Wednesday, January 14, 2015

Vegan Blog Going On Holiday & 3 Most Popular Posts

While my posts have been sporadic at best over the past 7 years, my blogging efforts for the months to come will be found elsewhere.

For those of you who just stumbled upon this blog, here are the 3 most popular posts over time:

The #1 Favorite: How Can Vegans Be Overweight?

Eliminating animal foods is one step in a healthy direction, but for many it's not the only step that is needed. This post explores a few reasons why people eating a vegan diet can still struggle with their weight. So what to do if you're still struggling? Find a vegan-friendly dietitian to work with and consider slowly picking up serious weight training or running. If that fails, a lifestyle medicine doc might be a good ally.

Many people write looking for a vegan-friendly PCP or Lifestyle Medicine MD. Some potential leads are here:

The #2 Runner Up: Why SOME People Struggle With A Vegan Diet

Each year, tens of thousands of people are inspired to go vegan out of deep concern for animals, the environment and their health. Sadly, the majority of those return to a regular diet of animal foods. Yes, it can be hard to not eat like everyone else and the effort of going out of your way to find vegan options can become hard to sustain for many. But some don't feel they are thriving on a vegan diet. Why is that? It's a topic that's almost never discussed, but one I encounter in clinic periodically and explore in this post. And no, the answer is not because we need to eat meat or combine proteins!

From my clinical experience, the first issue mentioned in this post - not eating enough calories - is the most common problem and is one that can be easily addressed if recognized. The common pattern is someone who switches to a vegan diet, loses a few pounds, feels fantastic at first but as the weeks and months go by they continue to lose too much weight or feel fatigued. Essentially, they need to learn how to eat more calories and monitor for weight periodically.

Dr. Furhman, one of the few docs with extensive clinical experience in this realm, also cites a need for some of his patients to supplement zinc, DHA/EPA and in rare cases possibly taurine, iodine, vitamin k2. Dr. Greger cites a rare Carnitine deficiency caused by a genetic disorder that might be unmasked by a vegan diet here. These are worth considering if other measures fail.

While cutting out a good 1/3 to 1/2 of your diet and replacing it with plants requires some learning for most people, it's definitely a doable (and highly worthwhile) challenge. But for those who struggle, don't revert back to the standard awful diet that is the norm. In the least, eat as many vegan meals as you can during the week and you'll be making a great difference in all realms. Sometimes, compromise is the answer. Adaptation takes a different time course for us all.

The #3 & Original Post: The Fears Of A Suspecting Vegan. Answered. 

Having been vegan for about 24 years, I have encountered innumerable health concerns borne of fear and propaganda along with every possible iteration of "You're vegan?!? Well, where do you get your protein/nutrients/vitamins/etc?". That inspired me to start a blog for some general responses. In this first post, I tried to spell out from my vantage point which things do actually warrant some attention. There's no reason to have fear on the menu, but there are a few important nutritional items those on a vegan diet should head. The list is much longer for those not on a vegan diet, and those can be found elsewhere.

Want More?

I highly recommend Dr. Greger's site - NutritionFacts.Org

Thanks Thanks Thanks!!!

Thanks to you for taking time to read my blog and share both feedback and your appreciation. Can't say how much that has given me over the years. Eventually, I'll get back to blogging more on these and other related topics.

But for now,
Much love to you all,
And thank you for all you do to make this a better world,


Monday, April 7, 2014

The Impeccable Doctor Murthy & Why He Deserves Your Help

Why the hoopla over your Surgeon General To Be? 

Recently, the NYT wrote about my dear friend and colleague Vivek Murthy, MD MBA - the US Surgeon General nominee whose Senate confirmation vote is being delayed in part because of intense efforts from the National Rifle Association. The NRA claims that Dr. Murthy is a rabid gun activist who is out of touch with the people and doesn't belong in office. To my knowledge, the NRA hasn't even met with Dr. Murthy. Their policy is clear - anyone who mentions the word 'gun' in anything but favorable terms is their Enemy #1.  Their agenda is singular, and it certainly has nothing to do with improving America's health.

As you might guess, I'm not a proud member of the NRA, but that is beside the point. Their efforts are a distraction and a disservice to this nation. Dr Murthy is the perfect candidate for the Surgeon General post, in a time of emerging technology, endemic obesity and disturbing health disparities. This is why he has been endorsed by a phenomenal array of medical groups and individuals.

