First, a summary of macro-nutrient (protein, fat, carbohydrate) ratios – can there be a “best” when we are all different and have different conditions and goals? Chris Kresser is a respected clinician who sees many chronic disorders, including obesity and diabetes and is one of my go-to health experts. He’s written extensively about Paleo and Low Carb High Fat (LCHF) styles, but fully acknowledges that we need our own personal approaches. How to Calculate Macronutrient Ratios that Work for You is an informative and readable summary.  Takeaways include:

• No matter what approach, quality of food is the key. Highly processed “foods” – including flour, refined sugar, and industrial seed oils like vegetable and corn oil - are not high quality.

• Most of us can benefit from a low carb approach (vs. the Standard American Diet, or SAD), but are any carbs OK? Kresser argues that cellular carbs are fine and that we should avoid acellular carbs. Carbs exist naturally inside fiber-walled living cells. Acellular carbs are removed from living cells and their fiber: refined grains (yes, that’s bread and most cereals – even those weekend bagels!) and sugar are again chief culprits. Examples of cellular carbs: cruciferous vegetables like broccoli and cauliflower, sweet potatoes, and whole fruits.

• Be reasonable about fats and proteins

Kresser gives recommendations about macronutrient ratios for 16 specific conditions and life stages, including general health, Type 2 diabetes, cardiovascular disease, weight loss, mood disorders, pregnancy and lactation, athletes, childhood, intestinal troubles, and cancer.

Next, a topic near and dear to my age group: how to live longer in health. We know that exercise and movement are key, but how and how much? Perhaps the sedentary among us would be convinced to move more if presented with evidence that you don’t have to join a gym or do CrossFit to gain real benefits from moving around. Many studies in this area have been faulty, but a new, rigorous meta-analysis shows that even light, gentle activity such as “moseying, housecleaning, cooking, or gardening” can reduce one’s chances of dying prematurely. Here’s a good article by Gretchen Reynolds published recently in the New York Times: For a Longer Life, Get Moving. The article focuses on simply living longer, but more movement also enhances a longer health span.

Third, it is always the season to scare people away from red meat. Over the last 50 years or so, red meat has been accused of causing much cardiovascular disease and cancer. Here’s Chris Kresser again on the annual red meat scare, this time concentrating on cancer. There are studies that show correlations, but they are necessarily “observational” and cannot show causality. Kresser writes “For example, most Americans that eat red meat eat it with a huge bun made of white flour, with a serving or more of other refined carbohydrates (chips, fries, soda) cooked in rancid, industrially processed vegetable or seed oils. How do we know that it’s the red meat—and not these other foods—that is causing the increase in cancer?”

A tidbit from the article about processed meat: “Even if you ignore everything I’ve written in this article and accept the WHO (World Health Organization) report at face value, just how much would your risk of cancer increase if you eat cured and processed meats? About three extra cases of bowel cancer per 100,000 adults. That means you have about a 1 in 33,000 chance of developing bowel cancer from eating cured and processed meats.”

We all make up our own minds, but I’m sticking with grass-fed beef and the occasional bacon.

My health decisions are informed by modern science and by how we evolved, or “ancestral health.” I’ve often wondered how we evolved over millions of years eating meat, and suddenly it’s unhealthy? For a good discussion about this, read the beginning of Should dietary guidelines recommend low red meat intake? Of interest: a chief health challenges for vegans is the lack of highly bio-available B12 from plants. It seems we humans lost our ability to support an intestinal biome that makes B12 about 1.5 million years ago, so it became essential to ingest it from animal sources. But other primates exist on plants, right? Turns out their microbiomes continue to make B12, among other major intestinal differences.

I’ll offer some thoughts about the very real environmental and ethical considerations in a later post but focus on nutrition here. If you’d like to dig further into environmental sustainability and nutrition from animals now, you might start with a very controversial article entitled Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems, published in the British journal The Lancet in January 2019, written by 37 authors after 3 years of study, recommending a diet that would purportedly reduce worldwide meat consumption of 90%.  Then read this immediate rebuttal on the nutritional value of the diet by Zoe Harcombe, Ph.D. In March, the World Health Organization dropped its endorsement of the Commission’s diet; it seems a “one-size fits all” approach to nutrition for all 7 billion of us is quite problematic.

And now, back to school!

Headline in the March 15, 2019 New York Times: “Are Eggs Bad for Your Heart Health? Maybe A new analysis found that for each additional 300 milligrams a day of cholesterol in the diet — and the more eggs you ate — the greater the risk for cardiovascular disease.”

Headline in the March 15, 2019 Wall Street Journal: “Study Links Eggs to Higher Cholesterol and Risk of Heart Disease Eating 300 milligrams of dietary cholesterol a day—or less than that of two egg yolks—was associated with a 17% higher risk of cardiovascular disease”

I began to see other versions of this story in other media, always with dramatic headlines or click-bait enticements. My email was filling up with “Hey Rick, I thought you said eggs were back in the good column! What’s up with this?”

The articles were referring to a paper to be published later that week in the Journal of the American Medical Association (JAMA) titled “Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality.” While the benefits and risks of eating eggs might still be called controversial, in my humble opinion it is settled: don’t worry – eat all the eggs you want.

