocopherol, supplementing with α-tocopherol may exacerbate it. As γ-tocopherol may reduce CHD mortality risk, supplementing with α-tocopherol absent γ-tocopherol may increase CHD mortality risk. Most Vitamin E supplements contain α-tocopherol only. Some Vitamin E supplements contain mixed tocopherols and these are O.K.

Ketogenic diets - when they're not ketogenic, Part 2.

Continued from Ketogenic diets - when they're not ketogenic.

If I said that Eskimos eating their traditional diet were eating processed carbs, what would you think?

Structure of the chitin molecule, showing two of the N-acetylglucosamine units that repeat to form long chains in β-1,4 linkage.

Eskimos eat marine mammals & oily fish, also any edible vegetation that they can find. Marine mammals eat oily fish which in turn eat crustaceans. Crustaceans have an exoskeleton made of Chitin. Chitin has a structure similar to cellulose and a function similar to keratin (hair & fingernails/claws). Humans cannot digest chitin unless it's first powdered and hydrolysed. Certain fish and bacteria are able to digest it using chitinases.

If Eskimos consume the stomach contents of the animals that they kill for food (they usually consume the whole animal, sometimes after leaving it for a long time to auto-digest), there is likely to be a significant amount of pre-digested chitin in their diets. Freshly-killed animals also contain glycogen. Therefore, Eskimos eating a traditional diet ate more carbohydrate than you would expect, which would reduce/eliminate ketogenesis.

Then there's the protein... See STUDIES ON THE METABOLISM OF ESKIMOS.

Quality >> Quantity.

Mum passed away peacefully in the middle of the night. I'm waiting for paperwork to be done.

"And the best you can hope for is to die in your sleep."

On the internet, I read that Dementia with Lewy bodies has a mean survival time of 6 years from the onset of symptoms. Mum first became confused in mid-July 2007, so it's been just under 6 years. Does this mean that all of the supplements I gave her were worthless. Hell, no!

As mentioned in Look after your brain., mum's MMSE score increased from 14 to 26 out of 30 after taking medication and supplements. The medication gave a 3 point increase in MMSE score on average, so the rest of the increase in MMSE score was probably due to the supplements, which had no undesirable side-effects.

On Christmas day 2008, mum was capable of preparing Brussels sprouts for cooking, though she got the knives, forks & spoons mixed up when she tried to lay the table. Here's her final Christmas at home. Roast duck with all of the trimmings. Om, nom, nom!

Mum's last Christmas at home.

People commented on how happy mum always was. Even though she probably didn't know who she was or I was, when I said "Fancy a cup of tea, mum?", she'd reply "Ooh yes, please!" That was the last part of her speech to go.

In conclusion, I believe that quality of life trumps quantity of life, so supplementation for the win.

PPP - another bijou rant-ette.

Blame it on the hot weather and screaming kids! :-D

From http://www.thamesvalleytango.co.uk/images/Rant.jpg

PPP stands for Piss Poor Parenting.

Why, oh why, oh why do some feckless parents allow children to dictate what they eat? As if children know what's good for them! At an event I attended recently, "Johnny*" was given a plate of chicken drummers (mechanically-recovered chicken formed into the rough shape of chicken drumsticks and coated with breadcrumbs) and oven chips. I asked Johnny if he would like a beefburger, sausage or pork steak. He replied. "I don't like them". He only wanted manufactured crap. Seriously, WTH?

When I was a lad, I was given the same food as my parents. If I didn't eat it, I went without. I ate it!
Nowadays, "children's menus" in restaurants (I'm being quite generous in the use of the word restaurant) consist of lots of manufactured crap that children like. Unlike veggies & fruit, this crap contains very little fibre/fiber or Magnesium.

Is it any wonder that childhood constipation is a problem? Why are children being given PEG or even Lactulose, when there's a much better solution - Epsom Salts (which contains 10% Magnesium by weight). The brain needs Magnesium to remain cool, calm and collected i.e. function properly. The brain also needs EPA, DHA and Vitamin D3 to function properly. Many kids don't like oily fish, so they won't eat it. It's not rocket science to purée some sardines or wild red salmon with some Bolognese/Sweet chilli/w.h.y. sauce so that they won't notice it. Many kids play indoors or are smothered in sunblock when they do go outdoors, so they get little or no Vitamin D3. Is it any wonder that childhood ADD & ADHD is much more common? Medication and psychotherapy? Seriously, WTH?

