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There Is Another Level Above “I’m Doing Fine”

How many times have we all heard this, or its equivalent?

“Sure, everyone knows soda and candy aren’t good for you…but why should I give up bread, pasta, muffins, and all that other wonderful stuff? I’m doing fine.

You can substitute any non-paleo foods of your choice, and you can phrase it a different way, but they’re all variations of the same question: “Why should I go to all the trouble to avoid almost everything in the grocery store and at restaurants, when I’m healthy and I feel fine?”

The implication is clear: “Sure, I know you’ve got some health problems and you need to be all weird about what you eat, but that’s because you’re abnormal. The rest of us live on that stuff, and we’re doing fine.

If I had to communicate one concept to the world at large—one reason to eat like a predator—it would be this:


There is an entire level of daily existence above “I’m doing fine.”

This is not to say that everyone in the world can suddenly stop taking all their medication and flaunt their new six-pack at the beach! What I mean is: there are many, many annoyances we take for granted as part of aging, or part of life, that are actually consequences of an evolutionarily inappropriate diet of birdseed (known as “grains”) and birdseed extracts (known as “vegetable oils“).

Are You Sure You’re Healthy? Half Of America Takes Prescription Medication

First, are you sure you’re healthy? Half the people in America (47.9%) took at least one prescription drug in the last month, one in five (21.4%) took three or more, and the numbers increase each year. (Source: CDC FastStats, “Therapeutic Drug Use”)

Figure 1

We can’t blame this entirely on old people living longer, either: 48.3% of people 20-59 are taking at least one prescription drug, right in line with the average.

Figure 2

These drugs are almost all used to treat chronic disease. The top five classes of prescribed medication are: 1. Lipid regulators (statins and other cholesterol-lowering drugs), 2. Antidepressants, 3. Narcotic analgesics (pain relievers), 4. Beta blockers (blood pressure drugs), 5. ACE inhibitors (blood pressure drugs). (The full list can be found here.)

Are You Sure You’re “Fine”?

Even if you’re not on prescription medication right now, are you really “fine”?

  • Do you need caffeine in order to wake up in the morning, or not fall asleep after lunch?
  • Do you still suffer from acne? Headaches? Acid reflux?
  • How about stiffness and joint pain? Gas and bloating?
  • Do you sleep through the night?
  • How quickly do you go through that bottle of Tylenol or Aleve? How about the cortisone, to deal with that random itchy, flaky skin?
  • Are you convinced that you must continually restrict your eating to maintain a healthy bodyweight—let alone the body composition you want?
  • What’s that stuff hanging over the top of your belt? Even if you don’t care about your appearance, imagine how much lighter on your feet you’d feel if you didn’t have to carry around that extra twenty pounds.
  • Can you go more than five hours without food, without becoming weak and shaky?

Biochemical Individuality: Everyone Is Different (within limits)

Not everyone starts with the same problems…and not everyone will see the same improvements. Furthermore, while I’ve never heard of anyone experiencing anything but positive effects from removing birdseed (“grains”) and birdseed extracts (“vegetable oils”) from their diet, it can take months of experimentation and tweaking to find out what types and proportions of Paleo foods produce the best results for you.

For example, we have the ongoing Potato Wars: some people (often the young, male, and/or athletic) radically improve their performance and mood by increasing their starch intake, while others (often older and/or female) find that there’s no such thing as a “safe starch”.

While I personally consume an approximately Perfect Health Diet level of starch, and I view their recommendations as an excellent baseline for beginning your own experimentation, I’m also an athletic male who has never been fat—so I don’t feel the need to evangelize my own potato consumption to those with a radically different hormonal environment.

Frankly, I find the religious fervor somewhat disturbing—and I can’t resist the observation that (with the exception of Paul Jaminet, whose sense of humor still slays me every time) the most vocal proponents of high starch intake tend to be somewhat…starchy. Lighten up! There’s no Low Carb Mafia enforcer waiting to assassinate you, and the Low Carb Boogeyman isn’t going to pop out from under your bed and force-feed you with butter until the Ketostix turn purple.

As for myself, I’m much more concerned with reaching the hundreds of millions of people who still think margarine and whole-grain bagels are healthy.

So don’t be discouraged if your health issues don’t immediately vanish, or you reach a weight loss plateau. It took decades of unhealthy eating to cause your problems…don’t expect healthy eating to fix everything in a week or two. (Or even a couple months…I was still experiencing perceptible improvements after nine months.)

My Own Level Beyond “I’m Doing Fine”

Here are some unexpected improvements I’ve seen in my own life. (Warning: N=1 ahead.)