Let’s briefly pick this study apart (with thanks to Zoë Harcombe Ph.D.) Here are a few of the problems:

• The paper is a “meta-analysis” that looks at six underlying studies of egg and dietary cholesterol consumption and their association with cardiovascular disease (CVD). These studies are not Randomized Controlled Trials, or RCTs, which attempt to find causation. They are epidemiological studies, which can establish correlations that might then lead to RCT studies. None of the underlying studies here attempted to show causation, and the study authors don’t claim that eating eggs causes a higher risk of CVD or earlier death. The very first word in the headline is “association” – that’s not causality, but inferring causality sells more newspapers.

• Data collection in nutrition studies is extremely difficult; these underlying studies have not found a way around that, and so rely on faulty data, perhaps extremely so. For instance, how do the studies collect data on the number of eggs eaten over the many years the studies ran? Participants were asked to fill out food surveys about what they ate, some just annually, some over even longer periods. Do you remember what you had for breakfast 3 days ago, let alone 300 days ago? Do you know how many eggs you had last year?

• The data rely on “mixed ingredients” foods that may contain eggs, not just actual eggs, but the articles fail to point this out. Mixed ingredient foods include cake, doughnuts, ice cream, etc. Since this JAMA paper only purports to show association, not causation, how can we know that it wasn’t the highly processed flour in those doughnuts, or the vegetable oil the eggs and home fries were fried in, or the sugar in the ice cream that “caused” the increase in relative risk?

• We encounter another incidence of that famous saying attributed by Mark Twain to the British prime minister Benjamin Disraeli: "There are three kinds of lies: lies, damned lies, and statistics." That Wall Street Journal headline would more properly read “…17% relative risk…” The largest study in the group of six began in 1989 and comes from a project called “The Atherosclerosis Risk in Communities Study (ARIC). It reported a 17% increase in relative risk of cardiovascular disease incidents in a study population of 255,000 that suffered 16 deaths per 1,000 person/years. A 17% increase raises that to 17 deaths per 1,000 person/years. In my humble opinion, that very slight increase is not worth the sensationalism, especially when we know that this only purportedly shows a correlation, not causation.

• Newspapers get away with this drama because of conventional wisdom that is actually highly disputed. First, it has been shown in many studies that that there is very little or no relationship between dietary cholesterol and blood cholesterol. For the most of us, eating eggs has no effect on those cholesterol numbers you get from your good doctor. Second, there are many studies that show no link between cholesterol in your blood and CVD – some even show a healthy correlation.

• The JAMA paper’s authors have many disturbing conflicts of interest, having worked for or had their research funded by pharma companies such as Astra Zeneca, Merck, GlaxoSmithKline, Novartis, and others – a who’s who of corporate interests eager to keep that flow of statins going. While those affiliations and the money behind them do not by themselves impugn their integrity, it is worth mentioning in the newspaper articles, don’t you think?

So pay no attention to these recent scare tactics from the sensationalists. For almost all of us, two to three eggs per day would be a step up in nutrition, especially compared to the standard American diet.

One last note: if you can, get “pastured” eggs. That’s the top of the hierarchy of terms like “cage-free”, “organic”, “hormone-free”, etc. That’s all good vs. conventional, factory-farmed eggs. Why pastured? The ratio of pro-inflammatory omega-6 fatty acids to omega-3 acids is far better eggs from hens kept cooped up, fed only grains, etc. Hens should be free outdoors, running around the yard, picking at bugs and grass and whatever else delights them. They’ll process it all for us.

I’m very lucky to live where friends with pastured hens bring them for house presents, and local farmers leave them in coolers by the side of the road with honor-system cash boxes. If you’re not that lucky, check out the Eat Wild site to find pastured eggs and other goodies in your area.

For a good, full debunking of that recent study, read Zoë Harcombe, Ph.D. For a great short article on why you should not fear eggs or cholesterol, read Chris Kresser’s recent blog “Three Eggs a Day Keep the Doctor Away!”  

P.S. Yesterday I had two eggs on a bed of kimchi for breakfast. What about dinner? Eggs scrambled with some potato starch and cheese. Yummy, and healthy!

My wife and I attended a parents’ night decades ago at our son’s school and spent ten minutes in math class, where the teacher explained the sequence of increasing difficulty in the curriculum that year. “First, we cover the basics like integers and absolute value, then the order of operations, then simple equations, then two-step equations, then equations with fractions, etc.” He summarized with that headline phrase: “And so, we never do one thing before we do another!” Now my head was spinning – how is that possible? I thought perhaps he was channeling Yogi Berra.

While his grammar may have been a bit garbled, he described the progression well. Increasingly difficult concepts would build on what had already been learned. You wouldn’t start with solving simultaneous equations, though that sounds pretty cool.

When we try to implement fundamental lifestyle changes our likelihood of long-term success will improve if we build on steps of increasing effectiveness.  A very, very few can gut it out by going cold turkey with a drastic behavior changes, but that doesn’t work for most of us for the long run. If you just want to lose 10 pounds before swimsuit season, then go on any diet. They all work in the short term. But if you want to teach your metabolism to burn fat, get your inflammation in check, repair your leaky gut, reverse your diabetes or autoimmune symptoms, sleep better, regain energy, and live longer while healthy, then designing and following your own path for lifelong success is the way to go.

