Qi…“matter on the verge of becoming energy, or energy at the point of materializing.”
…Ted Kaptchuk, The Web that Has No Weaver

In ancient times, centuries before the days of modern biochemistry, healers in the East used sensitive observation to develop highly sophisticated systems for promoting health, longevity, and healing. They saw the world through a holistic lens in which mind, body, and spirit participated in the same vital force energy (“Qi,” pronounced “chee”) and in which everything interrelates—working as interdependent parts to create balance and harmony within the larger universal system. Qi was the prime mover, the vital energy that pervaded all things. In contrast to the focus on physical matter in the West, Chinese healers adopted an energy-based medicine that defined health states and healing strategies in terms of energy/Qi.

It is fascinating, with their focus on Qi more than two thousand years ago, that Chinese healers implicitly recognized the modern quantum physics concept of complementarity—the ability of an entity to be simultaneously two opposite things. Through quantum physics and particle/wave theory, we in the West are beginning to appreciate and incorporate into our thinking the duality-dance of matter and energy, and, with it, the important role that energy medicine can play in supporting and prolonging physical health.

The Chinese Body-Energy Clock

For some time, I have been fascinated by Chinese Five Phase theory and the Body Clock. Both models present with economy and simplicity wisdom distilled over centuries. Now that these models are familiar to me, I find myself turning to them time and again. Five-Phase Theory (see earlier newsletters) incorporates extensive wisdom about mind-body states and how these correspond to organ systems, seasons of the year, elements, and foods.

The Body-Energy Clock, our subject here, is built upon the concept of the cyclical ebb and flow of energy throughout the body. During a 24-hour period (see diagram that follows) Qi moves in two-hour intervals through the organ systems. During sleep, Qi draws inward to restore the body. This phase is completed between 1 and 3 a.m., when the liver cleanses the blood and performs a myriad of functions that set the stage for Qi moving outward again.

In the 12-hour period following the peak functioning of the liver—from 3 a.m. onward—energy cycles to the organs associated with daily activity, digestion and elimination: the lungs, large intestine, stomach/pancreas, heart, small intestine. By mid-afternoon, energy again moves inward to support internal organs associated with restoring and maintaining the system. The purpose is to move fluids and heat, as well as to filter and cleanse—by the pericardium, triple burner (coordinates water functions and temperature), bladder/kidneys and the liver.

Lessons Based on the Body Clock

When one organ is at its peak energy, the organ at the opposite side of the clock, 12 hours away, is at its lowest ebb. For example, between 1-3 a.m., the liver reaches its peak, doing its work to cleanse the blood, while the small intestine, the organ responsible for the absorption and assimilation of many key nutrients, is at its ebb. What does this tell us? Principally, that it must be taxing to the system to deal with late night meals and snacking. The body is not programmed to accommodate the modern habit of late-night screen-based stimulation and the eating habits that go with it. When we eat late at night, food is not well absorbed by the small intestine and the liver has little opportunity to do its job of housekeeping.

The idea, then, is to try when you can to plan daily activity around an organ system’s peak energy, while avoiding actions that can tax a system when its energy is at its lowest ebb. Think of lifestyle habits you might modify in order to better synchronize your system’s energy ebbs and flows:

• Lungs: With the lungs at their peak energy in the early morning, you might want to schedule aerobic exercise at this time rather than later in the day. And, if you must speak through the long work day, presentations given earlier in the day benefit from greater lung energy. Laryngitis can set in late afternoon when lung energy is depleted .
• Large Intestine: To get the day off to a good start, give yourself enough time early in the morning to honor the normal elimination function of the large intestine.
• Stomach/Pancreas/Small Intestine: Try to eat heavier meals early in the day—at breakfast when the stomach is at its peak, and at lunch, to catch Qi’s expanding/warming energy as it crests at midday. Eating larger meals of the day early delivers nourishment to the small intestine when it is strongest, which aids absorption and assimilation.
• Kidneys: The kidneys are aligned with the adrenals, the glands that produce cortisol to help us spring out of bed in the morning. Early morning, from 5 a.m.-7 a.m., is when kidney energy is weakest—a reason that people with depleted kidney energy often have trouble waking up to a new day.
• Liver: The liver stores and cleanses the blood, a fact that becomes more interesting as we consider personal experience. Have you ever partied too much in the evening, and awakened in the wee hours of the morning feeling “off” and unable to fall back to sleep? Chances are good that you were tossing and turning between the hours of 1 a.m. and 3 a.m. when your alcohol over-loaded liver was struggling to do its work. The timing of the liver’s peak activity also speaks to consuming the last meal of the day as early as possible. The liver’s daily programming assumes an early dinner and bedtime. Before electricity and the light bulb, people ate super and retired early, allowing time for the last meal of the day to digest so that the liver could be most effective in its peak hours of activity. The “work shift” of the liver, then, reinforces the concept of making the last meal of the day a light one that is consumed on the early side. The more time that passes after food is eaten before peak activity of the liver, the better the liver will be able to carry out its myriad of functions.

I hope this brief overview of the Chinese energy model—something not common in our Western vocabulary—might help you think in new ways. When we honor the body’s inherent flow of energy, we work in harmony with its natural rhythms and avoid taxing it unnecessarily.

Reading Resources:

• Harriet Beinfield and Efrem Korngold, Between Heaven and Earth
• Ted Kaptchuk, The Web That Has No Weaver
• Paul Pitchford, Healing With Whole Foods

Stress elevates cortisol, and staying up late throws off the body’s natural cortisol rhythm.  Because cortisol is the fat storage hormone, chronic stress keeps cortisol elevated and encourages weight gain, particularly in the form of belly fat.  The connection between stress and cortisol is one of the reasons that whatever aerobic exercise you choose should be one that you enjoy.

Cortisol’s Functions in the Body

Cortisol is a vital hormone that helps us deal with stress.   Cortisol makes us active and mentally alert and, since it enters the brain to deliver glucose for energy, it also works to aid learning and memory.  In times of stress, cortisol teams with adrenaline to balance our energy:  It replenishes the body’s energy stores depleted by the “adrenaline rush” and converts the foods that we eat into storage forms, such as fat and glycogen.  We need cortisol.  It helps us spring out of bed in the morning to be mentally alert after a good night’s sleep.  But to work well for us, we need cortisol to ebb and flow in its own natural rhythm—rising early in the morning, gradually diminishing throughout the day and evening to reach a low around midnight to allow us a full night of restful/restorative sleep.

Unfortunately, our modern lifestyle—of late-night eating and activity, as well as daytime multi-tasking and lack of exercise—throws off the body’s natural cortisol clock.  Eating and electronic stimulation from television and computers elevate cortisol.  So, too, does chronic stress:  Because the brain is linked to the endocrine system (through the HPA axis, the hypothalamus, pituitary, and adrenals) just thinking about a stressful situation, whether an important work deadline or the frustration of a traffic jam, elevates cortisol.  Confined in an office or in the midst of a traffic jam, we have little opportunity to work off the energy mobilized by the stress response, so cortisol remains in our blood stream and tissues.

Cortisol does not work in a vacuum.  It partners not only with adrenaline, but also with dopamine and a host of other hormones and neurotransmitters.  Cortisol tends to diminish DHEA, growth hormone, and testosterone (an anabolic hormone that affects mood, skin, tendons, muscle mass, metabolism, and the immune system).  It also reduces the effectiveness of insulin (which can lead to insulin resistance).   These are some of factors that underpin why too much cortisol:

• Keeps us in a fat storage mode and keeps us hungry:   Cortisol leads to excess storage of abdominal fat, since abdominal fat is particularly attuned to cortisol.   [Abdominal fat also generates additional cortisol to keep us hungry and exacerbate insulin resistance];
• Prevents insulin from delivering glucose to muscles (a precursor of insulin resistance and diabetes);
• De-mineralizes bones and teeth (stress is an insidious factor in osteoporosis!);
• Accelerates the loss not only of bone mass but also of cartilage and muscle;
• Upsets the immune system and suppresses immune function over the long-term which can lead to a variety of diseases, as well as auto-immune issues; and
• Affects the brain and memory:  Unlike adrenaline and insulin which do not cross the blood-brain barrier, cortisol can enter the brain where it delivers glucose for energy and aids memory by enhancing glutamate and promoting neuron “excitability”—but, too much leads to depression, exhaustion of nerve cells, and shrinking of the hippocampus (a key for memory).

The Cortisol Clock

Sleep is by far the best way to manage stress.  It does more to restore the body than yoga, meditation, or other stress-relieving activities¹. Sleep is the body’s natural way to meditate.  We might think of sleep as “vitamin S”…as essential as any micronutrient for ensuring health.  Just as our soil is overworked and depleted of nutrients like the food that it grows, our modern hectic lifestyle erodes our vitamin S:  In 1910, the average adult was still sleeping nine to ten hours a night.  Now, the typical adult barely gets seven hours of shut-eye.  And, it is not just a question of quantity but also quality:  If evening cortisol levels are abnormally high, either from a day of chronic stress and/or late-night stimulation and eating, then sleep may be light and interrupted, with little nighttime sleep of the deep-restorative kind.

When we do not get enough sleep or when our sleep is not coordinated with daylight, we throw off the natural timing and intricate balance of hormones, including serotonin, dopamine, and melatonin, as well as the neurotransmitters in the brain.  While the intricacies of biochemistry are hard to follow, let alone to remember, we do not need to understand these concepts  to learn how better to deal with stress.

Instead, we can simply focus on cortisol—the major hormone associated with stress—and the lifestyle factors that can help control it so it works for, and not against us.  What I hope you will take away from this newsletter is the visual picture (below) of the natural daily ebb and flow of cortisol.  We want to strive to adjust daily habits, to the degree that we are able, in order to encourage these natural cortisol rhythms.

Cortisol normally peaks in the early morning hours between 6 a.m. and 8 a.m., and it bottoms out around midnight.  After reaching its early-morning peak, cortisol drops off sharply throughout the day, often leaving us with a dip in energy in late afternoon.  The body is really programmed for a light dinner around 5 p.m., followed by an early bedtime about three hours later².