See Effect of MAGNE-B6 on the clinical and biochemical manifestations of the syndrome of attention deficit and hyperactivity in children.

Supplementation of polyunsaturated fatty acids, magnesium and zinc in children seeking medical advice for attention-deficit/hyperactivity problems - an observational cohort study.

Moderators of treatment response in adults with ADHD treated with a vitamin-mineral supplement.


When I was a lad, there were a couple of show-offs in my class at school, but nobody behaved like "Jimmy*" (physically and mentally hyperactive with bad behaviour, screaming and shouting). Johnny was also badly behaved, but not as bad as Jimmy. The parents at the event seemed perfectly happy that, every day, their children had to be given "uppers" (e.g. Ritalin) to help them concentrate during the day and "downers" to help them sleep at night. Seriously, WTH?

I will now take a deep breath and count to twenty. There, that's better!

*Names changed.

The usual suspects.

On Facebook, on message boards and in conversation, I often see and hear:-

1. I'm down in the Winter/I keep getting infections/I have allergies/I have aches & pains.

2. I'm up & down a lot.

3. I'm down/I'm anxious/I can't sleep/I get restless legs/cramps/menstrual cramps/muscle spasms/lung spasms/migraines.

4. I've got inflamed or painful joints/skin/guts/lungs/w.h.y.


1. Vitamin D insufficiency/deficiency is widespread by the end of Winter (~90% of people have serum 25(OH)D less than 75nmol/L or 30ng/mL) due to insufficient sun exposure (or sun exposure through glass) during the Summer. A safe & effective dose is 50iu of Vitamin D3 per kg weight per day. See Randomized comparison of the effects of the vitamin D₃ adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients & Vitamin D.

2. Modern diets are lacking in long-chain omega-3 fatty acids (EPA & DHA), as many people don't eat any/enough oily fish. Tinned tuna is not a good source of omega-3 fatty acids. See Omega-3 fatty acids and major depression: A primer for the mental health professional. Women of reproductive age can take flaxseed oil, if they don't like oily fish, or take about ten 1,000mg fish oil capsules each day. Women not of reproductive age & men need to supplement with vegan DHA in addition to flaxseed oil, if they don't like oily fish or fish oil capsules.

3. Diets low in greens are low in magnesium. Excessive stress and/or alcohol consumption increases loss of magnesium in urine. Magnesium deficiency can cause all of the above symptoms. Epsom Salts are a very cheap source of Magnesium. 1 level teaspoonful/day (~4g/day) of Epsom Salts (spread the dose out over 24 hours to prevent it from having a laxative effect by dissolving the crystals in 250ml of warm water, then adding the solution to drinks to spread the 250ml out over 24 hours) provides ~400mg/day of Magnesium. See Magnesium and the Brain: The Original Chill Pill and  Magnesium in Man: Implications for Health and Disease.

4. Vitamin D and omega-3 fatty acids are anti-inflammatory. Inflammation that's worsened by stress and/or anxiety may be alleviated by magnesium.


Difficult-to-treat health problems such as depression are often multifactorial (with physiological AND psychological causes), so it's advisable to try 1. 2. and 3. (with your GP's consent). If you get improvement, you can discontinue supplements one at a time with a washout period of two months for 1. and 2. to see which supplement(s) was/were effective.

Here's a picture to go with the title.

And finally...
I'm so glad that I don't work with David Thorne.

Guess who didn't look after his brain?

Due to the sudden deterioration in my mum's physical & mental health and also due to struggling to come to terms with her having to spend the rest of her life in a nursing home (not the happiest of places), my diet went completely to pot.

I "went off" salmon, sardines & powdered linseeds and started to eat carbohydrate/fat-based comfort foods. A black cloud slowly descended over me. I lost the motivation to do anything, including updating this blog. I also slept a lot. This continued for several months.

Then, for no apparent reason, a few weeks ago I got an urge to eat smoked salmon. I added 200g of smoked salmon twice a week back into my diet and after a few weeks, the black cloud started to lift.

Before I started supplementing with Vitamin D3, I used to eat lots of oily fish but did not function correctly mentally. This time, my Vitamin D3 status was good (I never stopped taking supplements even when I had the black cloud over me) but my EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid) intakes were near zero.