We all need to start somewhere, so here’s a general path that works for many, focused on nutrition. And here’s the caveat: eventually, everyone’s path will be different. That’s not an excuse to quit before you start. It means that you’ve got to learn to pay attention to what works for you, what doesn’t work for you, and adjust along the way.

Arithmetic: cut out the foods that harm you. You probably have a pretty good idea of what they are, but here’s where the discipline starts. No more junk food. No chips, no sugary or “diet” drinks, no empty carb snacks, no McDonalds, no candy bars. Shop the outside of the market, not the inside aisles. Learn to read labels and remember that “lite” or “low fat” probably means it’s full of sugar and/or sodium. In fact, if it’s got a label at all, try to avoid it. Cut way back or eliminate grains, even if the USDA food pyramid or plate says we need seven helpings a day. That’s business and politics talking, not science. We need fiber, not grains. Flour – bread, pasta, crackers, cookies, many desserts – is a highly processed food and low in nutritional value. Toss out the vegetable oils. Eat real food. Like arithmetic, you can use this skill every day for the rest of your life.

Algebra I: add in healthy fats. Get over the false notion driven into our brains over the past 6 decades that all fat is bad. It’s hard to believe, but those studies were misleading and misused. Eat whole, pastured eggs, not just egg whites. Eat avocados, wild fish, grass-fed beef if you choose. But don’t overdo it. Counting calories is a poor approach to lifestyle change for weight loss, but calories do count, so don’t just add more by accepting healthy fats into your diet and not adjusting elsewhere.

Algebra II: figure out how exercise, sleep hygiene, and stress management fit into your life, and pursue each area with mindfulness. For instance, good sleep doesn’t just happen by luck or DNA – you can manage your eating, exercise, sleep environment, and other habits to get better sleep. This blog post is about nutrition, but a happy, healthy life is about much more!

Trigonometry: after you’ve cut out the bad food, added healthy fat, and starting mindfully working on sleep, exercise, and stress, your body may now be ready for a Low Carb High Fat (LCHF) approach.

To do this, you’ll need to track your food and drink with a food tracking app like MyFitnessPal or Cronometer. During the first semester of trig, keep your daily dose of carbohydrates under 150 grams. No problem, you say? Most Standard American Diet (SAD) followers consume 300 – 500 grams/day, and many consume far more. One personal (8”) pizza with two meats is 161 grams. One can of Coke has 35 grams, from its 33 grams of sugar. This will take some planning!

During the second semester, keep your daily dose under 75 grams. More planning, shopping, preparing your own foods – this is hard to do with packaged and restaurant foods. How do you know when the semester is finished? When you consistently feel good and in control of your nutrition. When you are not hungry as soon as you wake. When you are busy and full of energy, and only realize after work that you forgot about lunch. You’re burning fat, and you’re used to it!

Pre-calculus: a ketogenic diet, usually defined as under 20 grams of carbs per day. You’ll have to love your vegetables, and probably cut back on fruit. One whole fresh apple has about 25 grams, from its sugar. Ketogenic diets are safe if you are ready. They have been used since the early 1900’s to treat epilepsy. My favorite book on this is Mark Sisson’s Keto Reset Diet. Many “keto” practitioners cycle in and out of a strict 20 grams per day, and others set their limit at 30 or 40 grams. I’ll write more on this in the future.

Calculus: Intermittent Fasting, or IF. Perhaps it is unfair to assign “calculus” to IF. Just the word calculus is intimidating for most of us, and IF practices range from simply narrowing your daily eating window, for instance eating all food within 8 hours – skip breakfast, don’t snack after dinner – to fasting for weeks under medical supervision. This is a very intriguing new area of research and practices. Remember, we evolved doing IF. It’s only very recently that we’ve strived for three square meals a day, augmented in the last 50 years with tons of snacks in between. More on this in future posts as well, but here’s a great resource if you’re curious right now: Dr. Jason Fung’s Intensive Dietary Management program. See especially the Resources page.

OK, all well and good, but you said my path will vary from others if I listen to my body. How the heck do I do that? How can I learn to pay attention? Life is complex enough, and now I should add the complexity of nutrition on top of that? Here are a few ideas:

• Learn,·baby, learn! Continuously read about health, listen to podcasts, learn to cook. Don’t have the time or inclination to do this on your own? Get a health coach!

• Keep a food diary. Write down everything you eat and drink during the day, along with how you felt, and then analyze your diaries for patterns or problems. “I never noticed before, but it seems that the day after I eat [fill in the blank] my energy sags and I feel bloated. Hmmm…” Send me an email, and I’ll reply with my printable form, designed to be used in conjunction with a food diary app. Maybe a very low carb or keto approach leaves you tired and cranky, even though you’ve given it your best. Then add more carbs – not with junk food – and keep tracking how you are doing.

• Use one of the many food diary apps like MyFitnessPal or Cronometer mentioned above. MyFitnessPal is most popular, and like many it comes in a free version with ads and a paid version. You can track the time of meals, exercise, and other variables, and even link other data from smart watches, heart monitors, etc. Cronometer has perhaps the most accurate micronutrient database.