We can raise our cortisol and energy levels by eating meals (note the cortisol spikes around mealtime and snack breaks, which represent the impact of consuming food).  Other factors that boost cortisol include exercise; stimulants such as caffeine; and, of course, stress, which can include actual situations that are stressful/frustrating, as well as the times when we simply think about and anticipate them.

Source:  James L. Wilson,Ph.D,  Adrenal Fatigue

When I visualize this chart, I am inspired to eat a good breakfast, a hearty lunch and a lighter dinner.  Regular meals and snacks help maintain cortisol levels throughout the day.  The chart also suggests we might think twice about staying up late to finish emails or to watch the final exciting moments of a late-night sporting event.  It also means trying to plan as many social times around breakfast and lunch rather than late dinners, since the body is best served by a light, early supper.

Strategies to Lower Stress

Sleep: Sleep is the best defense against stress. Sleep is also the best strategy against weight gain since sleep lowers cortisol and insulin (the fat storage hormone) and helps prevent insulin resistance.  In addition, sleep boosts growth hormone (builds muscle mass) and leptin (curbs hunger and cravings for carbohydrates).    Sleep is also important for immunity, fertility, and mood:

“The immune system that controls metabolism…wages a battle every night when you sleep against bacteria and viruses.  Sleeping is actually ‘thinning the herd’ of bacteria…an adaptation that helps us get the jump on bacteria every planetary rotation.”  …T.S. Wiley

 

Sleep researchers at the University of Chicago found that the cortisol levels of people averaging just 6.5 hours of sleep were 50 percent greater and their insulin function was 40% lower compared to subjects getting 7.5-8.5 hours of sleep.  Similarly, a Yale study of more than 1700 men living on fewer than 6 hours of sleep a night “doubled their risk of weight gain and diabetes because of excess cortisol exposure and its interference with insulin metabolism and blood sugar control³.”

Just following an early-to-bed policy for a week can reset cortisol levels.   And, once you succeed in lowering cortisol, you have a greater chance of deep, restful nighttime sleep to help perpetuate early waking, daytime alertness, and future nights of restful sleep.

How much sleep do you need? Sleep researchers tell us that the typical person, if free to choose, will sleep 8 hours and 15 minutes.   I need a solid 8 hours, but I have family members who seem to thrive on much less (though they often nap in their chairs!).  How much sleep is optimal is a personal matter.  Do you wake up in the morning eager to get out of bed?  Do you need stimulants like coffee to get going?  Do you rely on caffeine to get through the day?  Do you feel mentally “off?”  Do you rely on naps?  If you answer in the affirmative, chances are good that you are not getting adequate sleep at night.

Strategies for sleep. Develop a relaxing bedtime routine and follow a regular bedtime schedule.  Go to bed and get up at the same time (when possible).  Try not to nap more than 20-30 minutes, and do not make napping a regular habit.  Make sure the room is dark to help your body make melatonin.

Avoid caffeine beyond lunch time and alcohol in the evening (it can awaken you between 1-3 a.m.).  Because it takes energy to fall to sleep, a very light carbohydrate snack may help you drop off to sleep.

Try to get some vigorous exercise each day, but not too close to bedtime; as well as exposure to the sun.

Exercise. Aerobic exercise and lifting weights can counter the effects of stress-related cortisol.  Enjoyable aerobic exercise helps burn off energy mobilized and stored in the muscles by stress.  It helps reset the body clock from jet-lag.  Exercise also heightens the body’s sensitivity to cortisol and insulin, so it can get by with less.  Be sure to choose an activity you enjoy.  Torturing yourself with exercise you dislike elevates cortisol and becomes self-defeating.

Weight training builds muscle mass, which is important for metabolism since a pound of new muscle is estimated to burn 50 additional calories a day.  Weight training helps to counter the normal muscle loss associated with aging:  While muscle strength can be sustained through age 50, it tends to decline by about 20 percent through age 70, and by 40 percent by age 80⁴. Lost muscle impairs balance and means slower metabolism, reduced insulin resistance and hormone function, lowered immunity, weaker bones, decreased conditioning and aerobic fitness.

Massage; Yoga; Meditation; Prayer; Time Outdoors. These are all effective ways to lower cortisol, but only if they are activities that you enjoy.  If trying to make time for a yoga class adds stress to your day and makes you feel guilty, sitting quietly in a chair listening to your favorite music might be a better choice.  Whatever you choose should be fun, stress-free, and enjoyable.

Cook, Knit, Play Games. If you like kitchen arts, cooking can relieve stress and be empowering.  Cooking, like knitting, can be creative and offers a sense of control at least over a small portion of life.

Eat Breakfast, Eat Lunch, and Enjoy Daytime Snacks. Breakfast is the most important meal of the day.  We need food to meet the 6-8 a.m. cortisol crest of early morning.

Try Not to Diet. Studies show that dieting is stressful and therefore boosts cortisol levels.  Eating at the right times of the day—breakfast, lunch, snacks, and an early dinner—helps keep cortisol on track.

Reading Resources

• Bruce McEwen, The End of Stress as We Know It
• Shawn Talbott, The Cortisol Connection
• T. S. Wiley, Lights Out:  Sleep, Sugar, and Survival
• J. E. Williams, Prolonging Health
• James L. Wilson, Adrenal Fatigue

1. Shawn Talbott, Ph.D., The Cortisol Connection, 141.
2. Talbott, 99.
3. Talbott, 142.
4. J.E.Williams, Prolonging Health, 38.

What is a “good” breakfast? It is anything that sustains you throughout the morning. The test of a good breakfast is…How do you feel at 10-11 o’clock? If you do heavy outdoor physical labor, you may need relatively more carbohydrates (and fats in winter) than if you sit at a desk, where you may need slower-burning, sustaining whole grains, proteins and fats. In general, a good rule of thumb for any meal, including breakfast, is to aim for one-third of all calories to be spread evenly over the three macronutrients—proteins, carbohydrates, and (traditional) fats.

Eating “Upside-Down”
Planning to eat a good breakfast really begins the night before. We sow the seeds of a good breakfast when we eat early enough and lightly enough in the evening so that we wake up hungry. We also sow the seeds of a good breakfast when we retire 30-60 minutes earlier than we might otherwise so that we can use this time at daybreak for breakfast. Think of it as an investment in morning productivity. The fact that more than 80% of retired people eat breakfast suggests that many more of us would eat breakfast if we allocated the time to do so.

Eating a good breakfast also starts with planning in advance, perhaps the day or evening or weekend before, to have something delicious to wake up to. This could be any balanced protein/fat/carbohydrate combination that appeals to you– piping hot whole-grain porridge with dried fruits and nuts and butter/cream/milk; lentil or split pea soup with hearty whole grains or accompanied with whole grain bread, organic peanut butter muffins, or banana-nut oatmeal treats; a chicken sandwich on sourdough bread; a can of wild sockeye salmon mixed with whole grains and leftover soup or vegetables; or, of course, eggs fixed in any way to suit your fancy. Egg custard, a favorite of many children, can be breakfast with a whole grain muffin. One of my own favorites is to have a bowl of steel cut oats with a couple of poached eggs mixed in. Eggs are nutritious and the combination of protein and fat provides real staying power. Baking muffins and preparing soups can be done on weekends; whole grain hot cereals can be cooked overnight in a rice cooker or even in a thermos…thermos oatmeal…to be taken with you. If you are trying to cut back on coffee, think savory rather than sweet foods. A sweet muffin demands coffee far more than a bowl of lentil soup or a chicken sandwich. [See recipes that follow.]

Crowding out Breakfast
Skipping breakfast was rarely an issue a century ago when women worked at home caring for children and when homemaking was seen to have value. The tendency to skip meals traces the entry of women and mothers into the labor force. According to the most recent data from 2008, 60% of all women are in the labor force. Mothers with children under 18 have the highest participation rate of any broad group (71%), and of subgroups of working mothers, the highest rate by far (78%) is by mothers with children aged 6-17. [The next highest at 63% is by mothers with children under 6. The lowest rate, 53%, of any group is by women with no children under 18 in the household.]

Today, time-squeezed two-income households as well as the ready availability of boxed breakfast cereals, prepared breakfast snacks such as Pop-Tarts, and fast-food breakfast options help explain the movement of modern households away from the family breakfast table to a morning “grab and go” or just “go” lifestyle. Over 40% of Americans aged 18-54 regularly skip breakfast, and more than half of all adults view breakfast as a mere mini-meal, snack, or simply a beverage. Surveys also suggest that one-third of all teens and one-fifth of all children regularly skip breakfast, while half of all children report that they sometimes skip breakfast. Children are inclined to skip breakfast if their parents do. (Breakfast Research and Statistics).

Breakfast matters…for adults. Skipping breakfast is associated with eating more fat-rich, high-energy calories throughout the rest of the day. A Harvard Study suggests that people who skip breakfast are four times more likely to become obese. Avoiding breakfast is associated not only with weight-gain, but also with higher cholesterol and elevated insulin (National Heart Lung and Blood Institute Growth and Health Study), and even cancer (Cancer Research UK).

Breakfast matters…for children. Skipping breakfast is particularly hard on children, who cannot “limp” like adults through the morning on coffee. A Reading University study of 12-year-olds found that skipping breakfast caused reaction times to drop to the level of a typical 70-year old. On the positive side, a Harvard/Mass General study of school children in Baltimore and Philadelphia found that children who ate breakfast received better grades, were more focused, and showed improved psycho-social behaviors compared to children who rarely ate breakfast.

What do Americans typically eat for breakfast? For those adults who eat breakfast at home, coffee, boxed cereals (three-quarters of which are high in sugar), and fruit juice (75%- 80% sugar) head the list of products consumed most frequently (Breakfast Research and Statistics). For 6-12 year-olds who eat breakfast, three-quarters choose what they eat, with 90% regularly consuming ready-to-eat (RTE) cereals. According to a Yale University study, RTE cereal companies spend more than $160 million a year marketing breakfast cereals to children, who typically view 642 television cereal advertisements a year. The Yale study found that boxed breakfast cereals marketed to children have 85% more sugar, 65% less fiber, and 60 percent more sodium than those advertised to adults.

