Jordan Peterson on Diet and Health

Jordan Peterson (born 1962) is a Canadian clinical psychologist and tenured professor of psychology at the University of Toronto. His research interests include self-deception, mythology, religion, narrative, neuroscience, personality, deception, creativity, intelligence, and motivation. He is a highly cited and respected researcher in his field.

Recently, and much to his own surprise, Peterson has become an internet sensation, appearing all over the alternative media where he is challenging the contemporary narrative on ‘social justice’, free speech and atheism.

He does this with such clarity and insight that his YouTube videos have quickly racked up millions of hits and he has been sought-after for interviews with alternative news shows such as Stefan Molyneux’s FreeDomain Radio, The Rubin Report and The Saad Truth, all of which are intelligent, thought provoking sites, which I also recommend.

To this new-found audience Peterson has brought a much needed paradigm shift in many areas of previously intransigent and polarised debate. In other words, he’s just my kind of man! If you have not heard him speak then I would recommend starting here (over 2 hrs long) or for here for a juicy 20 minute excerpt. His students really rate him, and I am sure you will see why if you listen to the longer interviews above.

The main purpose of this post, however, is to share some specific points that Peterson has recently made on diet and health as they are surprisingly concordant with the approach we advocate on this blog. I’ve selected the relevant clips from his recent live stream Q&A session below.

Peterson recommending regular sleep to improve circadian rhythms, as well as a protein and fat rich breakfast (2 min clip)…

Peterson explaining how a paleo diet helped his daughter and him improve their health (3 min clip)…

Peterson returns to the subject of diet and how his views on it changed (3 min clip)…

There! Isn’t he a good ‘un?

Please do watch the other videos of this man, his new found Rock Star status is justified on the basis of intellectual depth, breadth and honesty. What’s not to like?

Salt and cardio-vascular disease: Policy and Science clash

The recent video we posted of Dr SalimYusuf’s PURE study had a section on sodium intake, where he showed that the lowest risk of cardiovascular events, cardiovascular deaths and all-cause mortality was associated with an intake between 3000 and 6000 mg of sodium per day (equivalent to 7 to 15g salt per day). The current US average sodium intake is 3800 mg placing the general population nicely within this sweet spot, although towards the lower end.

Current US and UK dietary recommendations recommend an upper limit at 2300mg of sodium (6g of salt) whilst cardiovascular recommendations by bodies such as the American Heart Association aim to reduce sodium intake to 1500 mg per day (approx 3.75 g salt). If the PURE study is right (and it is not alone in questioning the current guidelines), then these aspirations would do more harm than good.

How did such discrepancy arise? The problem may be the use of surrogate markers. The thinking goes like this: Salt raises blood pressure. Raised blood pressure increases CVD risk, so salt increases CVD risk. This kind of thinking was evident in 2011 when the American Heart Association (AHA) called for salt targets to be reduced to 1500mg per day.At the time MedPage Today explained:

The evidence linking salt intake with blood pressure — and the major adverse outcomes of heart disease, stroke, and kidney disease — is “impressive,”…

That evidence includes more than 50 trials assessing the blood pressure effects of salt, as well as a meta-analysis showing that cutting salt intake by about 1,800 mg per day lowered blood pressure by 5 mm Hg systolic and 2.7 mm Hg diastolic.

This is a “critically important public health issue,” according to Appel and colleagues, and this AHA advisory must be considered “a call to action.”

On the basis of this ‘A leads to B leads to C, therefore A leads to C’ thinking initiatives were instigated all round the world to reduce public consumption of salt. A task force of concerned scientists even formed a lobby group to put pressure on food manufacturers, which successfully led to reductions in added salt in manufactured foods.

However, within a short time of the AHA call to action reports started coming in contradicting this advice.

Over this period it is clear that scientists were becoming more and more irritated with the dogmatic approach of the AHA and government bodies, and by the last article were publicly calling the AHA anti-scientific!

Despite all of the research questioning the validity of further salt reduction US and UK policy remains stubbornly wedded to the ‘less is best trajectory’. In their 2016 survey the UK government reported proudly that average sodium consumption fell from 3500mg in 2005 to 3200 mg in 2014.

Their report claimed “Too much salt in the diet can raise blood pressure which increases the risk of heart disease and stroke. A reduction in average salt intake from 8g to 6g per day is estimated to prevent over 8000 premature deaths each year and save the NHS over £570million annually.”