• Before you go to bed, think about what worked and what didn’t during the day, and plan for tomorrow. You can combine this with other practices, such as keeping a gratitude journal. (I’m not great at this, but my wife writes a few sentences every night.)

• Extend your planning to the week. When will I shop? Shall I make a week’s worth of a favorite food on Sunday afternoon? I’m going out with friends on Thursday – how will I handle that?

• And tons more…

In health as in math class, you should do one thing before you do another!

P.S. Friends, if you enjoy these occasional blog posts and think others might find them interesting, please forward this email - and thanks!

My preferred method of acquiring new knowledge is reading books, articles, web posts, articles – just about anything. (Podcasts are a close second; watch for some favorites in another post.)

I have never taken a course in biology, so in getting healthier myself and then coaching others I’ve had to learn the basics and unlearn a lot of standard misinformation and conventional wisdom. Here are three books you may enjoy that have been helpful to me in learning about some of the foundations of healthy living.

First, a note: I’m a serious follower of science, but not an acupuncturist, chiropractor, dentist, doctor, naturopath, or registered dietician. I don’t finish the day reading medical journals. So I appreciate clear explanations written for laypeople by scientists and science writers, and if there are some memorable stories, practical advice, and even a little humor, all the better. I also value an ancestral or evolutionary approach to understanding health, and a functional medicine viewpoint on disease and sub-optimal health. Functional medicine attempts to find and fix the root causes of disease and sub-optimal health vs. simply treat symptoms with drugs.

Since so much of health is determined by what we eat, what happens within our bodies when we do? How does digestion work? A fun and enlightening place to start is Gulp: Adventures on the Alimentary Canal, by Mary Roach (2013). She takes us on an informative digestive journey from the nose through the mouth, stomach, intestines – you get the picture. It is well-researched, with a full bibliography. Janet Maslin of the New York Times says “Far and away her funniest and most sparkling book, bringing Ms. Roach’s love of weird science to material that could not have more everyday relevance. . . . “Gulp” is structured as a vastly entertaining pilgrimage down the digestive tract, with Ms. Roach as the wittiest, most valuable tour guide imaginable.” Who knew that Elvis had a megacolon? Even GI docs will learn something.

The New Primal Blueprint (updated 2016) by Mark Sisson is a vast compendium of the ancestral approach to health. Sisson is a college biology major (Williams) turned world-class marathoner and triathlete and then coach who burned out and needed to understand why.  The discussion of primal “laws” covers nutrition, sleep, movement, stress management, play, community, and other pillars that contribute to everyone’s health.

His website’s summary: “Mark Sisson’s comprehensively updated and expanded edition of his 2009 bestseller will help you reject flawed conventional wisdom about diet and exercise that leads to failed weight loss efforts, burnout, and elevated disease risk. The New Primal Blueprint is based on ten immutable lifestyle laws, validated by health and evolutionary science, that enable you to reprogram your genes in the direction of weight loss, health, and longevity. The Primal Blueprint isn’t a fad diet or exercise program, but a sustainable set of nutrition, fitness, and lifestyle behaviors that align you with your genes’ expectations so that you can enjoy superior health and wellness without any of the conventional struggle or sacrifice.”

A key takeaway: our fates are not fully sealed by our genetics. How many times have we all heard someone say (or said ourselves) that getting cancer is just genetic bad luck? But we can make choices that decrease risks of diseases or sub-optimal health. While we can’t change our eye color, we can reduce our risk of cancer, live longer than our parents, and become more vibrant as we age.

I use this book as a reference all the time and trained as a health coach through the Primal Blueprint approach. I should have paid better attention to Primal Blueprint Law #9: Avoid Stupid Mistakes when I carelessly set my ladder last year to fix a window screen, resulting in broken ribs, an impinged shoulder, and a severely damaged ego.

Jason Fung, MD, is a Toronto-based specialist in kidney disease. How did he become an obesity researcher and clinician? First, he evolved into an advocate of functional medicine. He was treating kidney patients with dialysis, many of whom had Type 2 diabetes (T2D). He began to wonder if T2D was an underlying cause. If it contributed to the need for dialysis, was there a better way to treat T2D, obviating the need for dialysis? He writes of this exploration and the science of obesity in The Obesity Code (2016).  He pulls together the various obesity and T2D discoveries, approaches, clinical trials, peer-reviewed studies, and his own research findings like pieces of a puzzle that has yet to be assembled so clearly, in my opinion. He explains why methods like energy balance (Calories In – Calories Out) might be intuitively appealing but never actually work for more than a few months. It turns out the underlying problem is insulin resistance, not lack of willpower or inadequate education. The story is written for laypeople, with 30 pages of journal citations and footnotes for further exploration, verification, etc.

What’s new here? So much of what’s been learned about obesity/T2D and losing weight has to do with ­what we should and should not eat, and Dr. Fung embraces a low carb, high fat diet for most. But the innovative solutions used in his clinical program (Intensive Dietary Management) focus on when we should eat and not eat. Fasting, here we come! It is an important approach to better health. This readable book explains why.