Clearly it is not enough just to eat breakfast, if by breakfast we mean stimulants and sugar in the form of coffee, cold cereal, and juice. Such a breakfast does not meet the 10-11 o’clock test criteria of a “good” breakfast: Research indicates that a high-glycemic breakfast such as a bagel, cold cereal, or instant oatmeal creates a blood sugar spike, followed by a sharp drop in blood sugar, a kind of hyper-/hypoglycemic rollercoaster. The body’s hyper-insulin response to the surge in glucose from a high-glycemic breakfast leaves blood sugar actually lower two hours after breakfast than at the fasting/waking level prior to eating breakfast (Lioger, et al., 2009). In other words, eating a high-glycemic breakfast can leave you hungrier by mid-morning than when you woke up, thus creating the desire for a high-energy mid-morning snack. Lioger found that subjects consuming a standard high-glycemic breakfast cereal consumed 53% more calories over the rest of the day compared to subjects who ate a whole-grain breakfast. Put simply, high-glycemic breakfasts lead to snacking and the tendency to over-eat at the next meal.

Boxed Breakfast Cereal—Century-Ago Good Intentions, a Modern Day Mixed Blessing
As often happens in life, innovative products developed for one problem can contribute to another. In 1863, Dr. James C. Jackson who managed the Sanitarium in Dansville, NY developed “Grandula,” the forerunner of our modern RTE cereal. A dense nodule of bran made edible only by overnight soaking, it was designed to relieve the gastrointestinal problems brought about by the low-fiber beef and pork breakfasts typically consumed by our ancestors more than a century ago.

In the years following the development of Grandula, the Kellogg brothers serving at the Battle Creek, Michigan Sanitarium worked on their own grain-based breakfast options. In 1896, they discovered a cereal flaking process and a cereal that Will Kellogg patented (1906) with its new name Corn Flakes. Soon thereafter came pasteurized milk and the development of waxed-paper box liners. With these, both Kellogg and competitor C.W. Post (Grape-nuts and Post Toasties) had the essentials to grow and expand the RTE breakfast cereal market into what we know today—a booming $10 billion business with a cereal for just about any taste and with expansive grocery store shelf space to dwarf most any other product category, with the occasional exception of cookies and soft drinks.

High-Glycemic Boxed Cereals…Blame not just Sugar, but also the Botanical Degradation of Grains
The problem with many RTE breakfast cereals is that because they are readily digestible, they inherently contribute blood sugar issues—and, elevated blood sugar over time can lead to insulin resistance and diabetes. Because RTE cereals generally lack protein and traditional fats they may be questioned as the building block of a sustaining breakfast, especially for children. The Center of Disease Control estimates that one of every three Caucasian children and one of every two children who are Black, Hispanic, Native-American, or Asian-American born in the United States after the year 2000 will develop diabetes. Boxed cereal can put children at risk of mid-morning hunger and fatigue and set the stage for caffeinated soft drinks and overeating later in the day.

The glycemic index (GI) is one way to assess RTE cereals. It was developed by D.J. Jenkins in 1981 to measure (on a scale of 0 to 100+, with glucose=100) the rise of blood sugar after ingesting a specific food. The glycemic index of a low-sugar breakfast cereal can exceed many of the high-sugar varieties: What elevates blood sugar is not just the sugar content of a cereal but also how the grains are processed to make them more quickly digestible. Rolling, flaking, puffing, and cooking (as in gelatinized oatmeal flakes) makes the starch in grains readily accessible to digestive enzymes and thus quickly digestible. Starch converts to simple glucose molecules more rapidly than fructose/glucose sugar.

Many favorite low-sugar cereals have high glycemic indices, which means that eaten alone, they can elevate blood sugar to leave behind hunger,hypoglycemia, and fatigue. This is because any process that alters the botanical structure of whole grains—rolling, flaking, puffing, milling, and cooking (as in the gelatinization of oat flakes)—renders carbohydrates more digestible. In so doing, the digestive system is called upon to do less work and expend relatively less energy in processing food, so glucose enters the blood stream with greater speed. This is why the blood sugar impact of a breakfast cereal cannot be gauged by its sugar content alone. Puffing oats for Cheerios or rice for Rice Krispies and Rice Chex; flaking corn for Corn Flakes; and shredding wheat for Shredded Wheat are all examples. Several ideas are illustrated in the table below: (1) low-sugar cereals, the first column, can have higher GIs than sugar-laden varieties listed, center; (2) aside from sugar, the degree of botanical degradation of a grain, in this case oats, (the first three cells of the right-most portion of the table), affects GI; and (3) simply puffing brown rice for rice cakes can increase the GI by 60% (last two table entries). The key idea is that just because a RTE cereal is low in sugar does not mean it will have a moderate effect on blood sugar.

Cooking also affects the GI of rolled grains such as rolled oats. Raw rolled oats (used in cookies) have a lower GI than when cooked. This is because, while starch granules are not water soluble, they easily absorb water and swell when heated. The structure is then altered in a process known as gelatinization. When gelatinized, as when raw rolled oats are transformed by water and heat into gelatinous oatmeal, the surface area of starch granules becomes greatly exposed to digestive enzymes. This increases the speed of digestion and absorption, resulting in an elevated glycemic response. Oatmeal is best topped with butter, a poached egg, cream, milk, nuts…any protein/fat combination of your choosing that will contain the blood sugar effect so that you are not left hungry by mid-morning.

Copyright 2011 Pathways4Health.org

You probably recall that all foods represent one of the three macronutrients—proteins, carbohydrates, fats, or combinations thereof.  In the past, when winter provided no fresh sources of carbohydrate-rich foods, cultures relied in the cold months more heavily on good quality fats.  Today, of course, with the convenience of commercial transport and supermarket shopping, we easily override winter’s constraints with foods from around the world associated with almost any season.  It is true that global out-of-season foods can, indeed, be a blessing by supplying nutrients and variety we would not otherwise have.   But, if over-consumed they can crowd out healthy fats and disconnect us from the normal seasonal rotation that would naturally place fats in a relatively more important place in our winter diet.

Many clues point to the idea that to eat seasonally in winter means to eat relatively more fats.  Good quality fats fit winter.  Traditional fats and oils are perfectly designed as lubricating agents for the body during cold, dry days; and, as concentrated calories, they provide quick-burning heat energy to buffer the bitter chill.  They also supply fat soluble vitamins, particularly vitamin D, to fill in the sunshine gap and to act as an antidote to winter blues.

If we doubt the wisdom of fats in winter, look at nature’s planned progression of foods offered to us through the growing season:  Following winter, bitter greens with their cleansing power arrive in spring to clear our systems of the rich protein/fat meals consumed over the frigid, cold months.  Bitter greens are followed in summer by expansive, high-water content, quite perishable fruits and vegetables like zucchini, corn, and tomatoes that are meant for timely consumption.  Fall harvest vegetables such as roots and tubers, in contrast, are generally more concentrated, contractive, durable and sustaining (see: Seasonal Harmony, September, 2010).

Eating in Season–With the Life Cycle.

Beyond the seasonal calendar, there is a second way to think of eating seasonally, which is defined by the life cycle.  While good fats and oils are important at any age for neurological and proper cellular function, hormone balance, fertility (see bullets, below), a generous portion is especially called for as we age and journey into the “winter” season of life.

A quick way to think of this is captured by Ayurveda theory, which draws parallels between the seasons and the life span.  Ayurveda healers define Spring, from birth to age 15, as the growth years; Summer, from 15-55 years, as the time of productive activity; and, Winter, from 55 and beyond, as the time of wisdom but also when the body tends to dry out and requires extra hydrating fats and oils.  As we age, we need adequate amounts of traditional fats and oils to lubricate the system and cushion the aging process, to moisten skin and smooth wrinkles, and most importantly, to provide adequate nourishment for the brain.

The brain is largely composed of saturated fats.  A healthy mix of traditional saturated fats and essential fatty acids (EFAs) are needed for the building of healthy cell membranes and proper cell function.  EFAs are required for neurological and inter-cellular communication.  Consuming saturated fats with a generous complement of EFAs is a valuable strategy for the prevention of Alzheimer’s and dementia.  The “good fats” also elevate mood, sharpen focus, and work to prevent depression and anxiety.

Discriminating Fats.

“Bad fats and oils will destroy your health faster than sugar.  They cause more problems than any other class of food.” …Paul Pitchford

Fats have a bad name, and perhaps this reputation is deserved based on the amount of pro-inflammatory refined vegetable oils that compose the majority of fats consumed by Americans today.   Yes, fats are “bad” if by fats we mean the refined vegetable oils that are hidden in so many of the packaged and processed foods that we often, with little thought, rely upon.   These hardly resemble the health-promoting fats enjoyed by cultures in the past.

When thinking about fats, it pays to be discriminating.  Traditional fats are vital to health.  Life cannot be sustained without them.  Good fats and oils:

• Provide heat and energy and cushion organs;

• Help us assimilate the fat-soluble vitamins, A, D, E, and K and a variety of minerals including magnesium and calcium;

• Are vital to proper brain function (the brain is 60% fat), mood and nerve regulation;

• Are the building block of hormones, which are key for strong bones and general health;

• Satisfy hunger and boost metabolism to support weight loss; AND

• Are vital to give the body the right materials to build healthy cell membranes, which are made of fats.  Cell membranes need to be “smart” to monitor traffic in and out of the cell, just as the lining of the digestive tract screens and prevents toxic materials from entering the blood stream.

“…ourbalance of omega-6 to omega-3 affects our health as much as any other aspect of dietary fat…Because the ratio of omega-6s to omega-3s helps determine the flexibility of cell membranes, nearly all chemical communication throughout the body depends at least in part on the correct balance between omega-6s and omega-3s.  Within this context, it is difficult to imagine any health problem that isn’t partly related to the ratio of omega-6 to omega-3.”¹ …Elson Haas

What is meant by “traditional fats?”  Butter from grass-fed cows is one example.  In contrast to butter from commercially-raised animals with a 9:1 omega-6/-3 ratio, butter from grass-fed cows contains an ideal 1:1 ratio of omega-6s to omega-3s.  The following link offers a graphic picture of this relationship.
Other examples of traditional fats include nutrient-dense animal fats from pastured animals; extra virgin olive oil; unrefined, extra virgin coconut oil; and, fish oils and cod liver oil from reputable providers.