  • I used to be “that guy.” If I didn’t get to eat every 3-4 hours, I became cranky, snappish, and no fun to be around. Now I often fail to eat for 18 hours or more, simply because I’m not hungry.
         I can’t overemphasize how liberating it is to not have to find and ingest calories every few hours. Not only does it make traveling much easier…I have more useful hours in my day, and when I become engrossed in work or play, I don’t have to stop prematurely because I’m hungry.
  • I’ve never been fat, but I still lost about an inch around my waist…which must have been visceral fat, because there wasn’t much subcutaneous fat to lose.
  • After about a year, I noticed that the dark circles under my eyes were gone.
  • I don’t fall asleep after lunch anymore.
  • Acne is rare. So is itchiness.
  • I sunburn far less easily.
  • My dental health has improved dramatically.
  • Life is more enjoyable when I don’t feel guilty for eating delicious food.
  • It’s difficult to quantify, but my baseline mood is improved. I am happier and more confident than I’ve ever been.

Result: I’m in the best physical and mental shape of my life. I don’t feel “fine”: I feel great. Some days I even feel unstoppable. And while I still experience all the usual setbacks, like unrequited love, insufficient money, and dysfunctional bureaucracies, they don’t seem to crush me like they used to…

…and that’s why I still eat like a predator.


There is an entire level of daily existence above “I’m doing fine.”

Live in freedom, live in beauty.

JS


Yes, this is what being human is supposed to feel like. Help me out, readers: what unexpected improvements have you seen, and how can we best communicate this to others? Please leave a comment—and consider forwarding this to anyone you’ve been unable to get through to by other means. The share widget is below.

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Dental Health And The Paleo Diet: Gingival Sulcus Depth, Periodontal Disease, Systemic Inflammation, and Some N=1 Data

I recently visited the dentist for my regular six-month cleaning and checkup.

One mysterious practice you might recall from your own checkup is your hygenist probing around your gums with a pick, while calling out a bunch of numbers that someone else dutifully records in a computer.

This isn’t some mysterious rite of Dental Magick: they’re measuring the depth of each gingival sulcus—the space between your tooth and your gums. Ideally, in a healthy mouth with healthy gums, this space is approximately 2mm deep, a depth easily reachable and cleanable by regular brushing.

However, most people do not have a healthy mouth with healthy gums. Somewhere between 30 and 50% of the US population has mild periodontitis (inflammation of the gums), with approximately 10% having severe periodontitis.

Plaque and Periodontitis: A Vicious Cycle

The usual cause of periodontitis is dental plaque (a bacterial biofilm), which accumulates in the gingival sulcus. The resulting inflammation causes the sulcus to deepen, beginning a vicious cycle: more plaque = more inflammation = deeper gingival sulcus = more plaque.

A depth of 4mm or more almost always indicates a degree of permanent damage and chronic infection, and is termed a periodontal pocket. Since pockets deeper than 3mm are generally too deep to clean by brushing one’s teeth at home, they tend to become deeper and worse over time, leading to chronic periodontitis—and a depth of 7mm creates a strong risk of tooth loss.

Periodontitis Causes Constant, Low-Grade Inflammation

Even if the pockets never reach this depth, the continual low-grade oral infection of periodontitis (known colloquially as “gum disease”) causes systemic inflammation. We know this is a causal relationship, not just a correlation, because successful treatment of patients with severe periodontitis results in lower CRP and IL-6 levels:

J Clin Periodontol. 2004 May;31(5):402-11.
Periodontitis and atherogenesis: causal association or simple coincidence?
D’Aiuto F, Parkar M, Andreou G, Brett PM, Ready D, Tonetti MS.

“A median decrease in serum CRP of 0.5 mg/l (95% CI 0.4-0.7 mg/l) was observed 6 months after completion of periodontal therapy in this population.”

Also see:

J Periodontal Res. 2004 Aug;39(4):236-41.
Periodontal disease and C-reactive protein-associated cardiovascular risk.
D’Aiuto F, Ready D, Tonetti MS.

Given this, the strong association of periodontitis (“gum disease”) with deaths from coronary heart disease (= CHD, = “atherosclerosis”, = the blockage of the coronary arteries due to arterial plaque) should not be surprising.

J Periodontol. 2007 Dec;78(12):2289-302.
Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis.
Mustapha IZ, Debrey S, Oladubu M, Ugarte R.

RESULTS: Periodontal disease with elevated markers of systemic bacterial exposure was associated strongly with CHD compared to subjects without PD, with a summary odds ratio of 1.75 (95% confidence interval (CI): 1.32 to 2.34; P <0.001). This group was not associated with CVD events or with stroke but was associated with a significant increase in mean CIMT (0.03 mm; 95% CI: 0.02 to 0.04).