Enjoy!

If you know you should make significant lifestyle changes but just can't commit because:

• There will be a better time, when life settles down, there's less travel, the kids are older - you’ll get around to it someday.
• It's too confusing and complicated - who can tell what to eat?
• It will probably be really, really hard. You've dieted before - it just leads to failure. 
• Aging is inevitable, and besides, you can't change genetics...

... then a Health Coach may be just what you need to get you started and to guide you on the journey. A Health Coach can educate you about the pillars of health, help you build your foundation for a new lifestyle, and save you time by cutting through all the confusing and conflicting information.

I've been there - business stress and travel, low quality sleep, gaining weight, plenty of meds, and procrastinating for decades. Now I'm on a different path. I can empathize with you, learn about your current situation and health goals, and help you launch into a new vibrancy with a customized plan and coaching interactions. 

Let's get the conversation started:

"I was healthier once. I can do it again."

During a recent conversation, a friend who helps run a health coaching company said “A medical reporter gave a segment on TV last night about apple cider vinegar, and now our coaches’ phones are ringing off the hook. We need a point of view, stat!” So I decided to write one. The “folk medicine” characteristic of apple cider vinegar (ACV) then prompted some reflections about Western medicine’s gold standard for “real science”: the Randomized Controlled Trial, or RCT. But first, a point of view (often shortened to POV) on ACV.

A Point of View on Apple Cider Vinegar

What is ACV? From Wikipedia: "Apple cider vinegar...is a type of vinegar made from cider or apple must and has a pale to medium amber color. Unpasteurized or organic ACV contains mother of vinegar, which has a cobweb-like appearance and can make the vinegar look slightly congealed. ACV is used in salad dressings, marinades, vinaigrettes, food preservatives, and chutneys."

Common Uses: an ancient folk remedy, cited as useful for hundreds of conditions. Very few have been studied and verified in randomized controlled trials.  See this easily readable article for a list and discussion of common attributed remedies or uses. The article quotes Dr. Carol Johnston, a leading researcher in this area; see the reference to one of her papers below. Common uses discussed include:

• Controlling diabetes (Johnston says a causal link is not yet indicated.)
• Losing weight (one study shows a modest benefit)
• Teeth cleaning (a dentist says “Don’t”)
• Skin, hair, and nails (dermatologists say there are some benefits, but be careful)
• And many others…

Pros: It can help regulate blood sugar. Dr. Johnston was the principal investigator of this published study: Vinegar ingestion at mealtime reduced fasting blood glucose concentrations in healthy adults at risk for type 2 diabetes. Journal of Functional Foods 2013; 5: 2007–2011   

Downsides:  Few noted, if diluted with water and not overused. Of course, interactions with medications should be checked. Without dilution, it can irritate the esophagus and the lungs if inhaled. Dilution helps mitigate the sour taste as well.

Dosage often cited: 1 tablespoon, diluted, with meals or before bed. Use raw, unfiltered, unpasteurized, organic ACV. Bragg is a popular brand.

Summary: ACV can help regulate blood sugar, which in turn has beneficial effects. There are many other uses, but do your own research, and remember that almost all recommendations include dilution. From a Western medicine perspective, most uses are folk remedies at this point, but some are being studied such as ACV in cold prevention. While they may not be “scientifically proven” via the standard of an RCT, some uses may still be therapeutic either directly or through placebo effect.

Reflections on Randomized Controlled Trials (RCTs)

Many MDs in the U.S. would say any beneficial effects of nutritional therapies are not “scientifically proven” because the gold standard RCT has not been rigorously designed, carried out, published in a peer-reviewed journal, and replicated. But should that stop you from using all such “unproven” therapies?

RCTs attempt to isolate one variable (e.g. one chemical compound, one drug, one behavior modification, etc.) so that efficacy can be proven and any side effects uncovered. It makes sense, of course, but perhaps not as the only standard for all development.  Humans are extremely complex. Isolating a single variable can be very difficult, and by design ignores many complex interactions.  This is particularly difficult in nutrition science. For instance, there are millions of interactions among the various macro- and micro-nutrients each person ingests. And these interactions occur within each person's individual biology, environment, stress levels, and on and on.

We always want a silver bullet, and most research funding comes from pharmaceutical companies that want to own the next big one. Despite decades of RCTs, we still have no silver bullet for dementia – perhaps we need to use another scientific model that better recognizes complexity.

One of my relatives has three degrees from world-leading universities, and has suffered from severe asthma for decades. He’s on four meds daily. I’ve told him that thousands of asthmatics deal very successfully with their condition through nutritional approaches, but he won’t buy it. It just isn’t “scientific.”

Should you use ACV? Do some of your own research, and decide if you’d like to try. It may or may not help, but it is unlikely to cause harm if you follow guidelines, such as dilution.

And here’s the standard and valid warning: check with your licensed medical provider before undertaking any major changes in your health regime. For instance, what if there is a detrimental interaction between ACV and a med you are on? Your licensed provider might say “Sure, try some ACV for that; it may or may not work. Let me know.” Or you might hear "Not while you are on xyz. Let's try something else."