Over the past century, particularly with the population shift from farm to city and with the growth of the processed food industry, Americans have experienced a rather complete “oil change.”  Per capita, we have tripled in the last 100 years our consumption of fats, with the entire increase attributable to commercially-manipulated, denatured, pro-inflammatory vegetable oils².  We consume 25 times (!) the refined vegetable oils of a century ago, and less than a third the the amount of butter (see: 20th Century Oil Change, May, 2010.) Much of this shift is unconscious and unnoticed:  it reflects the changing American lifestyle away from home cooking to our modern reliance upon processed and packaged food products that are laden with refined vegetable oils.  In the early post-war years, the food industry replaced expensive butter and coconut oil with inexpensive vegetable oils that do not go rancid and therefore offer a long shelf-life for processed and packaged foods.

Rx for Winter—Quality Fats for Depression and Mental Focus

Traditional cultures used a variety of natural strategies to cope with winter.  During the dark, cold months, they intuitively relied upon cod liver oil, which they consumed in modest quantities, anchored by generous amounts of butter and other saturated fats from grass-fed animals.  Modern science now confirms this intuitive wisdom:  the highly fragile 5- and 6- double bond EPA and DHA fatty acids in cod liver oil require sufficient saturated fats like butter to be properly and effectively utilized by the body.

Throughout most of the last century, we moved away from many of the natural antidotes to winter—cod liver oil, butter from grass-fed animals, eggs from barnyard hens, milk and other animal products from grass-fed animals, and bone stocks—the foods that maintain a sense of health and well-being through the dark winter months.   In 1927, for example, the United States imported 5 million gallons of cod liver oil, a level ten times the meager one-half million gallons imported in 2000.³  If we consider the generous doubling of the population over this period, implicitly the average per capita consumption of cod liver oil in the United States currently stands at less than one-twentieth 1927 levels.  In recent decades, we have replaced traditional cod liver oil with an array of expensive prescription anti-depressant drugs.

Cod liver oil is a premier buffer for winter.  It is a rich source of vitamin A (immune function); vitamin D [strong bones, immune system, relief for depression⁴ ]; omega-3 oils (healthy nervous system, relief from pain and inflammation, antidote for depression).   Cod liver oil, as a rich source of vitamins A and D, works synergistically with other cofactors like calcium and arachidonic acid found in other animal products  to support mental focus and emotional well-being.    Some of the best work in this field comes from Chris Masterjohn.  In his 2008 Wise Traditions article “The Pursuit of Happiness:  How Nutrient-dense Animal Fats Promote Mental and Emotional Health” he provides the biochemistry and scientific detail to support the conclusion that good fats and oils containing vitamin A and D along with calcium and arachidonic acid work synergistically to help protect again depression and anxiety, while also supporting focused, goal-oriented behavior:

Modern science has now elucidated the role of nutrient-dense animal fats in preventing mental illness and supporting the focused, goal-oriented behavior needed to confront challenges and pursue a happy, satisfying, and successful life.                                                   …Chris Masterjohn

• Cod liver oil (vitamins A and D)
• Butter from grass-fed animal (arachidonic acid, vitamins A and D)
• Egg yolks from grass-fed chickens (arachidonic acid, vitamins A and D)
• Fats from grass-fed animals (arachidonic acid, vitamins A and D)
• Organ meats from grass-fed animals (arachidonic acid, vitamins A and D)
• Bone broths (calcium)
• Raw whole milk from grass-fed animals (calcium, arachidonic acid, vitamins A and D)
• Fish eggs (vitamins A and D)
• Small whole fish (calcium, vitamins A and D)
• Shell fish (vitamins A and D)                                                               Source:  Chris Masterjohn

To this ”feel good’ list I would add unrefined, extra-virgin coconut oil, a saturated fat that is high in anti-microbial lauric acid and, as a medium-chain fatty acid, metabolizes rapidly to provide quick energy.

Additional Comments:

• Cod liver oil (CLO)— Taken in moderation, CLO is generally safe for most people and causes no major reactions.  However, if you are on medications, it is best to check with your doctor before using it.  Dosage for the winter months of ½ to 2 teaspoons a day is generally appropriate unless you are pregnant, in the intense sun or sunbath regularly, take vitamin A supplements, or are scheduled for imminent surgery (since it affects blood clotting).  Fermented CLO is more easily digested than regular CLO, and it is more nutrient-dense so you can take less.  In summer, to avoid vitamin D toxicity if you spend long hours in the sun, you may wish to switch to fish oil, which has no vitamin D (or vitamin A for that matter).  All CLO is screened by the Association of Analytical Communities (AOAC) for 32 contaminants before being imported.  Mercury is water soluble so it appears in the flesh of fish but not in CLO and fish oils.

• Butter for Pastured Animals—Butter, extra-virgin coconut oil, and other saturated animal fats work synergistically with CLO for its assimilation and utilization.  To benefit, consume both.

• Egg Yolks—After CLO, egg yolks are the second most potent source of vitamin D, but only if hens are exposed to full sunlight, sunlamps or receive a 2% dietary CLO supplement.  Eggs from commercially-raised hens may not provide the nutrition that we have come to expect.

• Liver—Liver is rich in B vitamins, iron, arachidonic acid and vitamin A but not vitamin D.  It can provide a sense of well-being for anyone concerned about vitamin D excess.  [CLO is a rich source of vitamins A, D, and DHA, but unlike liver, it provides no iron or B vitamins.]

• Bone Broths—Bone broths are best using the bones of organic, grass-fed animals.

Finally, if you begin a program of consuming these healthy fats and oils, allow a few weeks to feel the positive benefits.  Depressive symptoms diminish over time with daily use (The Hordland Health Study).

A Word about the “Feel-Good” Nutrients:

• Vitamin A—Liver and cod liver oil are by far the richest sources of vitamin A.  Vitamin A is important for proper immune function, vision, the digestive system, and healthy skin.

• Vitamin D—Vitamin D helps maintain healthy bones and teeth, assists in blood pressure regulation, strengthens the immune system, and reduces the risk of many forms of cancer, and can work as an anti-depressant.

• Omega-3 Fatty Acids, EPA and DHA—Omega-3s help reduce pain and inflammation and the inflammatory response. EPA reduces inflammation and works as an antidepressant.  DHA supports a healthy nervous system, vision, learning and mental function, relieves depression, and promotes healthy skin.

• Arachidonic acid (AA)—AA supports growth, digestive health, fertility, healthy skin and hair.

A Yin/Yang Word of Caution—Any Extreme Can Transform to the Opposite—More is Not Better…

Cod liver oil, when used in moderation and complemented with quality saturated fats for assimilation, can support health and vitality and ameliorate a variety of health conditions.  Omega-3s help relieve pain and inflammation for arthritis sufferers; reduce stress and relieve depression; prevent allergies and cancers; and relieve high blood pressure.  They also work to support healthy skin and hair.

However, excessive levels of CLO and fish oils can disrupt immune function, result in scaly skin and hair loss, elevate blood pressure, cause internal bleeding, and create complications for diabetics—the very issues that in moderation they address.  Cod liver oil, a rich source of fat-soluble vitamins A and D, can accumulate in the body (unlike water soluble vitamins) and lead to toxicity.  Always use cod liver oil and fish oils with care.  More is not better.

Shopping Resources:

• Cod Liver Oil and X-Factor Butter Oil:  GreenPasture.org and Radiant Life.com are several reliable sources.  I like Blue Ice “Cinnamon Tingle” Cod Liver Oil which I order from GreenPasture.org.  I find its “.org” status to be reassuring.

• Liver: North Star Bison and Hawthorne Valley Farms are several fine providers, or consult your local Weston A. Price Foundation chapter for other source in your area.

• Seafood, Canned Salmon, and Sardines: Try Vital Choice.com for wild, sustainably-caught fish and seafood.  Their website is a wealth of information.

For other shopping suggestions, see the Resources tab of my website and January, 2009 The Gift of the Kitchen.

Reading Resources:

Mary Enig, Know Your Fats

Udo Eramus, Fats that Heal, Fats that Kill

Chris Masterjohn, “The Pursuit of Happiness:  How Nutrient-dense Animal Fats Promote Mental and Emotional Health,” Winter 2008, Wise Traditions.

M. Baroy Raeder, V.M. Steen, S. Emil Vollset and I. Bjelland (2007).  Associations between cod liver oil use and symptoms of depression:  The Hordaland Health Study.  Journal of Affective Disorders, 101 (1-3), 245-249.

See also A Primer on Good Fats and Oils and May, 2010, The 20th Century Oil Change.

Winter Recipes—Cooking in Season:  Bone Stocks and Cooking with Bones

On cold, invigorating days, I think of my stock pot.  I like to fill it with an organic chicken or two, some vegetables, and leave it for hours to slow-simmer.  For me, nothing feeds the soul more than the inviting, nurturing aromas of a bone stock.  In Traditional Chinese Medicine, bones are associated with winter and with our “kidney essence” energy.  Beyond the calcium and other minerals that they provide, they also seem to feed our deep inner energy and convey a profound sense of well-being.  Bone stocks are versatile and can be used in cooking grains, hot cereals, and soups to add flavor and nutrition to meals.  Used this way, they are an especially good tool to add nutrition to meal—especially if you have a picky eater in the house (see February, 2010, Investing in Stocks).

Winter is also the perfect season to cook with bones.  Bones enrich winter soups and stews.  And, they lend extra character and extra nutrition to slow-simmering meals that feature beans, legumes, and grains (see March, 2010, Putting Bones Back on Your Meat.)

Copyright 2011 Pathways4Health.org

1. Staying Healthy With Nutrition.
2.  Economic Research Service, USDA
3.  Katharine Blunt and Ruth Cowan, Ultraviolet Light and Vitamin D in Nutrition and Krispin Sullivan.
4. http://www.vitamindcouncil.org/depression.shtml

With modern technology and the current composition of agriculture—still heavily weighted toward small family farms that earn only modest agricultural receipts—we do have in place the tools and the agricultural profile to implement, without major dislocation, many of these ideas.