In further support, periodontitis is associated with lower HDL, higher LDL, and increased non-fasting blood glucose:

J Clin Periodontol. 2007 Nov;34(11):931-7. Epub 2007 Sep 17.
Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case-control study.
Nibali L, D’Aiuto F, Griffiths G, Patel K, Suvan J, Tonetti MS.

Summary: Our Story So Far

  • Dental plaque is a bacterial biofilm that accumulates on our teeth.
  • Plaque causes tooth decay—because of the acids the plaque bacteria produce when they ferment sugars in our mouth.
  • A gingival sulcus (the space between tooth and gum) deeper than 3mm allows plaque to accumulate unmolested by regular brushing. Its ideal depth is 2mm.
  • Plaque accumulation is usually a vicious cycle: more plaque = more inflammation = deeper gingival sulcus = more plaque.
  • A sufficiently deep sulcus is known as a periodontal pocket, which usually leads to periodontitis (“gum disease”), and sometimes tooth loss.
  • Periodontitis causes systemic inflammation. It is associated with increased risk of heart disease, and with several bad metabolic markers.

Result: we would like all the measurements our dental hygenist calls out to be 2s (signifying a depth of 2mm), with perhaps a few 3s.

A Paleo Diet And My Own Gum Health: Some N=1 Data

I’ve cautioned about extrapolating based on personal experience (“N=1″) before, so I’ll preface this with “correlation is not causation, etc.” However, my warning applies primarily to proving the negative: just because something doesn’t make us feel bad or kill us within a few months doesn’t mean it’s either harmless or good for us!

If we take objective measurements and/or a consistent record of our observations, though, and are careful to evaluate possible confounders (was it that I started eating liver and pastured eggs, or that I got a new job and am sleeping better now that I don’t have to worry about making rent?), it’s often reasonable to correlate improvements with changes we’ve made.

To that end, here is some fascinating data I was able to obtain from my dentist’s office. I think the data is reasonably solid: my measurements were all taken by the same hygienist in the same office, I’ve used the same Sonicare toothbrush and kept the same program of indifferent dental hygiene, and my diet hasn’t changed radically.

Links updated 10/13!

Note that there are several different types of Sonicare toothbrushes: the type I linked above works best, is easiest to clean, and its battery lasts the longest. And if you need two, here’s a two-pack at a discount.

Also note that I was already eating a strongly anti-inflammatory diet previous to “going Paleo”: I had independently found the original research on n-3/n-6 ratio, and had long since removed all seed oils from my diet (I was rendering my own beef tallow back in 2007!) The major dietary changes were going gluten-free, grain-free, and legume-free (except for occasional white rice), and dramatically decreasing my carbohydrate intake—mostly as a consequence of no longer eating bread or pasta.

I went Paleo between the first and second measurements. Therefore, the first set of measurements (#1 on the far left) is my pre-Paleo baseline.

Each tooth is measured six times: at the center and each edge, both front and back. Thus, there are 28x2x3 = 168 such measurements if your wisdom teeth have been removed, 192 if you still have them. For those interested in the raw data, here’s a scan:

Note that there are no 4mm pockets at all after the third set of measurements.

Result: starting from a reasonably healthy mouth and an already strongly anti-inflammatory baseline diet, my oral health has improved dramatically—to the point that my dentist told me “Your teeth are great! Whatever you’re doing, keep doing it.”

I have also experienced subjective improvements. My teeth are much less sensitive than before: I used to dread the approach of the electric tooth scaler at each cleaning (it was painful to the point that I would white-knuckle the armrests) but now it doesn’t bother me at all. They’re far less sensitive to cold as well, and less prone to bleeding when I neglect to floss for days or weeks.

In short, while I can’t rule out coincidence, it certainly appears that my excellent dental health is strongly correlated with eating like a predator.

Live in freedom, live in beauty.

JS

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Book Review: “It Starts With Food,” by Dallas and Melissa Hartwig

Buy "It Starts With Food" from Amazon

What Is The “Whole 30″?

There are two approaches to “going Paleo”: the “taper off” approach, in which you eliminate non-Paleo foods from your life in multiple steps as you feel ready, and the “boot camp/detox” approach, in which you commit to a completely new diet all at once.

The most vocal and successful proponents of the boot camp/detox approach to Paleo are Dallas and Melissa Hartwig. In their “Whole30″ program, you commit to eating 100% strict Paleo for 30 days. No cheat days, no 80/20 rule, no white rice or white potatoes, no exceptions. The purpose of It Starts With Food is simple—to get you to do a Whole 30—and the Hartwigs are betting that your health and life will improve so greatly that you’ll stick with it…

…or at least be cautious about re-introducing non-Whole30 foods, so you can rationally evaluate the effect of each one instead of simply falling off the wagon.

What Distinguishes “It Starts With Food” From The Other Paleo Books Out There?