A few personal words, about the good Dr.

In all of our lives, some people just stand out. I've lived in 3 countries, trained at 5 institutions and worked in 4 distinct sectors. I've been extremely fortunate to cross paths with thousands of truly phenomenal people over the past several decades. Vivek stands out amongst them. Why?

It could be that he possesses a very rare combination of traits. Vivek is as humble, down-to-earth and mild mannered as people come. He's earnest, self-sacrificing, works tirelessly and selflessly for the good of others. His accomplishments range from admission to the world's top academic institutions, to starting several grassroots non-profit organizations, to launching successful businesses. But this might not be noteworthy if he also weren't such an amazing human being. His ability to truly listen and to connect and understand others is stunning. There's a presence about Vivek that is other worldly.

I first met Vivek at Yale School of Medicine 15 years ago, where he was a year ahead of me. I followed in his foot steps to train at Harvard's Primary Care and Population Medicine residency program. I've seen him in many a trying situations, from comforting ailing patients to the ER-like-drama of "coding" a patient to bring them back to life. Above all, Vivek consistently brings his intense focus, his immense compassion, his calm level-headedness and far-beyond-his-years wisdom to everything he does.

In case it's not clear, this man is not only a brilliant physician and entrepreneur, he's a phenomenal human being who will energize the national conversation around nutrition, exercise and obesity.

What you can do NOW & how you can help. 

Do we really want the NRA to pick the nation's Surgeon General? They've outright said that they will be counting Senators' votes on the matter - which is about as close to [legal] political blackmail as it comes. Even if you support gun ownership, do you think the NRA is qualified to determine who should be Surgeon General?

One small thing you can do right now:

Go to and add your name to the Million plus people who support Vivek for Surgeon General.

Then help us spread the word. Join us on Team Vivek. 

Then reward yourself with this little Daily Show clip on the matter.

Monday, August 12, 2013

More Veggies for More Happiness :-)

Let this be another reminder of why eating more veggies is good for you: Happiness! Guest blogger Virginia Cunningham explains below.

Some Take Homes:

  • There seems to be a correlation with eating more veggies and greater mental health.
  • A British study that looked at data from 80,000 people suggests that 7 or more servings of vegetables and fruits per day is needed for optimal mental well-being.
  • It's not an all or nothing phenomenon, increasing your fruit and vegetable intake by any amount should make a difference.
On a similar note, Dr. Greger has some fascinating posts on interesting mechanistic research explaining why certain vegetables ease depression and why chicken, eggs and other animals products can worsen it

Eat Your Veggies For Happiness!

You’ve been told that eating lots of fresh fruits and vegetables is good for you about a million times. You’ve likely heard it on TV, read it in newspapers and magazines, and likely grew up hearing it from your parents and family too.

That’s why most of us equate eating fresh fruits and vegetables with a healthy diet and a healthy body; however, it turns out that eating your vegetables and snacking on fruit could actually make you happier in your daily life.

The Link Between Physical Health and Depression

Most people think they should eat their fruits and vegetables to preserve their physical health. Of course, this is absolutely true. Fresh fruits and vegetables are full of nutrients, vitamins and minerals that your body needs, and they’re generally very low in calories, while being free of harmful fats. 

However, there’s also a major link between physical health and depression. In many cases, adults that suffer from depression may have a higher incidence of heart disease and other types of cancer. 

It seems the opposite is also true – that what you eat and how it affects your physical health can also alter your mood and general disposition. In this way, physical health and depression are very much linked, and what you eat appears to be linked to how you feel – both mentally and physically. 

Food May Affect Brain Chemistry

Research has elucidated that depression is caused in part by temporary or permanent chemical imbalances in the brain. 

The more researchers study food and how it affects our brains, the more they’re starting to understand that what people contribute to their biochemical and metabolic processes control how our brain’s produce necessary neurochemicals, like serotonin. Some of these chemicals may be linked to both depression and general feelings of wellbeing. 

How Much Should I Eat?

According to a 2012 British study, which looked at data from 80,000 people, the more fruit and vegetables people ate, the better their reported moods and mental health. And the best moods and mental health were found in those who ate about seven or more servings per day. While that might sound like a lot, it really isn’t when you break it down. 