Barcodes

Barcodes, whose initial digits already code the country of origin, could be made to code the environmental and health “footprint” of a product.  The glycemic index as well as the amount of sugar, transfats, chemical ingredients, and GMOs could be coded, with products taxed accordingly.  We eat what is cheap.  Taxing to make products that foster diabetes, metabolic stress, and chronic disease less attractive would discourage demand.  It would also shift more and more purchasing power toward healthier whole-food choices, particularly if ways could be found to reduce the cost of organic, whole-foods.  One way that this could be achieved is to direct the tax revenue from barcode-levied unhealthy processed foods, recycling these funds to subsidize organic, sustainable farming.

Agricultural Profile…The Reason Barcodes Could Work. When we think of U.S. agriculture, we may think of the vast acreage tied up in modern agri-business and commercial farming efforts.   While it is true that much of our food today is produced on these mega-farms, small family farms are still the bedrock of our agricultural system.  According to the latest Census of Agriculture (2007, released 4 Feb, 2009), 90% of all farms are still owned by individual farmers.  In addition, farm receipts for the majority of farms total less than $10,000 annually.¹  This profile suggests that most U.S. farms are small, rather flexible production units.  With the backing of federal subsidies and shifts in consumer demand, this broad network of small, individual farmers might adjust rather quickly and well to a growing demand for organic, sustainable, locally-grown foods.

Measuring GDP to value “product” in the home. Support for sustainable organic foods and humane animal husbandry does not reach far enough.  We need also to teach cooking skills and give value to home cooking.  The government’s GDP may measure earned, reported income and product, but it imputes nothing for quality of life or the value added to goods that are associated with man-hours contributed at home.  The GDP adds no value for foods grown in family gardens or prepared in home kitchens [nor the hours that parents spend on providing childcare, for that matter² ].  Growing food, buying from local organic farmers, and taking time to cook meals at home mean that we gain the added value of knowing where our food comes from.  And, the kitchen gives us a creative outlet right in our own homes (see The Gift of the Kitchen, January, 2010).  We need government statistics to measure quality of life behaviors that encourage connection to food, family and better health.

“Fairness.” We like to pride ourselves on our free market economy, but in reality we live in an agricultural system that is neither “free” nor a real market.³  The government not only uses tax revenues from individuals to pay farmers not to produce, but also offers subsides to (GMO) grain and soybean farmers to compensate them for depressed market prices .   It seems to me that the government is really subsidizing, through our commercial food system, our own medical system. Aren’t our tax dollars supporting a “double-dip” structure that benefits medical care—through subsides that allow for cheap food that fosters chronic disease AND through our subsidized national health care system?  Is it any wonder that medical care is the prime growth sector in today’s otherwise lackluster economy?

Projected upon this canvas, the thought of using barcode-taxing to shift incentives away from fractured, commercial foods toward whole foods grown sustainably is hardly a wild proposal.  Given the lobby-generated bias in Washington that creates an “upside-down” Food Pyramid, as well as subsides for GMO crops and school lunch programs saturated with processed foods, attempts to shift demand and production toward healthier choices seem both reasonable and justified.   Barcodes can be used to educate consumers, shifting demand toward healthier food choices.  And, our vast network of small family farmers, far from intractable, seems more than able—if led by the nurturing hand of government— to shift more and more of our natural and human resources to the production of “real” food.

Copyright 2011 Pathways4Health.org

1. http://www.ers.usda.gov/StateFacts.US.htm
2. Because we live in a service-based economy, parents are really in the capital investment business.  The quality of childcare determines the quality of our future capital stock.
3.  See Joan Dye Gussow, Growing, Older

Restoring “Traditional” Carbohydrates—To Control Blood Sugar

• The Role of Carbohydrates in Nutrition
• The Glycemic Index in Perspective
• Mapping Post-meal Blood Sugar Behavior—Clues for Combining Foods to Control Blood Sugar

Carbohydrates are the essential dietary mainstay of all population groups. Today, they account for between 40%-80% of the calories consumed by people around the globe.  Carbohydrates are the cleanest burning of the three macronutrients—proteins, carbohydrates, and fats—and the primary fuel of the brain.  Carbohydrates perk us up and make us feel good.  We like carbohydrates because our taste buds are primed to “sweet.” And, we buy and consume refined carbohydrates in abundance because they are inexpensive and readily available, have a long shelf-life, and require little if any refrigeration.  Refined carbohydrates are everywhere and go anywhere.

Measuring Carbohydrates as a Tool to Assist in the Prevention of Blood Sugar Diseases

The glycemic index (GI) developed by Dr. David Ludwig or the University of Toronto is the classic way to gauge the blood sugar impact of carbohydrates.  In recent years, particularly through the efforts of the University of Sydney, the concept of the glycemic index, a measure of the quality of carbohydrates has been expanded to include a quantity refinement termed glycemic load (GL).   The University of Sydney’s website www.glycemicindex.com provides information about carbohydrate foods and blood sugar, including GI and GL listings for hundreds of foods that have been tested in the rigor of the science lab.  Measures such as GI and GL can be used to select foods to balance blood sugar.  For example, coupling a low-GI food with one that is high on the GI scale creates a meal with a GI that strikes a balance between the two.

In these modern times, with the plethora of blood-sugar-related diseases, we need tools like GI and GL to help us understand ways to control blood sugar.  I believe that there are two major reasons why blood-sugar chronic diseases are so prevalent today:  The shift in the American diet from fats to carbohydrates and from traditional to refined carbohydrates.

The Recent American Fat/Carbohydrate Exchange. The relative shift in the diet from fats to carbohydrates was set in motion during the postwar years when consumers heeded warnings to avoid fats and cholesterol.  Fats, which accounted for 45% of the American diet in 1965, now hover around 32%.  Meanwhile, carbohydrates have increased their share from around 40% to over 50% during this same time period.  [With this shift from traditional fats to refined carbohydrates (and refined vegetable oils) has also gone the demise of the shirtwaist dress and the hourglass figure.]

The Shift From Traditional to Refined Carbohydrates. The second factor—the postwar shift from traditional to refined carbohydrates—is largely due to the growing role of the commercial food industry and processed, convenience foods.  Convenience foods must have a long shelf-life, so food companies rely upon refined flours and oils, which do not go rancid.

Data from the Economic Research Service of the USDA indicate that of the carbohydrates Americans do consume, most are derived from grains (rather than from fruits and vegetables).  Of these grain-based carbohydrates, 90% are in the form of high-glycemic cereals and bakery products that spike blood sugar to foster inflammation and chronic disease (such as insulin resistance and coronary heart disease).   Only a small proportion—about one in every nine calories—is derived from slower-metabolizing whole-kernel grain products for a more moderate blood glucose effect.

Looking At and Beyond the Glycemic Index—A Dynamic View of the Behavior of Blood Sugar

In this newsletter, a sequel to April, I want to first consider some measurement limitations and variations associated with trying to gauge the true blood glucose impact of various foods.  Not to be critical of the glycemic index, the goal is rather to support the notion that self-testing is perhaps one of the very best ways to discover how our own bodies react to favorite foods, eaten at the times of day when we consume our meals and snacks, and against the backdrop of our own personal lifestyle, including our level of activity.  We do not live under scientific lab conditions, nor do we consume most of our food as the first morning meal following a 12-hour fast.  As discussed below, many factors, such as the amount of cooking, can affect the GI “score” of a food.

The self-testing, graphic approach to food testing developed in the balance of the newsletter is a less scientific but a more dynamic way to explore postprandial (post-meal) blood glucose levels (BGLs). Visual pictures of postprandial blood sugar behavior, while less scientific than GI measurements, are nevertheless powerful learning tools, providing a real flavor for how our body reacts when we eat different kinds of foods.

The Glycemic Index and Its Limitations. The glycemic index, developed in 1981, moved carbohydrate classification beyond the categories of “simple” and “complex” carbohydrates into a new era where a carbohydrate’s quality is ranked numerically on a scale of 0-100 (compared to glucose, the more popular standard) or 0-140 (to white bread).  As with many attempts to standardize measurement in a world fraught with personal and material variation, there are several recognized reservations about GI:

1. GI measures the blood glucose impact of foods eaten in isolation, yet we rarely consume foods this way.
2. GI readings for the same food can vary widely depending upon whether a food is measured in relation to white bread (higher numbers) or glucose (lower readings).  Looking at some breakfast foods illustrates the variation in GI, where either white bread or glucose is the measurement standard—for example, a bagel (GI=103; 72), corn flakes (GI= 116, 81), and a piece of whole-grain toast (GI=58, 41).   Glucose is the typical standard, although white bread is thought to be more reliable.  If you read a GI in isolation, know which standard is being used.
3. The GI of any food will vary with the temperature of the food and amount of cooking (warmer and well-cooked is higher than cold and raw); the degree of ripeness (ripe scores higher than “green”); and particle size (a whole, raw carrot’s GI=16 will be lower than a diced raw carrot, GI=35, or one that is diced and cooked, GI=49).
4. GI readings vary with the individual—blood sugar and insulin reactions are more extreme for diabetics, for example (See Charts 2A and 2B).
5. GIs are calculated in the science lab as the day’s first meal after a 12-hour fast and using a fixed serving that includes 50 grams of carbohydrate.  Most of our daily calories, however, are consumed in combination and throughout the day, when our blood sugar is affected by other foods that we have eaten earlier, as well as by our level of activity.   In addition, we rarely consume foods in 50-gram carbohydrate portions [that is a lot of oatmeal!].
6. As a final factor, and my major point for constructing graphics and writing this newsletter, is that GI is a static number that cannot convey what happens in our body when we consume a meal.  GI cannot provide a visual picture of blood sugar behavior—its shape and trajectory—during the time following a meal (for an example, see Chart A).  I believe pictures are the best tool for learning how to combine foods effectively to control blood sugar.  A single number cannot touch us and teach us in quite the same way.

Thinking of Carbohydrate Foods in Terms of Blood Sugar Curves

To control blood sugar, what we are after—the real goal—is to avoid “metabolic stress” that puts our hormone system on “red alert” and our body through a hyper/hypoglycemic rollercoaster. Metabolic stress occurs when we eat too much high-glycemic food and/or too much carbohydrate without sufficient protein/fat “buffers.”  The result is a sharp rise in blood glucose (Chart A), forcing insulin, the glucose storage hormone, to come to the rescue, and remove excess glucose from the blood stream.