What distinguishes the different Paleo books isn’t so much their actual dietary recommendations. Sure, the Perfect Health Diet permits white rice and white potatoes, both it and the Primal Blueprint are moderately tolerant of dairy, and there is still a bit of push-pull over optimal fat and carb content…but at the end of the day, everyone agrees that meat and vegetables ought to be the foundation of our diet (plus eggs unless you’re allergic, and fruit in moderation), and that anything containing grains, seed oils, and/or refined sugar is right out.

Therefore, I won’t spend a lot of time on the factual content of It Starts With Food, because it won’t be surprising to anyone in the paleo community—especially if you’ve already read Robb Wolf’s The Paleo Solution, of which ISWF’s middle sections are, in most respects, a less chatty and informal version. (Although ISWF is explicitly saturated fat-tolerant, though not fat-philic, and it’s worth noting that clarified butter gets a hall pass.)

What distinguishes ISWF is the approach it takes to advocacy. For instance, the Perfect Health Diet is primarily based on modern-day biology and biochemistry, and the Primal Blueprint works mostly from an evolutionary context. In contrast, It Starts With Food bases itself on changing your relationship with food, using a tough-love (though not harsh) approach throughout.

“The food you eat either makes you more healthy or less healthy. Those are your two options. There is no food neutral; there is no food Switzerland…” (p. 12)

However, it’s not all whip-cracking and ominous warnings. Aside from the usual promises of better health, relief from sickness, etc.—anecdotes of which are planted throughout the text—Chapter 4 closes with the following promises:

First, you will once again be able to appreciate the natural, delicious flavors (including sweet, fatty, and salty) found in whole foods.
Second, the pleasure and reward you experience when eating that delicious food will once again be closely tied with nutrition, satiation, and satiety—you’ll be able to stop eating because you’re satisfied, not because you’re “full”.
Third, you will never again be controlled by your food. (p. 38)

The Hartwigs maintain these themes throughout: if you eat according to the Whole 30, you ought not to have to count calories, always be hungry, or continually crave cheat foods.

Goal: To Sell You The Whole30

The Hartwigs’ stated goal is to convince you that it’s a good idea to do the Whole30—to be strict Paleo for 30 days straight—without cheating. And since they know that most such New Year’s Resolution-styled efforts end in abject failure, they want to make it as easy for you as they can.

Then, after you’ve been “clean” for 30 days, you can start evaluating your favorite non-Whole30 foods to see what effect their reintroduction has on you.

Does It Succeed?

I think the best argument for trying a Whole30 is found on page 204:

“Think of it like this. You’re allergic to cats, and you own ten of them. One day, fed up with your allergies, you decide to get rid of nine of your cats. Will you feel better?”

And the reason I think this book will succeed in convincing many people to try a Whole30 is primarily because of Chapter 16 (“Meal Planning Made Easy”) and Appendix A (“The Meal Map”). Too many diet books, paleo and otherwise, leave the reader with a giant list of forbidden foods (including everything you eat on a daily basis) and, if you’re lucky, a thinly veiled advertisement for another book with actual recipes in it. “Now what do I do?” you think.

In contrast, these two chapters of ISWF tell you everything you need to complete a Whole30 on your own. Their quantity guidelines are both simple and refreshing (“one to two palm-size servings of protein” … “a meal-size portion is the number of eggs you can hold in one hand”). Even better is their mix-and-match approach to meats, vegetables, spices, and sauces, which allows the reader to create hundreds of their own dishes using the flavor combinations they personally find most palatable.

I’ve been using the “one-skillet cooking” technique for quite a while, and Appendix A has given me several new ideas to try.

(Minor Quibbles)

I do have a couple nits to pick. The information on magnesium left out the important fact that if magnesium citrate gives you the runs, other chelates, like malate and glyclnate, have a much reduced laxative effect. Also, ghee and clarified butter are not the same thing! (To make ghee, you must “toast” the residual proteins before pouring off the pure butterfat.) And while this isn’t a quibble, it’s worth noting that “coconut aminos”—a common ingredient in the recipes—are a soy sauce substitute.

However, this is small stuff.

Conclusion

It Starts With Food successfully balances encouragement, tough love, and a simple yet option-rich meal plan to produce a solid, well-placed motivational kick in the butt. In other words, it’s everything you need to do a Whole30 except your own desire and willingness to try it.


Disclaimer: I received two free copies of this book, and gave one away to a lucky member of the gnolls.org mailing list. And if you buy a copy of It Starts With Food from any of the Amazon links on this page, including this one, I get a small spiff. (At no cost to you…buying stuff through my affiliate links is a great way to make Amazon contribute to gnolls.org. Note that you can buy anything, not just the item you clicked through to.)

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