Yet contrary evidence from studies including PURE would suggest that this is not simply futile but probably harmful. You would think that with the swathe of research challenging the low salt dogma that public policy would be questioning the wisdom of further reductions. Not a bit of it. Dr Alison Tedstone, chief nutritionist at Public Health England, makes no bones about it:

Our analysis makes clear that there is a steady downward trend in salt consumption. While people are having less salt than 10 years ago, we are still eating a third more than we should.

Many manufacturers and retailers have significantly reduced the salt levels in everyday foods. However, more needs to be done, especially by restaurants, cafes and takeaways.

The intransigence of health policy makers leads researchers to exasperation and despair. As one writer put it:

…the ‘salt hypothesis’ is rather like a monster from a 1950s B movie. Every time you attack it with evidence it simply shrugs it off and grows even stronger. – Malcolm Kendrick

In an interview with MedPage today researchers who found that patients with heart failure who ate more salt did better than those who ate less made the following statement which we have published before, but is such a gem it deserves another outing:

“We have had no basis for any of our recommendations regarding sodium restriction during the past 50 years, although these recommendations have changed a great deal (for no good reason). After this report, we still have no basis for any of our recommendations regarding sodium restriction. We were ignorant before; we are not any smarter now. Did we really need this report to tell us that we lack evidence for our recommendations regarding dietary sodium in patients with heart failure?”
Milton Packer, Professor in the Division of Cardiology, UT Southwestern

Further reading:

Salt vs sodium measurements

We made a boo-boo in out recent post (Cardiologist attacks diet dogma at 2017 symposium) where we summarised the findings from the PURE study regarding salt intake. We originally stated that 3 to 6 grams of salt per day appeared optimal but this should have read 3 to 6 grams of sodium per day.

What’s the difference?

Salt is a simple compound sodium chloride, NaCl, composed of sodium and chlorine atoms in a 1:1 ratio. Sodium has an atomic mass of 23 and chlorine a mass of 35, so the the fraction by weight of sodium in salt is 23/58 = 40%; or said the other way round, 1 gram of sodium is found in 2.5g of salt. To make things even more confusing, sodium is often quoted in milligrams (mg) whilst salt is given in grams, so the conversion becomes: 1000mg sodium = 2.5g salt

Let’s put this to the test with a confusing pair of health policies: UK guidelines recommend you eat no more than 6g of salt per day, whereas US guidelines place the limit at 2,300 mg of sodium per day. How do these compare?

First, converting the US 2,300 mg of sodium to grams gives 2.3 g of sodium. Next, convert this to the equivalent amount of salt by multiplying by two and a half: 2.3g x 2.5 =  5.75g. This figure rounds to 6g. i.e. they are essentially recommending the same thing, but expressing them in different ways. (That’s the special relationship for you!)

Here is a handy table for converting between sodium, salt and teaspoons:

Salt in
grams
Sodium in mg Approx. equivalent to                Guidelines – daily limit
0.5 200 Average pinch of salt
2.5 1000 Half a teaspoon salt
3.75 1500 ¾ a teaspoon salt Recommended (AHA)
5 2000 One teaspoon salt
6 2400 1¼ teaspoons salt Upper limit (UK / US)
10 4000 2 teaspoons salt Current average consumption
15 6000 3 teaspoons salt Upper limit (PURE study*)

*The PURE study found that the lowest risk of cardiovascular and all-cause mortality was associated with a sodium intake of 3000 to 6000 mg per day. A concern I will look at in the next post is that public health policy does not take into account the lower limit, and assumes that less salt is always better. PURE and other studies suggest otherwise!

This sodium/salt mistake crops up a little too often and leads to confusion. For example MedPage Today, a respected medical news site, reported in 2011 that the American Heart Association had called for salt intake to be limited to 1,500 Mg. (I will write more about the conflict between this figure and the findings of the PURE study in my next post)

First off, I’m sure they meant milligrams (mg), not mega grams (Mg). Autocapitalising their title, put them out by a ‘trifling’ factor of one billion, but that’s forgivable. Where they really sowed confusion was by muddling up sodium and salt like I did. The AHA were calling for sodium intake to be reduced from 2300mg per day to 1500 mg per day (for adults), but MedPage reported these figures as salt not sodium.

One bemused commenter wrote “This article suggests 1 1/2 gms of salt a day, in the UK we are told 6gms per day”

So to clarify, the UK and US recommended upper limit is 2300 mg sodium per day (= 6 g salt), and the AHA recommendation is 1500 mg sodium (=just under 4g of salt). In contrast the PURE study found the ideal range was 3000 to 6000 mg sodium (=between 7.5 and 15g of salt per day).