In conclusion, it would appear that my brain needs adequate Vitamin D3 and EPA and DHA (and magnesium) to function correctly.

I won't be blogging as much as I have been previously, as I've now dumped the vast majority of the nutritional knowledge within my brain into this blog. If I come across anything new, I'll post it here.

Finally, I've found the cheapest source yet of 5,000iu Vitamin D3 gelcaps.

Supplements: Who needs 'em?

According to Health Professionals, nobody. Apparently, we get all of the vitamins, minerals & other nutrients that we need from a "Healthy Balanced Diet" (whatever that is!).

According to me, just about everybody. Due to modern farming methods, food ain't what it used to be. Dammit, even nostalgia ain't what it used to be! Due to changes in lifestyle:-

a) People are more sedentary than they used to be. This means that they require less food than they used to in order to not get fat. Less food, coupled with less nutrients in the food = dietary deficiencies.

b) People don't get as much sun on their skin as they used to, as they now work, play & live mostly indoors and when they do go outside, they are encouraged to Slip Slop Slap (slip on a shirt, slop on sunscreen and slap on a hat). This results in hypovitaminosis D, as only an Eskimo's diet contains enough dietary Vitamin D. The RDA of 200/400/600iu/day (depending on age) is woefully inadequate and totally out of touch with modern research.

c) Many people don't eat much oily fish. Also, animal & vegetable produce now contains more omega-6 & less omega-3 than it used to. This can result in a large imbalance. I eat two 120g cans of mackerel in spicy sauce a day. This also provides protein.

d) Diets low in dark green vegetables & fruits lack Magnesium & Potassium.

e) Diets low in fermented foods lack Vitamin K2.

I currently supplement with:-
400mg/day of Magnesium, as 4g/day Epsom Salts dissolved in water & the solution added to drinks.
5,000iu/day of Vitamin D3.
15mg/day of Vitamin K2.

See also The usual suspects.

I was just thinking......

On a messageboard in a galaxy far far away, someone suggested that as many as one in three people in the UK could have impaired carbohydrate metabolism. This set me thinking.

London is 51degrees North of the Equator, so the sun has to pass through ~45% more atmosphere to reach us, compared to the Equator.

According to Elina Hyppönen & Chris Power, (edited) "The prevalence of hypovitaminosis D was highest during the winter and spring, when 25(OH)D concentrations less than 75nmol/L were found in 87.1% of participants, respectively; the proportion was 60.9%, respectively, during the summer and autumn."

Note that 75nmol/L was insufficient to give me normal Insulin Sensitivity. See Chiu, Chu, Go & Saad. However, greater than 160nmol/L was sufficient, but that was only obtained after I supplemented with 5,000iu/day of Vitamin D3 (25 x RDA).

A deficiency of omega-3 EFAs can cause Insulin Resistance (poor Insulin Sensitivity). See Ghafoorunissa, Ahamed Ibrahim, Laxmi Rajkumar & Vani Acharya, Storlien LH, Kraegen EW, Chisholm DJ, Ford GL, Bruce DG & Pascoe WS and Yam D, Bott-Kanner G, Friedman J, Genin I, Klainman E & Shinitzky M.The typical omega-6:omega-3 ratio in the British diet is ~15:1. This is partly due to the fact that animal produce from grain-fed animals contains a lot more omega-6 and a lot less omega-3 than it used to. See Is food less nutritious than it used to be? Andre Purvis investigates. In addition, people eat grains, nuts, seeds, oils & spreads high in omega-6 and don't eat much oily fish, powdered Flax-seeds (a.k.a. Linseeds) or Purslane (a plant that's relatively high in omega-3).

With all of these problems, I wonder what percentage of the UK population actually do have some degree of impaired carbohydrate metabolism? It might be more than one in three.

According to The eatwell plate, one third of our total Calories are supposed to come from bread, rice, potatoes, pasta and other starchy foods. Some of these foods rapidly raise blood glucose a lot. Impaired carbohydrate metabolism makes for roller-coaster blood glucose levels which encourages over-eating, leading to obesity (see my Blog post on Blood Glucose, Insulin & Diabetes.)

I think that that's enough thinking for now.

Fats: Spawn of Satan or Dogs' Doodads?