But if he or she says “Treating illness with food (or acupuncture or chiropractic or meditation or a ketogenic diet…) is quackery”, you have two choices: follow that advice, or find a new provider.

And that’s my POV on ACV and RCTs!

Scientific knowledge about our various microbiomes - gut, skin, sinuses, etc. - is still young but growing rapidly, with new discoveries and ideas coming every day, it seems. Within this body of knowledge, I often get asked about probiotics, especially for gut health. Do you take them? If so, which ones?

I use various methods to help my microbiome along. First and foremost, I eat plenty of fresh, organic vegetables and fermented foods like kimchi and sauerkraut. I drink kombucha, and brew my own water-based kefir. I cuddle my dogs, who roll around on the ground picking up soil-based organisms. And while there's a long way to go for science to tell us which strain has exactly which effect for each individual, in the meantime I also choose to supplement with a rotation of probiotic pills, taking one every third day.

I'm going for variety. My rotation of Prescript Assist, Primal Probiotics, and the Swanson 16 product includes 50 unique strains. The occasional VSL#3 adds 3 unique strains.

What about the popular brands?

I steer people away from these popular brands, often recommended by the medical establishment (don’t get me started…) and found in major drug stores because they only contain ONE beneficial strain:

• Culturelle: one strain only: Lactobacillus GG, with a probiotic (chicory root)
• Align: one strain, a made-up marketing word they call Bifantis (actually B. infantis 35624)
• Florastor: one ingredient: s. boulardii, which I get in Primal Probiotics. An MD told my mother to take this after she was hospitalized with C. difficile. That's good - s. boulardii has been shown to be effective when battling C. difficile, but any single strain is insufficient for broader benefits.)

Feed the Microbiome with Prebiotics

Now that we’re getting more probiotics, we must feed them. Most of these beneficial (and also the pathological) probiotic strains establish colonies in the large intestine. Anything you digest must go through the prior digestive steps before reaching that hallowed hall, but these good colonies living further down the digestive system still must be fed. Hence, resistant starch, or starch that resists digestion until it reaches the large intestine. Here’s a good summary: http://www.marksdailyapple.com/the-definitive-guide-to-resistant-starch/ 

Mark Sisson mentions food sources, and has a link to a popular brand of unmodified potato starch from Bob’s Red Mill. I take about 3 teaspoons per week. If I ate more sweet potatoes, cooled rice, Jerusalem artichokes, and other sources of resistant starch I wouldn’t supplement.  That said, there’s a great recipe for scrambled eggs with potato starch. Many stores have a whole section of Bob’s Red Mill products; you can find lots of non-grain flours, for instance, for non-grain baking, pancakes, etc. I occasionally make grain-free pancakes for the grandkids.

If you decide to add more prebiotic foods and/or probiotic supplements to your diet, you might want to start with small amounts. We are all different, and your particular gut might need to ease into this change.

Addendum: Three Probiotics in My Routine

Here are three probiotics supplements I take in rotation. I've listed the ingredients to drive home the point about variety!

Prescript Assist Ingredients

Arthrobacter agilis
Arthrobacter citreus
Arthrobacter globiformis
Arthrobacter luteus
Arthrobacter simplex
Acinetobacter calcoaceticus
Azotobacter chroococcum
Azotobacter paspali
Azospirillum brasiliense
Azospirillum lipoferum
Bacillus brevis
Bacillus marcerans
Bacillus pumilus
Bacillus polymyxa
Bacillus subtilis
Bacteroides lipolyticum
Bacteriodes succinogenes
Brevibacterium lipolyticum
Brevibacterium stationis
Kurthia zopfii
Myrothecium verrucaria
Pseudomonas calcis
Pseudomonas dentrificans
Pseudomonas fluorescens
Pseudomonas glathei
Phanerochaete chrysosporium
Streptomyces fradiae
Streptomyces cellulosae
Streptomyces griseoflavus

VSL #3(capsule total: 112.5 billion CFU)

Lactobacillus acidophilus
Lactobacillus plantarum
Lactobacillus paracasei
Lactobacillus delbrueckii subsp. bulraricus
Streptococcus thermophiles
Bifidobacterium longum*
Bifidobacterium breve
Bifidobacterium infantis*

*Reclassified as B. lactis

 VSL #3 has a higher Colony Forming Unit (or CFU) count than most non-prescription probiotics. CFU is the standard measurement for probiotic amounts. Rick takes this VSL #3 occasionally.

Swanson Probiotics-dr-stephen-langers-ultimate-16

FOS (Fructooligosaccharides)
ConcenTrace® Trace Mineral Complex (from the Great Salt Lake, 72 naturally occurring minerals, plus other minerals found in seawater) – a prebiotic
Bifidobacterium bifidum
Bifidobacterium breve
Bifidobacterium infantis
Bifidobacterium lactis
Bifidobacterium longum
Lactobacillus acidophilus
Lactobacillus brevis
Lactobacillus bulgaricus
Lactobacillus casei
Lactobacillus helveticus
Lactobacillus plantarum
Lactobacillus reuteri
Lactobacillus rhamnosus
Lactobacillus salivarius
Lactococcus lactis
Streptococcus thermophiles

Primal Probiotics

Bacillus coagulans
Bacillus subtilis (only overlap with Prescript Assist)
Bacillus clausii
Lactobacillus plantarum
Bacillus Bifidus
Saccharomyces boulardii (a yeast; helps vs. diarrhea; refer to c. difficile)
Potato starch (50mg)

My wife and I live in a small town in southwestern New Hampshire, having escaped (mostly…) from urban life ten years ago. Every month or two we enjoy various combinations of family and friends visiting for a night , and each visit is cherished, often with hiking or skiing in the woods, swimming at the lake, games, music, long dinners, and conversations that solve all the problems of the world.