Instead, we want to choose low-glycemic foods and higher-GI carbohydrates balanced by proteins and fats (their GIs=0) so that blood sugar rises moderately and is sustained for several hours above the pre-prandial (pre-meal) zero line (Chart A). Such a low-glycemic pattern is what helps maintain energy and mental focus.  In contrast, high-glycemic foods eaten alone or in combination create a blood sugar spike that can result in hunger, irritability, lack of concentration, and overeating shortly after a meal.  [See the work of David S. Ludwig, High Glycemic Index Foods, Overeating, and Obesity, www.pediatrics.org].

Metabolic Stress. As touched on above, metabolic stress describes what happens in the body in reaction to excessive levels of blood sugar following a high-glycemic meal.  In an attempt to restore blood sugar to normal levels, the pancreas releases insulin to remove excess glucose.  With the help of insulin, much of this glucose is stored in the form of glycogen in the liver, in the blood as high triglycerides, and as fat in the cells of muscles and tissues, particularly around the belly.

Unfortunately, in the “alarm mode” it is easy for the pancreas to overshoot.  Insulin in excess can then cause a steep drop in blood sugar (BGLs plunging below the zero line, as shown in Chart A) and a hypoglycemic condition that can trigger a new cycle of hunger, irritability, cravings for carbohydrates, and overeating.   When insulin does its job too well and blood sugar dips to hypoglycemic levels that are inadequate to fuel the brain, the body calls upon a new set of hormones—principally glucagon, as well as adrenal hormones such as cortisol and adrenaline—to  restore blood sugar to normal levels by reversing the fat-storage process.  Glucagon does this by setting in motion enzymes needed to convert the liver’s glycogen stores back to glucose.

When we select foods, the idea then is to avoid metabolic stress.  This is because metabolic stress taxes the body’s hormone and organ systems, particularly the pancreas (which produces insulin and glucagon), the adrenals (cortisol and adrenaline), and the liver thus leading to a variety of issues including insulin resistance.  One way is obviously through the foods that we chose to eat.  Another is to eat well-balanced meals frequently enough to avoid hunger and rapid carbohydrate assimilation: “Carbohydrates are absorbed more slowly with increased meal frequency, often resulting in a reduction of insulin response, postprandial blood glucose, and serum cholesterol levels.³

Graphics—Blood Sugar Behavior Following a Variety of “Meals”

Of the following numbered charts, the first three are based upon scientific research journal articles (Charts 1, 2A, 2B), while the last four (Charts 3-6) are constructed from my own self-testing of foods⁴ using a simple blood glucose monitor.  I decided to do my own testing for two reasons—I wanted to try a variety of foods and combinations that, to my knowledge, have not been tested and presented graphically in scientific journals; and, I wanted to illustrate how easy this can be as a way to encourage you to try testing your own favorite foods.

From graphic drawings of what happens to blood sugar after eating different foods, we can discover  strategies for “food combining” that will moderate blood sugar—combining fats and proteins with high-glycemic foods (to offset their blood glucose impact), while emphasizing combinations of lower-glycemic whole grains, legumes, fruits, and vegetables to avoid metabolic stress.   It is interesting to note that, apart from vigorous exercise, only proteins and fats, with their flat-to-negative impact on blood sugar, can effectively temper high-glycemic carbohydrates.  While fruits and vegetables are laudable in so many ways, their own carbohydrate content adds to the glycemic load of a refined carbohydrate meal.  Thus, fruits and vegetables cannot be counted on in the same way that proteins and fats can to effectively dampen the metabolic impact of refined carbohydrates.

Concepts Suggested by the Charts:

Chart 1:  Blood Sugar Curves of White Bread Compared to Bread with Added Fiber, Sourdough, and Vinegar. Eating white flour products like white bread readily exposes starch granules to digestive enzymes.  Starch is quickly digested and absorbed, and glucose is rapidly delivered to the blood stream.  The resulting spike in blood sugar at 30-minutes is followed by a hypoglycemic “low” within 90 minutes of eating.  In other words, within 90 minutes, hunger can set in.  As the work of insulin removes excess glucose from the blood following the 30-minute peak (Chart 1), and, without other foods to slow digestion and delay gastric emptying (like proteins, fats, and fiber), blood sugar plummets to below pre-meal levels soon afterward—we are hungrier than before!  Acids like sourdough and vinegar slow digestion and moderate this pattern.  Of the variations shown, fiber added to foods is the most effective at moderating postprandial blood sugar.

Charts 2A and 2B:  Blood Glucose and Insulin Reactions of Normal and Diabetic Subjects. These charts illustrate several points.  The first, people can experience very different blood sugar reactions to exactly the same meal.  This is especially true of diabetics, for whom the blood glucose reaction is greater than for normal subjects (Chart 2A). For diabetics, blood glucose levels are generally higher both prior to and after eating.  More importantly, the insulin reaction of diabetics is far more extreme, as indicated by the dotted lines (Chart 2B).  Insulin levels for diabetics rise far in excess of normal subjects—double the reaction—and these are sustained high levels.  High insulin levels cripple efforts to lose weight:  When insulin stays high, the body is less able to tap into fat stores. This is why diabetes and obesity often go hand-in-hand (90% of diabetics are either overweight or obese). With high insulin levels, it can be hard to avoid the double-edged sword of belly fat that partners with hunger and overeating:

According to Dr. Jennie Brand-Miller, “If insulin levels are high all day long, as they are in insulin resistant and overweight people, the cells are constantly forced to use glucose [rather than fat] as their fuel source…The blood glucose level (BGL) then swings from low to high…playing havoc with appetite…and the store of carbohydrates in the liver and muscles undergo major fluctuations over the course of the day.”

Chart 3:  Instant Oatmeal, Whole Oats (Soaked and Not Soaked), and Whole Oats Combined with a Protein and Fat. Instant oatmeal, which we might think to be a wholesome breakfast, in fact traces a blood glucose pattern similar to white bread (shown in Chart 1).  This may be indicative of the fine particle size to which oats must be ground to become “instant” and to the oat flour that is often added to instant oatmeal as a thickening agent.  In two separate tests, I also consumed instant oatmeal adding 1 tablespoon of sugar, which resulted in a higher 30-minute peak; and, instant oatmeal adding 1 tablespoon of butter, which reduced the peak at 30 minutes and sustained the curve above zero through the 2-hour test period (I did not clutter the chart to show these expected results).   Chart 3 also illustrates that soaking whole oats (to degrade phytic acid, a mineral inhibitor) greatly increases the glycemic impact compared to oats that are not pre-soaked before cooking.  This is because soaking makes grains more digestible and renders the starch more available to digestive enzymes.   Adding a protein/fat to pre-soaked, cooked whole oats—in this case 2 ounces of salmon—significantly dampens the metabolic reaction and easily sustains blood sugar throughout the two hours following the meal.

Chart 4: Blood Sugar Curves of Proteins; Fats; Carbohydrates:  Salmon, Kidney Beans, Whole Oats, and a Coke. This is one of my favorite charts because it illustrates disparate blood sugar reactions to quite different foods—a protein/fat (salmon); a whole-grain carbohydrate (oats); a carbohydrate/protein (beans); and a pure high-fructose corn syrup (HFCS) carbohydrate (Coca-Cola).  The footprint of the Coke is a classic case of metabolic stress:  the peak glucose increment of 50 at 30 minutes is by far the greatest reaction of any food I tested as a first meal.  With the Coke, insulin comes to the rescue to such an extreme that blood sugar plummets to pre-fasting levels within the first hour following the Coke.   What the chart says is, if we have a Coke for a breakfast on the run, we can be hungry by the time we arrive at school or the office —and, all the while we have also put our body’s hormone system through the wringer.

As an extreme contrast to Coke, salmon drops initially in the first 30 minutes (the flat-to-negative glycemic effect of proteins and fats) and then rises above pre-meal levels.  In the case of both slow-metabolizing proteins and fats, the body has time to moderate the flow of insulin and glucose to keep blood sugar well-balanced.  Because the body reacts to proteins and fats in mirror-image fashion to carbohydrates (contrast salmon with oats), proteins and fats can be paired with carbohydrates to modulate the 30-60 minute blood sugar rise normally associated with carbohydrates (as in the Coke and whole oat curve) and cushion the 60-120 minute drop in blood sugar that would otherwise occur with these carbohydrates.  In other words, in view of the salmon curve, it seems to make sense to begin meals with sufficient proteins and fats before introducing high-glycemic foods.

Our final example here is kidney beans, which illustrates the value of foods that are balanced combinations of carbohydrates, fiber, and protein (see the food composition list in Appendix A, which outlines the macronutrients of our test foods.).  Kidney beans can be eaten alone due to the inherent blend of fiber, protein, and phytic acid (phytates reduce the glycemic effect).  After a meal of kidney beans, blood sugar traces a moderate initial rise and a gentle tapering off, but at levels that are sustained above pre-prandial levels throughout the 2-hour test period.

Chart 5:  Kidney Beans with Added Grains; Vinegar; and Vinegar and Oil. Because kidney beans trace a gentle, sustained blood sugar curve, I chose to use them to test the addition of an acid (apple cider vinegar); an acid and oil (vinegar and extra virgin olive oil); and a carbohydrate (whole oats that were pre-soaked before cooking).  Adding vinegar to beans and even more so, vinegar and oil, significantly moderates the blood sugar effect of kidney beans.  Vinegar and oil accomplishes this same function for other foods if you keep them handy at a central place in the kitchen and on your dinner table.

Combining beans with grains (in our bean-whole oats example) would normally call for a 1:2 ratio of beans-to-grains in order to assemble complementary amino acids in the right proportion for a complete vegetarian protein.  Yet, eating beans and grains in this standard vegetarian way spikes blood sugar.  The idea that “wholesome” vegetarian meals push blood glucose to an uncomfortable zone is also borne out by other examples of vegetarian meals explored in my own day-to-day personal testing.  It appears that vegetarian meals, without the anchor of animal proteins and fats, easily spike blood sugar. [Vegans and vegetarians may be particularly interested in using a simple blood glucose monitor to sharpen food combining skills.]  What I believe this specific beans/oats case tells us is that beans and grains alone can deliver too much carbohydrate for the body to handle, if not offset with adequate protein/fat buffers.