From http://ajcn.nutrition.org/content/65/5/1628S.full.pdf

Fats get a lot of bad press in the media. There are so many adverts with "X% fat-free" or "only 1g of fat per Jaffa Cake" as if that's going to stop you from getting fat when you "om nom nom" your way through a whole box of the things!

Saturated fats are usually described as "bad" and polyunsaturates are usually described as "good". This is simplistic. Everything is bad in excess, even polyunsaturates. The thing about fats is that there are four basic types (saturates, monounsaturates, ω-6 polyunsaturates and ω-3 polyunsaturates) and they need to be consumed in roughly the right proportions for optimum health. Suffice it to say, the majority of people in the West do not eat them in anywhere near the right proportions. So, what exactly are fats?


Fats

Fats are an ester of glycerol (CH₂OH-CHOH-CH₂OH) & 3 fatty acids, and are also known as triglycerides (TG's) or triacylglycerols (TAG's).

1 molecule of glycerol + 3 molecules of fatty acid = 1 molecule of triglyceride + 3 molecules of water.

It's the fatty acids that determine whether a fat is saturated, monounsaturated etc. The four different types of fatty acid have a CH₃ at one end and a COOH at the other. The difference is in the middle section.

Saturated fatty acids have a middle section consisting of CH₂'s. Here's a diagram for Stearic acid (the predominant fatty acid in beef):-

__H H H H H H H H H H H H H H H H H O
H-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-O-H
__H H H H H H H H H H H H H H H H H


Monounsaturated fatty acids have one C=C bond in the middle, which is usually (but not always) 9 from the left-hand end, resulting in monounsaturates often being referred to as ω-9's, as ω is the last letter of the Greek alphabet. Here's a diagram for Oleic acid (the predominant fatty acid in olive oil):-

__H H H H H H H H_____H H H H H H H O
H-C-C-C-C-C-C-C-C-C=C-C-C-C-C-C-C-C-C-O-H
__H H H H H H H H H H H H H H H H H


ω-6 polyunsaturated fatty acids have two or more C=C bonds in the middle, with the last one always being 6 from the left-hand end. Here's a diagram for Linoleic acid (the predominant fatty acid in sunflower oil):-

__H H H H H_____H_____H H H H H H H O
H-C-C-C-C-C-C=C-C-C=C-C-C-C-C-C-C-C-C-O-H
__H H H H H H H H H H H H H H H H H


ω-3 polyunsaturated fatty acids have three or more C=C bonds in the middle, with the last one always being 3 from the left-hand end. Here's a diagram for Alpha-linolenic acid (the predominant fatty acid in flax-seed oil):-

__H H_____H_____H_____H H H H H H H O
H-C-C-C=C-C-C=C-C-C=C-C-C-C-C-C-C-C-C-O-H
__H H H H H H H H H H H H H H H H H


These diagrams are slightly misleading. Where there is a C=C bond, there are two H's on the "underside" only of the molecule. This asymmetry causes the H's to repel each other and bend the molecule into a V-shape at each C=C bond. C=C bonds with H's on the same side are known as "cis" bonds. The above molecule is really cis, cis, cis (c,c,c) Alpha-linolenic acid. The other type of C=C bond is known as "trans" and looks like the following diagram:-

__H H H___H H___H H___H H H H H H H O
H-C-C-C=C-C-C=C-C-C=C-C-C-C-C-C-C-C-C-O-H
__H H___H H___H H___H H H H H H H H


This is a diagram of trans, trans, trans (t,t,t) Alpha-linolenic acid. As the H's are on opposite sides of the molecule, they do not repel each other and the molecule is straight, as shown above. Note that saturated fatty acid molecules are naturally straight. Therein lies the problem with trans-fatty acids. They're straight, like saturated fatty acids, but they have unsaturated bonds, which are prone to peroxidation. See http://www.cyberlipid.org/perox/oxid0002.htm WARNING! Heavy-duty organic chemistry!

Our bodies take trans-fatty acids and incorporate them into cell membranes as if they were saturated fatty acids. This results in atherogenicity (artery-clogging), damage to the immune system and other health problems. Trans-fatty acids are found in partially-hydrogenated vegetable oils, so any cooking/spreading fats which have the word "hydrogenated" high-up in the ingredients list should be avoided. These are bad fats.