Overnight guests need breakfast, of course, and it is a wonderful time to gather informally in the kitchen or on the porch, sip coffee or tea, share crossword puzzles, and plan the day.  Our own breakfasts emphasize protein and fat, with a varying combination of farm-fresh eggs, bacon or sausage, nuts, yogurt, cheese, perhaps a little leftover salad, sauerkraut or kimchi, or recently some canned wild salmon.  We just tried poached eggs baked in avocados - yummy! No cereal or bread, and various fruits and berries usually come later.  We’ll usually offer all these – less the cereal and bread – for our guests.

We don’t have orange juice in the house. Put simply, it is mostly sugar.  It is not much different than having a glass of Mountain Dew; its few benefits are easily obtained through other, more nutritionally-dense foods, or even a multivitamin.  But overnight guests should be treated with love and respect at breakfast, and orange juice is a morning tradition for many.  One good friend says she simply cannot abide a day that does not start with orange juice.

So what to do?  Do we buy orange juice and feed this unhealthy drink to our dear friends, our children, our grandchildren?  What about stocking apple juice for the little ones – surely that’s better than stocking Coke? Should I give a mini-lecture on the health issues of too much sugar along with the glass of juice?  If I have such knowledge and am concerned about the health of my loved ones, where does my moral obligation kick in?

I don’t have a good answer to this. We usually buy and offer orange juice and leave the choice up to our guests.  In the past few years, we end up tossing it more and more often.  That’s good – more people are aware, changing long-held habits.

To learn more, here’s a 2014 study published in the journal Nutrition: Nutrition article 2014 Fructose content in popular beverages made with and without high-fructose corn syrup    For an easier read, here is an article based on that study: NPR article on sugar in soda and fruit juice 2014

A quote from that article that should give anyone pause, perhaps especially those feeding children: “The sneakiest — and sweetest — juice is Minute Maid 100 percent apple, with nearly 66 grams of fructose per liter. That's more than the 62.5 grams per liter in Coca-Cola and the 61 grams per liter in Dr Pepper.”

I’ve gathered some practical advice from some experts about sleep, but before jumping in, let’s make sure we understand why getting enough high-quality sleep is crucial to wellness.

You are probably aware that we sleep in cycles of both rapid eye movement (REM) and non-rapid eye movement.  Besides getting rest, other beneficial processes happen during these cycles. We relax, our blood pressure and core temperature drops, we restore our energy, and we release growth and other hormones into the bloodstream. We consolidate memory, turning short-term memories of the day into long-term memories, and even create new ones. (Ever wonder why we can’t hang on to all that information we crammed into our brains during a sleepless night before an exam?) We create long-term memories of physical activities we’ve done. We make new connections, even make decisions, and clean out toxins. And in REM, we dream.

So, it’s extremely important for every aspect of our health and longevity. Think of it this way: we can fast for months and survive. Many of us live for decades on junk food, rarely exercise, paying no attention to stress. But if we don’t sleep well, the next day is tough. If we don’t sleep at all one night, we are severely compromised. If we don’t sleep for just two days, we are downright dangerous. So why don’t we more actively manage our sleep?

Here are the simple rules of sleep hygiene promoted by two sleep experts. First, Michael J. Breus, Ph.D., is a Clinical Psychologist and both a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine:

1. Stick to a strict sleep schedule. Each of us has a circadian (circa = around, dia = day) rhythm, mainly established by the rising and setting of the sun, but also determined by our own patterns.
2. No caffeine after 2 p.m. It takes 6 - 8 hours to dissipate, and it effects the quality of sleep, even if you are one of those who can fall asleep after evening caffeine.
3. No alcohol 3 hours prior to bed. It helps us fall asleep (especially after a late coffee!), but it leads to restless, fragmented sleep.
4. No exercise 4 hours prior to bed – it raises your core temperature.
5. Get sun during the day, especially early, to help you maintain a good circadian rhythm.

Kirk Parsley, M.D., became a doctor during his U.S. Navy service. He has been a member of the American Academy of Sleep Medicine since 2006 and has served as Naval Special Warfare’s expert on Sleep Medicine.

1. Darken your room. Really, absolutely. Tape over the smoke alarm light. Get comfortable with a sleeping mask if necessary.
2. Remove electronics. He’s a Navy Seal, so when he says “remove” he means “remove.”
3. Get a large, comfy bed.
4. Maintain a cool to cold room. Remember, our core temp needs to drop. We evolved sleeping at night as our environment continuously cooled until sun up.
5. Maintain a quiet room, devoid of noisy distractions. Use ear plugs if necessary.
6. Get your body ready for sleep. (Rick’s note: I watch my son and daughter-in-law prepare their kids for bed, turning off any devices well in advance, gradually calming down, quieting their voices, cleaning up, changing into PJs, reading a final book, and then lights out. It takes a little time, but it works. My pulse is slowing and I’m getting sleepy just writing this… Why shouldn’t we adults practice calming routines that prepare us to sleep?)