Why then do researchers and nutrition labels quote sodium, not salt quantities? Because in principle at least, you could get sodium from sources other than sodium chloride. In practice non-salt sources of sodium are insignificant.

Anyway, hope that clears up the confusion about measuring sodium levels.

Next up I’ll tackle how the national guidelines are pushing us in the opposite direction to that suggested by the PURE study.

Kids eat sugar. But no one knows how much. Apparently.

The headline drew me in. I couldn’t resist. My Sword of Irony was twitching eager for a fight. It was going to be a blood bath…

Children’s sugar intake equals five doughnuts a day, campaigners say.

The Guardian, 24/02/17

So sugar is measured in donuts now? How much is one donut of sugar? Are we talking metric donuts or imperial? Couldn’t we just say it in tea spoons or sugar lumps? I read on hoping for clarification… “Children and young people are consuming the equivalent of 20 chocolate chip biscuits a day in sugar, according to anti-obesity campaigners.” Right. That’s cleared that up. Metric donuts obviously.

I press on being told that much of their sugar intake is ‘hidden’ in drinks and food. Hidden? How? Do you mean to say that parents don’t realise a can of coke contains sugar? Is the sugar in fruit juice really hidden? Have we all lost the ability to tell that sweet tasting foods contain sugars? OK, granted, some savoury kids’ staples like baked beans contain a bit of sugar, but you’d have to eat a hell of a lot to reach even five imperial donuts worth, let alone five metric ones.

Ah! This looks better: “Children and young people aged between 11 and 18 typically have an intake of 73.2 grams of sugar a day, far in excess of the 30g – or seven teaspoons – maximum recommended in official health advice”.

Woah! The sugar measuring system just swung from the hopelessly vague to the impossibly precise: 73.2 grams? One wonders why the point two was needed – is it somehow relevant? Call me cynical, but I suspect it’s so that after intensive government intervention and millions of tax payers money they can claim success when it is announced that intake has fallen to 73.1 grams.

Anyway, the article finishes with the promise extracted under duress from big name brands including Tesco, Waitrose, Nestlé, Lucozade, Ribena and Kellogg’s (whose sugar content has never been particularly occult to my knowledge), who have announced plans to reduce their use of sugar as part of a ‘reformulation drive’ ahead of the government’s sugar tax coming into force in 2018.

Damn right! They should get on with driving that reformulation and drive it hard. And while they are at it they should stop hiding donuts in kids food. Disgraceful.

As for the Guardian’s sloppy metrology, I am writing to them to insist they stick to units everyone recognises: the size of Wales.

Whole grains? Not a health food say these researchers

heart-health-whole-grainsIn the conclusion to their study examining the links between cardiovascular disease (CVD) and food consumption across 42 European countries, Pavel Grasgruber et al. make this bang-on-the-money statement about the propaganda surrounding so-called “heart healthy whole grains”:

A very important case is that of cereals because whole grain cereals are often propagated as CVD prevention. It is true that whole grain cereals are usually characterised by lower glycaemic index and insulin index values than refined cereals, and their benefits have been documented in numerous observational studies, but their consumption is also tied with a healthy lifestyle. All the available clinical trials have been of short duration and have produced inconsistent results indicating that the possible benefits are related to the substitution of refined cereals for whole grain cereals, and not because of whole grain cereals per se.

To use an analogy with smoking, a switch from unfiltered to filtered cigarettes can reduce health risks, but this fact does not mean that filtered cigarettes should be propagated as part of a healthy lifestyle.

In fact, even some unrefined cereals [such as the ‘whole-meal bread’ tested by Bao et al.] have high glycaemic and insulin indices, and the values are often unpredictable. Therefore, in the light of the growing evidence pointing to the negative role of carbohydrates, and considering the lack of any association between saturated fat and CVDs, we are convinced that the current recommendations regarding diet and CVDs should be seriously reconsidered

Source: Grasgruber et al.,Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries, Food and Nutrition Research, Sep 2016

Fish n Chips a l’Afifah

fish-n-chips

It’s Friday tomorrow. Are you thinking fish and chips?

This is my version. None of those reheated, oxidised seed oils and wheat batter here!

  • Wild Alaskan Sockeye Salmon fillet (Waitrose)
  • Organic peas with samphire (Waitrose)
  • Broccoli with grilled sheep’s cheese (Parlick Fell, Sainsbury)
  • Chips par-boiled then roasted in goose fat

The salmon is gently pan-fried in ghee, with just a light seasoning of salt and pepper. The meal is very satisfying, even with such a small portion of chips!