There are naturally-occurring trans-fatty acids made by bacteria in the stomachs of ruminant animals, like Conjugated Linoleic Acid (CLA). This looks a bit like the diagram below:-

__H H H H H_____H___H H H H H H H H O
H-C-C-C-C-C-C=C-C=C-C-C-C-C-C-C-C-C-C-O-H
__H H H H H H H___H H H H H H H H H


This has one of the C=C bonds shifted to the left and also has one cis bond and one trans bond, so the molecule is always bent. CLA has possibly beneficial properties, but human trials show mixed results. It's certainly not artery-clogging, so don't let anyone put you off eating butter from grass-fed cows (e.g. Anchor or Kerrygold butter) by saying that it has trans-fats in it. CLA is a harmless trans-fat.


Saturated fat consumption should be about 10% of total calories. This is because, even though saturated fats are not essential (our bodies can synthesise them), this guarantees adequate synthesis of sex hormones. Total polyunsaturate consumption should be about 5% of total calories, with a ω-6:ω-3 ratio of between 1:2 and 4:1. As ω-3's are found in greater quantities than ω-6's only in flax-seeds (a.k.a. linseeds) and oily fish, and many people eat way too little or no oily fish (and who, other than body-builders and some vegetarians/vegans, eats flax-seeds?), the ω-6:ω-3 ratio in the West is ~20:1. This is due to the widespread consumption of meats, eggs & milk from grain-fed animals, grains, nuts and seeds. There are high rates of heart disease and other inflammatory diseases in the West, as ω-6's end up in series 1 & 2 prostaglandins, and series 2 prostaglandins are pro-inflammatory. ω-3's end up in series 3 prostaglandins, which are anti-inflammatory.

So eat up yer oily fish if you're not vegetarian or vegan. Otherwise, eat up yer ground-up flax-seeds!

Monounsaturates can make up about 15% to 35% of total calories, depending on activity levels. From the histogram in Everyone is Different, sedentary people, on average, burn twice as much energy from fats as from carbohydrates.

So, if 25% of energy comes from protein say, 25% of energy can come from carbohydrates, and 50% can come from fats, i.e. a 2:1 ratio of fats:carbs. The cyclists at the left-hand end of the histogram in Chapter 1 would do best on 25% protein, 15% carbohydrate, 60% fat, when sedentary, whereas the cyclist at the right-hand end of the histogram would do best on 25% protein, 60% carbohydrate, 15% fat, when sedentary. When active, more carbs are needed by everyone.

Which fats contain which fatty acids? See https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQcYggz8ORx7mdTT7_ngR-jKOG-2FB4sm5HZWFyJF7xFYlNn-XCkbs4tSIuFFaJFVUdFTw13Q5M2-Adu_jeVnu3O37NhPlK_XWrxIACJ_QT1KmVElpl1YoLO4nfBBoqJNI5FQlhSDh/s640/comparison-of-fats.gif for a Comparison of Dietary Fats.

For high-temperature cooking, saturates are the least likely to oxidise (when they're on fire, they're oxidising!), followed by monounsaturates, then ω-6's, with ω-3's being the most likely to oxidise. An oil doesn't have to be smoking, to be oxidising. Alpha-linolenic acid oxidises to varnish at room temperature without smoking, which is why linseed oil is used to varnish cricket bats and dilute putty. The best non-animal fat for high-temperature cooking is Coconut Oil, followed by Palm Oil and then Olive Oil.

Extra-Virgin Olive Oil (EVOO) has a lower smoke point than refined Olive Oil (due to higher levels of free fatty acids), but has higher levels of polyphenol antioxidants, which makes it heart-healthy.

Oils high in polyunsaturates shouldn't be heated to temperatures greater than 100°C, as polyunsaturates can change from the cis configuration to the trans configuration at 102°C. See http://www.harricksci.com/sites/default/files/pdf/application_notes/FatIR_App-Notes_ATR_Oil-Analysis.pdf

Cholesterol And Coronary Heart Disease

From http://www.health-heart.org/

Cholesterol & coronary heart disease are mentioned a lot in the media. Unfortunately, most of what you see & hear is either completely wrong, or dumbed-down so much that it's inaccurate.

Fat & cholesterol don't stick to the insides of artery walls like grease on the inside of a drainpipe. This article explains what cholesterol is, how arteries get blocked and how to minimise the risk of having a heart attack or ischaemic stroke.