The Second Meal Effect

The second meal effect means that what we eat at one meal affects the glycemic and insulin response at the next.  A low-glycemic breakfast will curb the response at lunch, and a low-glycemic dinner can have the same muting effect at breakfast the next morning.⁵  A breakfast of pancakes with maple syrup will work best when preceded by a late steak dinner the evening before.

Chart 6: Blood Glucose Response to Instant Oatmeal as a Second Meal. This chart illustrates the second meal effect– that what we eat at one meal affects postprandial blood sugar behavior at the next. Procedure: On three separate mornings I ate instant oatmeal as a second breakfast three hours after a first 12-hour fasting breakfast.  On each of three separate mornings, the first meal was either—two poached eggs; instant oatmeal; or a Coca-Cola.

To fully appreciate the impact of two back-to-back carbohydrate breakfasts please notice that the scale used for Chart 6 is twice that of Charts 3-5.

Results: Eating two successive carbohydrate breakfasts dramatically spiked blood sugar at the second meal.  This was true for Coke-oatmeal, but especially oatmeal-oatmeal. In dramatic contrast, 2 poached eggs as a first breakfast comfortably accommodated the carbohydrate load of oatmeal as a second meal—this curve meanders around the zero line.  There was no rise in blood sugar following the second meal of oatmeal—a food that normally spikes blood sugar.  This second meal experiment points to the wisdom of eating dessert at the end of a meal—when ,like 2 eggs, proteins and fats from a typical dinner can buffer the sugar in a sweet dessert.

More importantly in terms of successive meals, it, of course, suggests the importance of a good breakfast that includes proteins and fats, not only to help get through the morning without hunger, but also to blunt the blood sugar effects of the 10 o’clock coffee/snack break.  If nothing else, it means we need to feed children a wholesome breakfast that includes proteins and fats to stay with them through the morning and to curb the blood sugar impact of snacks—such as graham crackers and apple juice that are so often served at nursery schools. What we do to our children when we give them a sugary cereal or a Pop-tart for breakfast extends beyond this first meal to affect their blood sugar, hunger, concentration, and desire to overeat throughout the rest of the day.  For a more complete discussion, I again recommend the work of Dr. David Ludwig regarding high-glycemic foods and overeating, cited in the Recommended Reading section at the conclusion of this newsletter.

Using a Blood Glucose Monitor For Your Own Personal Experiments

Blood glucose monitors are sold in most drug stores, where they are principally inventoried to serve diabetics.  They are not expensive.  A simple monitor sells for around $30.  The sophisticated replacement test strips that are used to take each reading (expressed as mg/dL) are what can be expensive (though strips can be covered by insurance).  Refills usually cost more than $60 for a set of 100.  A monitor is quite easy to use.  Most pharmacies can help you if you are having trouble.

Normal Range for blood glucose are:

Fasting or before meals   <100 mg/dL

2 hours after a meal         <140 mg/dL

Resetting the Table–to Control Blood Sugar (For a discussion of other strategies, see April 2011).

When you sit down to a meal, ask yourself  if you have incorporated sufficient protein and fat and consider adding some of the following to your dinner table in order to moderate blood sugar:

• Ramekins filled with condiments like nuts and seeds (GI=0).  Nuts and seeds provide healthy fats, fiber, vitamins, minerals, and antioxidants, while they slow digestion and curb blood sugar.
• A tart vinegar⁶ and extra virgin olive oil.  Or, flax oil.  Ume plum vinegar, which is alkalizing and a good digestive aid, is also a good choice
• Sourdough bread or whole-grain bread with whole kernels; butter from grass-fed cows and organic nut and seed butters such as tahini and pumpkin seed butter.
• A pitcher of water and glasses for all—sometimes we mistake hunger for what is in fact thirst.  You might flavor the water with a little lemon juice or other flavoring.
• Coconut sugar to replace cane sugar.  Coconut sugar is not refined so it retains minerals, including magnesium, zinc, and iron, as well as B vitamins.  Its GI about half that of cane sugar.
• Powdered cinnamon. One of the best herbs and spices to moderate blood sugar.  It can be sprinkled on hot cereals and desserts such as puddings, custards, and stewed fruits.
• Crudités such as celery. Celery is a great way to end the meal, whether to cap off a rich dessert or simply to add “crunch” when hunger is satisfied but you are still looking for “something more.”  Celery provides moisture and fiber to slow gastric emptying and moderate blood sugar.  Celery helps clean the teeth.  It also provides electrolytes and detoxifies while it lowers cholesterol.  Be sure to buy organic. Because celery is normally treated with ethylene gas to remove the bitterness (and its dark green color), it is one of the most chemically-treated foods.⁷
• If you currently take a chromium supplement to curb blood sugar, consider brewer’s yeast, if you do fine with yeast—yeast is a common allergen.   [Brewer’s yeast is a different variety from torula yeast, the yeast linked to Candida].   Brewer’s yeast is loaded with B vitamins and minerals.  One tablespoon provides 70% of the RDA for chromium,⁸ the primary micro-mineral required by the body to regulate blood sugar.  Brewer’s yeast can be sprinkled on salads, soups, yogurt, or mixed in drinks.  It is high in phosphorus (40% RDA), so be sure to consume sufficient calcium, and do not overuse.

Side Question:  How can people in some LDCs consume an 80% high-carbohydrate/high-glycemic diet and avoid diabetes? My guess is there are at least three reasons—more chromium in the soil; fewer refined carbohydrates (refining removes 90% of the chromium in wheat, as well as the fiber); and vigorous physical activity.  High-glycemic foods are not “ bad;” they are appropriate to restore the body from rigorous physical labor.

Appendix A:  Self-Testing Methodology

For my own self-testing of foods, I used a simple blood glucose monitor.  I appreciate that to hold scientific weight my tests would require a large sample size and multiple rounds of testing, but this was not my intent.   Instead, I wanted simply to provide a rough feeling for how foods affect blood sugar following a meal.  I did apply a degree of rigor, by testing foods as the first meal of the day consumed after a 12-hour overnight fast, and I consumed comparable quantities of food, where applicable.

In selecting foods for testing, I wanted to try foods that were rather pure proteins, fats, carbohydrates, as well as combinations thereof.  In reality, few foods are totally protein, carbohydrate, or fat.  Even though we think of whole oats as a carbohydrate, they are also fiber, protein, and 3 fat.  So, to interpret the charts, I list here the composition of the foods in my test universe.

Organic oats, 40 g dry weight=27 g carbohydrate (4 g fiber); 6 g protein; 3 g fat;

Butter, 1 teaspoon=5 g fat; 0 g carbohydrates; 0 g protein;

Eggs, 2 poached=12 g protein, 8 g fat, 0 g carbohydrate.

Canned wild sockeye salmon, 2 oz. serving= 12 g protein, 4 g fat; 0 g carbohydrates (0 g fiber);

Organic canned kidney beans, ½ cup serving= 18 g carbohydrate (10 g fiber), 8 protein; 0 g fat;

Coca-Cola, 12 oz. serving=42 grams carbohydrates (42 grams sugar as HFCS), 0 fat, 0 protein;

[A 50 gram serving was consumed to test instant, steel cut, whole oats, and kidney beans.]

Because 12-hour fasting, pre-meal blood sugar reading can vary, all data points at time zero prior to the first morning meal were indexed to zero in order to illustrate the change from a neutral starting point.

Reading Resources:

Granfeldt, Y., Liljeberg, H, Drews, A., Newmand, R, & Bjorck, I. (1994).  Glucose and insulin responses to barley products:  influence of food structure and amylase-amylopectin ratio.  American Journal of Nutrition, 59, 1075-1082.

Jenkins, D.A., Wolever, T.M., Taylor, R.H., Griffiths, C., Krzeminska, K., & Lawrie, J. A. (1982).  Slow release dietary carbohydrate improves second meal tolerance.  American Journal of Clinical Nutrition, 35, 1339-1346.

Juntunen, K.S., Niskanen, L.D., Liukkonen, K.H., Poutanen, K.S., Holst, J.J., & Hykkanen,H.M., (2002).  Postprandial glucose, insulin, and incretin responses to grain products in healthy subjects.  American Journal of Clinical Nutrition, 75 (2), 254-262.

Ludwig, D.S, Majzoub, J.A., Al-Zahrani, A., Dallal, G.E,, Blanco, I, & Roberts, S.B.  High-glycemic index foods, overeating, and obesity (1999). Pediatrics, 102 (3), e26.  Retrieved November 6, 2010 from:  http://pediatrics.aappublications.org/cgi/content/full/103/3/e26.

Ostman, E.  (2003) Fermentation as a means of optimizing the glycaemic index:  food mechanisms and metabolic merits with emphasis on lactic acid in cereal products.  Department of Applied Nutrition and Food chemistry, Lund University, Sweden, 1-59.

Ostman, E.M., Nilsson, M., Liljeberg Elmstahlt, H.G.M, Molin, G. & Bjorck, I.M.E. (2002).  On the effect of lactic acid on blood glucose and insulin responses to cereal products:  mechanistic studies in healthy subjects and in vitro.  Journal of Cereal Science, 36, 339-346.

Reaven, G. (1979).  Effects of differences in amount and kind of dietary carbohydrate on plasma glucose and insulin responses in man.  The American Journal of Clinical Nutrition, 32, 2568-2578.

Wolever, T.M.Jenkins, D. A., Ocana, A.M., Rao, V.A., & Collier, G. R.,  (1988).  Second meal effect:  low-glycemic-index foods eaten at dinner improve subsequent breakfast glycemic response.  American Journal of Clinical Nutrition, 48, 1041-1047.

Books:

Gropper, Smith, and Groff, Advanced Nutrition and Human Metabolism.

Institute for Functional Medicine, Clinical Nutrition: A Functional Approach.

Pizzorno and Murray, Textbook of Natural Medicine.