Having a piece of fruit as part of a healthy breakfast, and a lunch salad or main course with an additional two servings of fruits and vegetables accounts for about half of those seven servings. A healthy fruit or vegetable as a snack and an additional two servings of vegetables for dinner can easily make up those seven servings per day. 

It might take some getting used to on your part, especially if you’re used to reaching for the cookie jar when you want a snack, or relying on dessert to finish your dinner; however, the physical health and emotional benefits of eating more fruits and vegetables appears to be well worth the effort. 

About the author:
Virginia Cunningham is a health and beauty writer who works with Bellezza Spa, a Miami salon, to help others maintain a healthier and happier lifestyle. As a yoga enthusiast and mother of three, she always makes sure that her family stays healthy, both emotionally and physically. With daily yoga and a well-balanced diet, she is able to maintain a healthy lifestyle.

Thursday, May 9, 2013

EarthDay 2013 Interview

I did a two part interview with One Medical a few weeks back on the impact of our food choices on global warming -- this year's EarthDay them.

Part 1 is here. Why eating plants over animals is so important...

Part 2 is here.  Organic vs. local and a few other topics... 

Tuesday, March 19, 2013

Iron Status - Vegan Style

Here's a helpful guest post by Evelyn Pearce on achieving optimal iron status.

Some take homes:

  • Vegans can have optimal iron status
  • Iron from meat (heme-iron) might be a causative factor in the link between meat and many chronic  diseases
  • Being conscious about eating healthy whole plant foods usually means including an iron rich food at each meal
  • There are a few little food tricks that can boost iron absorption which might be important for some people... read on to learn more... 
Demystifying Iron: Why Vegans Can Have Optimal Iron Status
A vegan diet offers many health benefits. It is lower in calories and saturated fat, yet high in antioxidants, B vitamins, potassium and fiber, all of which reduces your risk of heart disease. There is also growing evidence that those who avoid or limit their intake of animal produce are less likely to develop diabetes and cancer. As all three medical conditions are highly prevalent in the United States and other industrialized countries, this can only be a good thing. While the advantages of a vegan diet for your health are well recognized, worries relating to potential nutritional deficiencies are one of the barriers standing in the way of more people adopting a completely plant-based diet.  It is true that you can develop particular vitamin and mineral deficiencies on a vegan diet, but equally this can occur if you eat meat or other animal produce. The key is ensuring you include the right balance of foods whichever dietary approach you choose to adopt.

The question of iron
However, when people hear you follow a vegan diet, one of the most common things they assume is that you must be anemic. It’s still a widely held belief that avoiding all animal produce will leave you deficient in iron. As any vegan with a good awareness of nutrition knows – which to be honest is a lot of us – there are a variety of plant sources of iron and obtaining adequate iron through our diet is easily achievable. We just need some forward planning, but then everyone should be putting thought into their meals irrespective of whether they eat meat or not.

Admittedly iron deficiency anemia is a relatively common in America, with figures showing that it affects around 9% of women under 50 years of age. It’s not a pleasant condition; you’re left extremely tired, as your blood is unable to carry sufficient oxygen, which makes even day to day activities difficult. However, research suggests that vegetarians are at no greater risk than non-vegetarians of developing this form of anemia. While less well studied in vegans, the National Institutes of Health doesn’t identify us as an at risk group for iron deficiency anemia. However, it does suggest we may need twice as much iron as meat eaters to prevent deficiency, though more on this point shortly.

Vegan source of iron
When relying solely on plant produce for iron, there are a number of key foods that provide this; though as a matter of following a vegan diet, they are probably included already. Pulses (peas, beans and lentils), wholegrain cereals and those which have been fortified with iron (which many are, so check the label), tofu, green leafy vegetables like kale, spinach and cabbage, dried fruit and seeds are the main providers. We should ideally be including at least one of these foods at each meal and consider the likes of cereal, dried fruit and seeds for snacks.