What is cholesterol?

Cholesterol is a large, waxy molecule (C₂₇H₄₅OH) consisting of a hydrocarbon (fat-soluble) tail, a middle section consisting of four carbon rings (the steroid bit) and an alcohol (water-soluble) group on the end. Cholesterol is a powerful anti-oxidant and is what bile acids, mineralcorticoids, glucocorticoids and sex hormones are made from.

Cholesterol is "chauffeured" around the body in lipoprotein "limousines". Lipoproteins are lipo (fat-soluble) at one end, protein (water-soluble) at the other end and they form a spherical shell around their contents with the lipo end pointing inwards and the protein end pointing outwards. The shell is like the body of the limousine. In the shell, there are apo(lipo)proteins which are like the chauffeur, as they determine where the particles are taken up. HDL has apo A in its shell which makes it get taken up by receptors in the liver. LDL has apo B in its shell which makes it get taken up by receptors in cells, artery walls etc. The passengers are cholesterol, cholesteryl esters, phospholipids and triglycerides. These limousines have different types, like chylomicrons, VLDL, LDL, IDL & HDL, the difference being the type & amount of apo(lipo)protein and the relative proportions of cholesterol & the other passengers. There are also sub-groups of each type.

The different variants are affected by serum triglycerides. High serum triglycerides (caused by a chronic over-consumption of sugary & starchy carbohydrates for activity level) result in cholesterol-depleted, triglyceride-rich particles and low serum triglycerides result in cholesterol-rich, triglyceride-depleted particles. As cholesterol is a powerful antioxidant, smaller cholesterol-depleted particles (Type B) oxidise faster than larger cholesterol-rich ones (Type A).

Oxidised LDL particles are "bad cholesterol" and are swallowed by scavenger macrophages. These expand into foam cells, which become embedded in the intima of artery walls. Other processes occur which cause cholesterol & calcium to accumulate as a plaque inside the media of artery walls. To see a cross-section through an artery wall, see the top of this page. Unoxidised LDL particles are not swallowed by scavenger macrophages, so unoxidised LDL particles are not "bad cholesterol". In young people, plaques of cholesterol with no calcium can accumulate within artery walls, making Coronary Artery Calcium (CAC) scans ineffective. See Stenosis Can Still Exist in Absence of Coronary Calcium.

Plaques force the inner artery wall inwards, making the artery narrower, impeding the flow of blood through it. This can cause angina pectoris (pain in the chest) as the heart is starved of oxygen, or vascular dementia as the brain is starved of blood. The cap covering the plaque may rupture, causing chunks of plaque to circulate and block coronary arteries (causing a heart attack), or cerebral arteries (causing an ischaemic stroke).

It's possible to reduce serum triglycerides significantly by eating lots of long-chain omega-3 fats from oily fish. These inhibit the conversion of glucose into triglycerides. Inhibiting the conversion of glucose into triglycerides can result in increased blood glucose levels (not good - see below) if sugary/starchy carbohydrate intake is too high. Solution? Reduce sugary/starchy carbohydrate intake to suit activity level.


Why do foam cells embed themselves into the intima of artery walls?

Arteries are elastic, muscular tubes which stretch a bit each time the heart pumps and contract again between beats. They also relax & constrict to control the flow of blood through them. When you get cold, they constrict to reduce the flow of blood to the skin to prevent excessive heat loss. When you get hot, they open to increase the flow of blood to the skin to increase heat loss.

Foam cells don't go just anywhere. They embed themselves into damaged areas of artery walls. This is a good thing, otherwise damaged artery walls could rupture, causing a haemorrhage.


What damages artery walls?

Chronically high blood pressure.
Chronically high blood glucose.
Chronically high blood free radicals.
Chronically high blood homocysteine.
Chronically low blood antioxidants.
Chronically high blood pro-oxidants.
Chronically low blood anti-inflammatories.
Chronically low Vitamin K2.
Chronically high LDL due to hypothyroidism or other factors.


How can I reduce damage to my artery walls?

1) Have blood pressure (BP) tested regularly. There's one problem with having your BP taken in a GP's surgery and that is 'white-coat hypertension' where the stress of having your arm squeezed by the cuff sends your BP up! If you buy your own BP monitor (Lloyds pharmacy sell a fully automatic BP monitor with standard cuff for £9.99), you can become accustomed to using it and overcome white-coat hypertension. 5,000iu/day of Vitamin D3 can reduce BP by making artery walls more elastic. 4g/day of Epsom Salts provides 400mg/day of Magnesium, which acts as a smooth muscle relaxant, reducing BP & cardiac arrhythmias.