Copyright 2011 Pathways4Health.org

1. I use the label “traditional” carbohydrates, just as we call unrefined fats, “traditional” fats.
2. . Hegarty, Nutrition:  Food and the Environment (1995), 143-68.  Plants, through photosynthesis, create carbohydrates in many forms—simple sugars (e.g., glucose, fructose, glactose); oligosaccharides (e.g., fructooligosaccharides); starch (amylase and amylopectin); and non-starch polysaccharides (cellulose, pectin, hemicelluloses, and gums). They all play different metabolic roles, particularly soluble fiber which slows gastric emptying and helps curb blood sugar response.  Americans consume less than one-fifth the fiber of people worldwide.  Fiber protects against CVD, diabetes, and cancer.  (Clinical Nutrition, 27).
3. Clinical Nutrition, 35
4. For a description of the testing procedures used, see Appendix A.
5. DJ Jenkins et al. (1982); and TM Wolever, et al. (1988).  See Reading Resources.
6. Vinegar weakens bones (we add vinegar to bone stocks to leach minerals).  Fats and oils buffer this action, so vinegar should be used in moderation and accompanied by a fatty acid when possible.
7. Rebecca Wood, The Whole Foods Encyclopedia, 35.
8. People in some LDCs consume a very high (80%) carbohydrate diet, yet have no major diabetes problem.  Why?  Perhaps because, unlike the U.S., their soil is not depleted of chromium and they do not consume vast quantities of refined carbohydrates.  Refining extracts almost 90% of the chromium from wheat.

As a sequel to my April and May 2011 newsletters on blood sugar and metabolic stress, this a short June piece on the liver. Spring and summer are the perfect seasons to think of revitalizing the liver. Spring brings bitter greens to cleanse the liver following the rich heavy meals of winter. Meanwhile, summer provides antidotes to detoxify and de-stress the liver with its vast array of rainbow-colored fresh, nutrient-dense vegetables and fruits. It is these nutrient-laden whole foods that provide the liver with the tools—vitamins, minerals, and micronutrients—needed to convert toxins for their safe elimination from the body. Because summer also brings a more leisurely pace of living, there is perhaps no better time to alter dietary and lifestyle habits for a healthier liver.

A well-functioning liver is vital to good health because of the many important functions it performs in the body. Among its jobs, the liver helps to regulate blood sugar and the burning of fat; and, it processes and helps the body discard many toxins—drugs, pesticides, food additives and chemicals, environmental toxins, caffeine, alcohol, and toxic metals. Thus, it is the liver that bears the brunt of many of our modern dietary and lifestyle habits.

Over the past weeks in researching blood sugar and reading the lead article in the Spring 2011 Weston A. Price Foundation Journal on fatty liver disease, I think of one primary theme to emphasize in this newsletter—we need to think of the impact of processed foods on the liver.  The key idea to take away from this letter I would summarize as follows:

Our modern diet that relies upon refined carbohydrates and refined vegetable oils—so often consumed in convenience foods—takes a heavy toll on the liver. Refined carbohydrates and omega-6 vegetable oils such as corn, soy, and canola provide concentrated, inflammatory, empty calories but without the fiber (to slow and assist digestion) and essential neutralizing phytonutrient cofactors to allow the liver to do its job well. The speed with which empty calories are consumed—particularly from the sugar and high fructose corn syrup (HFCS) in soft drinks—exerts an enormously heavy burden on the liver. It is the calorie load, the speed, and the lack of nutritional cofactors needed by the liver to effectively process toxins that underlie the current epidemic of fatty liver disease.

Fatty Liver Diseases

Current research suggests that fatty liver disease is not just a disease troubling alcoholics. Nonalcoholic fatty liver disease affects more than 70 million Americans and is fostered by the modern American diet. The following factors are worth enumerating and repeating again. All are particularly detrimental to the liver…

1. Refined carbohydrates such as sugar and high fructose corn syrup (HFCS), especially when consumed as soft drinks. These high-glycemic carbohydrates tax the liver because of the speed with which the liver is forced to deal with the rapid-metabolizing calories and because they lack the nutritional co-factors required by the liver for their processing.
2. Refined vegetable oils such as corn, soy, safflower, and canola. These are polyunsaturated, inflammatory oils that are subject to oxidative stress/free-radical damage due to their fragile double bonds. As in the case of refined carbohydrates, processing strips refined oils of their natural protective antioxidants.
3. The relative absence of choline in the modern diet. Choline, found in egg yolks, liver, and organ meats, is necessary for the proper transport of fats from the liver.

The dynamics of nonalcoholic fatty liver disease is clearly explained in A Silent Epidemic of Nutritional Balance from the Spring 2011 WAPF Journal, which is available on line at http://westonaprice.org/health-issues/2162-nonalcoholic-fatty-liver-disease. If you do not have time or the inclination to read it in its entirety, much of the flavor is captured in the following excerpts:

Over seventy million Americans may have nonalcoholic fatty liver disease. The disease begins with the accumulation of fat within the cells of the liver, but can progress to inflammation, the development of scar tissue, and in some cases death from liver failure or cancer.

Simple accumulation of fat within the liver generally proceeds without producing any overt symptoms, but it is not necessarily harmless. The liver regulates blood glucose and blood cholesterol levels, plays a critical role in burning fat for fuel, helps eliminate excess nitrogen, contributes to the metabolism of endocrine hormones, stores vitamin A, protects against infections, and detoxifies drugs and environmental toxins.

Any damage to the liver is thus likely to impact whole-body health. Indeed, fatty liver disease increases the risk of cardiovascular disease three-fold in men, fourteen-fold in women, and seven- to ten-fold in type one diabetics. Fatty liver is thus a dangerous silent epidemic, and… it is likely caused by the overabundance of calorie-rich, nutrient-poor refined foods and the banishment of traditional sources of choline like liver and egg yolks from the modern American menu.

…numerous studies have confirmed the relation between fatty liver, obesity and diabetes…the disease is present in up to three-quarters of obese people. Similar studies have shown that 45 percent of type-one diabetics and 70-85 percent of type-two diabetics have fatty liver. Moreover, even in the absence of diabetes and obesity, those with the lowest insulin sensitivity have the highest accumulation of liver fat.

…fatty liver disease occurs in two distinct stages. In the first…fat accumulates within the cells of the liver. In the second, inflammation, the proliferation of fibrous connective tissue (fibrosis), and eventually the formation of scar tissue (cirrhosis) ensue.

The totality of the evidence suggests that the initial accumulation of fat in the liver is triggered by nutritional imbalance…fatty liver seems to occur as a result of too much energy flowing through the liver without sufficient nutrients to process it. The accumulation of delicate fats, especially polyunsaturated fatty acids (PUFAs) [like corn, soy, safflower, and canola oils]increases the vulnerability of the liver to oxidative and inflammatory insults in the form of infections, toxins, or poor metabolism. These insults launch the progression from the first stage of simple fat accumulation to the second stage of inflammation.

The key culprits, then, are nutrient-poor refined foods, choline deficiency and polyunsaturated oils.

…dietary protein, methionine, and choline …protect against sucrose-induced fatty liver disease. [This suggests, just as protein “anchors” alcohol to prevent a hangover, it is also a necessary component when we eat sugar. See May 2009 Newsletter on sugar cravings].

…unrefined foods supply a wide variety of interacting vitamins, minerals, and other nutritional substances that aided in the metabolism of the sugar, helping the liver to burn it for energy, store much of the excess as glycogen, and export any fat made from it into the bloodstream… supplying extra choline in the diet provides powerful protection again fatty liver, whether induced by sugar, alcohol, or fat.

…while there are special roles of including egg yolks, liver, and other organ meats, and spinach in the diet, as well as avoiding polyunsaturated oils and refined foods—especially sugar—there is likely to be a wide range of different diets that can promote liver health. What they all have in common is that they are ancestral diets, rich in nutrient-dense foods that we are well-adapted to…The emergence of fatty liver as a silent epidemic in the modern era is a call to nourish our livers with age-old traditional wisdom as we pursue the vibrant health of our ancestors.

Strategies for a Healthy Liver

The primary way to support the liver is through a diet rich in nutrient-dense whole foods. Bitter greens, now in season, are especially effective in cleansing the liver. Other strategies to support the liver include consuming fresh, organic (to avoid pesticides) fruits and vegetables and organic animal proteins rich in choline, while avoiding sugar, HFCS, refined vegetable oils and other refined, processed foods. So, too, will eating hearty meals early in the day, with a light supper consumed at least several hours before bedtime time. The liver cleanses the blood between 1 a.m. and 3 a.m. when it is at its peak activity. Late-night eating prevents the liver from doing its job efficiently and well (see November 2010 newsletter, The Body Clock).

Another aspect of liver health involves avoiding modern environment and lifestyle toxins. Do we give sufficient thought to how convenience foods combine with drugs and medications compound, creating an ever greater toxic load for the liver? Layer upon layer, toxins that burden the liver are everywhere—from synthetic prescription drugs, over-to-counter medications such as Tylenol and Nyquil, caffeine, alcohol, food additives and food colorings, pesticides in foods, and chemicals in cleaning agents.

Summer provides a time to pause, take stock, and alter dietary and lifestyle habits. Try to read labels and think of the factors in your present lifestyle that might be placing an unnecessary load on your liver. If you do not eat them already, try some cleansing bitter greens and think of shopping for fresh, organic food at a local farmers’ market. For sustainably grown foods, see www.localharvest.org and to find a local farmers’ market, go to www.ams.usda.gov/farmersmarkets.

June Recipe: Watercress Bisque

• 1 onion, chopped fine
• 1 parsnip, chopped fine
• 8 cups filtered water or rich vegetable or chicken stock
• 2 bunches watercress with stems, washed and chopped
• 2 tablespoons light miso or umeboshi vinegar, to taste

Simmer onion and parsnip in stock 20-30 minutes, covered, until very tender. Add watercress and simmer 3-5 minutes, uncovered. Add miso and puree with an immersion wand or in a blender. Serve with favorite garnishes. This is delicious topped with a broiled or poached fillet of fish.
(For a thicker soup, add some cooked grain with the miso and puree. Or, add 4 T. agar flakes when cooking, for increased mineral nutrition.)

Source: Pathways4Health, derived from Elson Haas.

Reading Resources

• April 2010 Newsletter, Managing Inflammation
• November 2010 Newsletter, Living by the Clock
• Unsaturated Oils: Structure and Food Sources
• Composition of Nut and Seed Oils

Copyright 2011, Pathways4Health.org