I’ll add one more that appears on other lists: get some blue-light blocking glasses. Blue light from lamps, TV, laptops, iPads, and mobile phones tells that the sun’s still up, no reason to lower cortisol and increase melatonin now – you just thought it was dark. By itself, this won’t do the trick – better to just turn off all the devices – but combined with other ideas it may help.

Try those ideas first, please, but if you still have issues, here are two others:

1. Talk to your primary care physician (PCP), and ask about a referral to a sleep specialist. Get data from a sleep study.  I did this about 15 years ago, learned I had obstructive sleep apnea, and used a C-PAP (continuously positive air pressure) machine for years. It takes some getting used to, and you look like you’re a patient in the ICU, but it was wonderful to return to restorative sleep. As part of my own journey and losing significant weight, I no longer need it.
   Your PCP may suggest a “sleeping pill” like Ambien, but that should be a last resort. Just Google the myriad side effects of Ambien. That should scare you into trying something else…
2. Try natural supplements that promote falling asleep and/or higher quality sleep.

If you decide to supplement, magnesium may be the place to start. Many of us are deficient in magnesium anyway. Chinese medicine has recommended green tea, with its calming ingredient L-theanine. You might then try 5-HTP, a precursor to the natural hormone serotonin which helps calm us. You may need to supplement with 5-HTP for a few weeks to feel the effect. Next in line might be melatonin itself, but take a low dose – 0.5 mg or less. I’ve seen melatonin pills in pharmacies at 5 mg, 10 mg, and 20 mg, a really high dose of a hormone our body makes anyway. You could disrupt your natural production, cause drowsiness the next day, or even have an adverse reaction, like insomnia. Stop if you still need it after a few weeks and keep looking for the underlying cause to fix.

Doc Parsley spent considerable time formulating a natural sleep aid he sells as Sleep Remedy:

“Ingredients: simply very small amounts of the nutrients involved in the production of melatonin: L-tryptophan, 5HTP, Vitamin D3, Magnesium, and a very small dose of melatonin. Since an increase in brain GABA levels is also a normal player in the initiation of sleep, we have also included a small amount of a GABA derivative that can cross into the brain called “phGABA”. The quantities of each ingredient are intended to replenish normal levels of these nutrients, to allow for the normal production of melatonin, and to help initiate the initial cascade of events that lead to deep, natural sleep.”

I have not tried it, but if it is good enough for the U.S. Navy, it may be worth a try if other methods above don’t work. And remember, even Doc Parsley recommends that you follow his six rules first and only use his supplement if necessary.

Sleep soundly, my dears!

Bonuses: For more information about sleep, see the National Sleep Foundation.  And for a real treat, listen to the incomparable Renée Fleming sing “O Sleep Why Dost Thou Leave Me?” from Handel’s Semele.

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In my thirties through my fifties, my energies were spent on being a good husband, father, provider, community and church member, friend, and singer.  I paid some attention to exercise, and even ran the Boston Marathon twice.  If I could run 26 miles without stopping, especially at 5’11” and over 200 pounds, well, I must be doing something right. My nutrition at home was quite good thanks to my wife Jody, but I consistently made poor choices when given the chance, especially at work, dining out, and on the road, which was often.

I gained a pound or two or three every year, and over time developed hypertension, obstructive sleep apnea, and high cholesterol, etc. My primary care physician put me on different combinations of medications to control the hypertension and cholesterol. We paid scant attention to underlying causes, and worked on treating symptoms with pharmaceuticals. We rarely discussed losing weight or nutrition.  Perhaps he knew I had little appetite for dieting. I had plenty of colds, moved less, got hurt more often, and of course recovery takes more time with age. I was generally puffy and inflamed, and even though I used a CPAP machine to sleep at night, I never felt fully vigorous. Unfortunately, it’s a typical story.

So then what happened? Jody had just finished Gary Taubes’ book “Why We Get Fat and What to Do About It” and she wanted to share it; she knew it would appeal to me, and I’d learn a lot.  From the blurb on Amazon: “He reveals the bad nutritional science of the last century—none more damaging or misguided than the “calories-in, calories-out” model of why we get fat—and the good science that has been ignored. He also answers the most persistent questions: Why are some people thin and others fat? What roles do exercise and genetics play in our weight? What foods should we eat, and what foods should we avoid?”

That book launched me!  Finally, the scientific research story, told in words we could all understand – destroying conventional wisdom and exploding myths, sure, but mostly just giving us the science underneath what we’d been reading in dribs and drabs, all in one place. 

Much more learning followed – it was the beginning of a great and healthy and on-going adventure.  And here’s what happened: we had welcomed granddaughter Molly to the clan, Jody got a new haircut, and in the 8 months after finishing that book I dropped 40 pounds, stopped all the meds, tossed out the CPAP machine, and regained vitality.

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