2) Have blood glucose (BG) tested regularly. If you're lucky, you may be able to get a HbA1c test. This shows accumulated damage to red blood cells by blood glucose.

3) Don't smoke! Apart from lung cancer, chronic obstructive pulmonary disease & emphysema, smoking speeds the oxidation of LDL.

4) Take a B-complex containing B6, B12 & folic acid, which lowers serum homocysteine levels.

5) Eat a diet rich in anti-oxidants from coloured veggies (beta-carotene), fruits (Vitamin C + bioflavonoids), tomatoes (lycopene), nuts & seeds (gamma-tocopherol & copper), Brazil nuts (selenium), beer/wine in moderation (muscle relaxant), green tea (polyphenols), cocoa/dark chocolate (polyphenols & copper), onions/garlic (quercetin) etc. See Antioxidant state and mortality from coronary heart disease in Lithuanian and Swedish men: concomitant cross sectional study of men aged 50.

6) In men and non-menstruating women, too much iron in the blood relative to copper is pro-oxidant, so don't supplement with iron. Menstruating women have the opposite problem.

7) Take about 2g/day of long-chain omega-3 fats from oily fish, or about 20g/day of flaxseed oil if male, or about 10g/day of flaxseed oil if female. Please note that tinned tuna contains very little omega-3 fats. See Clinical nutrition: 4. Omega-3 fatty acids in cardiovascular care.

8) Eat a diet rich in Vitamin K2, to make calcium go into bones & teeth, instead of into artery walls, kidneys & brain. For good sources of Vitamin K2, see HERE. Note: Warfarin/Coumadin works by depleting Vitamin K, so lots of Vitamin K2 makes Warfarin/Coumadin ineffective.

9) If you're feeling tired and are gaining weight for no obvious reason, get serum thyroid hormone levels tested (TSH, FT4 & FT3 preferably), as low thyroid hormones down-regulate LDL receptors, resulting in LDL particles lingering in the blood for longer than usual. This increases LDL-C, LDL-P (particle count) and the oxidation of the particles. See Neovascularization of coronary tunica intima (DIT) is the cause of coronary atherosclerosis. Lipoproteins invade coronary intima via neovascularization from adventitial vasa vasorum, but not from the arterial lumen: a hypothesis.


What about Benecol & Flora Pro-Activ?

These yoghurts & spreads contain plant sterols/stanols, which reduce total serum cholesterol by up to 15%. However, LDL quality is more important than LDL quantity (up to a point) and there is no evidence that these foods save lives.


What about statins?

Statins (HydroxyMethylGlutarate Coenzyme-A Reductase inhibitors) reduce serum cholesterol. They also have anti-inflammatory & anti-clotting effects by reducing levels of the non-sterol derivative mevalonate and subsequent products. Click HERE to see the cholesterol synthesis pathway. Statins save lives in people who have had a heart attack and in men between the ages of 30 and 60. However, younger & older men and women do not get a significant reduction in deaths, (though heart-attack deaths may be reduced) and there can be undesirable side-effects (muscle pains, memory loss etc). I strongly recommend that anyone taking statins, supplements with at least 100mg/day of Co-Q10, as the synthesis of this vital substance is reduced. Note that fish oils have anti-inflammatory, anti-clotting and anti-arrhythmia actions, but don't suppress the production of Co-Q10.


What about dietary cholesterol?

When cholesterol is eaten, the liver produces less cholesterol. An average egg contains about 250mg of cholesterol. The vast majority of people (who don't have genes for familial hypercholesterolaemia) can eat two eggs a day without significantly affecting their serum cholesterol & triglyceride levels. See Effect of dietary egg on human serum cholesterol and triglycerides. People with the ApoE4/E4 polymorphism are more sensitive to dietary fat & cholesterol raising serum LDL, and cannot eat fat & cholesterol willy-nilly.

There are a couple of sites that have CVD risk calculators, JBS2 and QRISK®2-2013. The National Institute for Clinical Excellence (NICE) no longer recommends the use of JBS2, as it's overly-pessimistic.