Why aren’t hospitals doing their detective work?

profile-afifahI was talking to a doctor today about a seriously ill patient who I am keeping close tabs on, but whose medical condition is still unclear. His comments about the hospital were very telling. Here is the gist of the conversation:

I explained to this very experienced GP that this 50 year old patient had been taken to the local hospital with extreme abdominal pain some weeks ago, following two months of deterioration in health. Despite treatment by their GP with a range of different stomach acid blocking drugs, the gut pain had got much worse. Eventually they were whisked to A&E where we all hoped a detailed investigation would be undertaken.

Once in the hospital they were given morphine. A couple of hours later the doctor in charge had asked if the patient was feeling better, which they were (a known side effect of morphine I believe!) so he discharged them home. Once home the pain returned with a vengeance as the morphine wore off (surprise, surprise) and they were again in agony and again admitted to hospital.

My GP friend agreed with me that this had been a bizarre episode and added that as a GP he would send a very sick patient to hospital expecting them to do the investigative work required to ascertain the cause of the illness. Hospitals, of course, have the means to do this, with access to a broader ranger of expertise and a laboratory at hand. He was shocked that instead of doing the expected detective work it appeared that they instead found a way to free up the bed as quickly as possible. We agreed that morphine is not the answer to a seriously ill person when you have not yet ascertained the cause of their pain and obvious illness.

The medical profession really need to see themselves as medical detectives. This is, in fact, what patients expect. The fact that this is not what happens on so many occasions – and this is just one of dozens of patients I could tell you about – is, as far as I can see, not only a waste of expertise and resources but a betrayal of the public.

If a proper focus is applied to the sick patient, in endeavouring to identify the actual cause of the problem and address it at cause, sone would expect a better success rate. This is obviously a more health-effective approach, but more than that, it would surely also be more cost effective!

This patient of mine had to be admitted to hospital twice, and despite being admitted for twelve days the second occasion they managed to lose four biopsies, failed to make a meaningful diagnosis and discharged them home just as ill as when they went in. All this time and expense, and no nearer to understanding what was causing the problem. Their suffering, as you can imagine, is immense!

Of course I will do due diligence and read, think, pursue and dig for possible causes but, like most GPs, I do not have advanced diagnostic kit at my disposal. Neither am I a biochemist or specialist – we rely on our hospitals (at our peril it seems) for that level of expertise. This patient’s symptoms demand serious investigation as there is definitely more than one thing afoot here.

What is the point of someone being transferred to hospital in a seriously ill state if the required detective work is not done? What is the hospital for?

Just a few weeks ago a Care Quality Commission report stated that the health service’s failure to properly investigate hospital deaths is “a system-wide problem” that means hospitals are not learning from their mistakes and thus stopping other tragedies from occurring [The Guardian, Dec 2016]. I fear that “failure to investigate” may too often apply during admission as well.

Acrylamide – is it really a risk?

profile-keirAcrylamide is a potentially cancer causing compound produced when starches are browned during cooking. As reported in our Jan 2017 News Round Up concern about dietary acrylamide has led the Food Standards Agency to recommend the public ‘go for gold’ – avoiding medium and heavily browned toast, potatoes and pastries. But is this advice overblown?

‘Risk’ is always a slippery subject and human evolution does not appear to have equipped us to deal with it intuitively. The very word ‘risk’ is enough for many of us worry, or exclude a food ‘just to be on the safe side’. Hopefully, the following will put to bed any such concerns about the risk from acrylamide.

This graphic shows the commonest sources of acrylamide exposure:

acrylamide-intake

One of the highest sources is coffee. Coffee consumprion, however, is associated with reduced all-cause mortality. The benefits across a huge range of measures from heart disease to dementia, increases with consumption, up to six cups per day, and has been shown to be independent of caffein. [See our post on coffee here]

If the risk from acrylamide was significant you would expect to see the reverse, with more coffee consumption linked to more cancer. As the data does not show this then the risk from acrylamide must be very small. Small enough to be countered by the beneficial phytonutrients in a cup of coffee.

Ah! If only all risks in life were so easily neutralised!

Looking again at the table above, apart from the coffee there are plenty of reasons to avoid the junk on that list: oxidised oils, gluten, n6 PUFAs… Acrylamide would be a long way down my list of concerns.