A matter of absorption
As hinted previously, the iron in plant-based foods is not as well absorbed as that from meat and fish, which is why we need to consume more iron to ensure our bodies receive sufficient. This relates to the fact that the iron present in the two sources is slightly different, with that found in animal produce more readily available to the body. However, we can take steps to increase our uptake of iron from plants.
  • It’s well-known that vitamin C increases absorption of iron by converting the iron in plant foods to the more favourable form, so a source of the vitamin should be included with meals. Good sources of vitamin C besides citrus fruits include berries, kiwis, peppers, tomatoes and green vegetables. 
  • Meanwhile the tannins and polyphenols found in tea and coffee make it more difficult for the body to take up iron if these are consumed near meal times; try to avoid them for an hour either side of meals to give your body a better chance of iron absorption. 
  • Phytates, which are found mainly in pulses and wholegrains, also reduce iron absorption. However, as these foods are also a source of iron, you should not avoid these in your diet, but instead concentrate more on increasing your vitamin C intake and avoiding tea and coffee near meals.
Health benefits of non-heme iron
Obtaining your iron from plant sources (known as non-heme iron) in contrast to that derived from animal flesh (heme iron) could be a healthier option according to research. There is increasing evidence that heme iron encourages production of free radicals - damaging substances that cause injury to cells and are implicated in the development of heart disease and cancer. This may explain why meat eaters have been shown by studies to have a higher risk of heart disease and bowel cancer than those who avoid it. Research also suggests that consuming heme iron increases the risk of developing diabetes; this condition of impaired glucose metabolism is certainly less common amongst vegetarians and vegans. As non-heme iron is less readily absorbed, it is unlikely that iron stores will accumulate; it is these high iron stores which have been linked to increased susceptibility to chronic diseases.

About the author:
Evelyn Pearce is a freelance writer and mother of two, who when not at her keyboard or minding the children, likes to take her German shepherd for a walk in the hills around her home in Red Oak, Iowa.

Sunday, March 3, 2013

Sleep Better - 4 Tips To Fall Asleep

Many people struggle to fall asleep. Having the odd sleepless night is not a big deal, but day after day of poor sleep can have a major impact on your health and sense of well-being. A patient of mine asked if I would post a few tips for those who struggle with sleep.

First, a caveat: there are many causes of insomnia. If this is a major struggle of yours, it's worth having a detailed clinical evaluation. For example, perhaps the main cause is Obstructive Sleep Apnea and the best treatment for your restless sleep is weight-loss and a CPAP breathing machine.

That said, irrespective of the cause, it's also worthwhile learning what factors you can control to improve your sleep.

Here are 4 sets of tips I find helpful:

Basic Sleep Hygiene

Many factors influence the ease at which you can fall asleep. You don't necessarily need to do all of these, but likely the more you do the better. You've probably heard some of this before:
  • Go to bed and waking at the same time each day is the best way to regulate your circadian rhythm
  • Make sure your bedroom is sufficiently dark and quiet
  • Sleep in a bed you find comfortable
  • Dim the lights as early as you can to allow melatonin levels to rise
  • Do something to relax before you go to bed, like meditate or have a hot bath/shower
  • Don't use your bed for anything other than sleeping and physical intimacy (there are exceptions, for example if you've conditioned yourself for decades to fall asleep after reading in bed) 
  • Understand your caffeine sensitivity: for most people caffeine after 3p or so will interfere with sleep (caffeine has an ~8 hour half life)
  • Alcohol can be sedating but it always worsens sleep quality. Some people can do fine with a drink or two, others need to avoid completely
  • Exercise daily - for me, this is the single most important thing I can do to guarantee a good nights sleep. Exercise increases sleep quality. Just be aware that intense exercise late at night can be activating and keep you up.

Advanced Sleep Hygiene

Turns out there are some new discoveries based on sleep physiology that offer even more insight into factors that help, some of which I learned at last years American College of Lifestyle Medicine meeting:
  • Being well hydrated: this enables your peripheral blood vessels to dilate (see below) without a large increase in heart rate. However, try to drink a lot during the day as if you drink a lot right before bed you might have to wake to urinate.
  • Be warm before you go to bed, but sleep in a cooler environment - to induce sleep your body dilates blood vessels to lower your body temperature. Presumably it won't be able to lower your temp much is you are already cold. So make sure your extremities (hands and feet) are warm before going to bed.
  • Many find the combination of black-out shades and a dawn-simulator light an effective combination for creating a dark sleep environment and having light wake you up.
  • Don't use a back-lit screen an hour before you go to bed (i.e. computer, ipad, smartphone, TV, etc.) as the blue light will decrease melatonin production.
  • If you nap in the afternoon, limit your naps to 30 minutes or less.

Advanced Sleep Hygiene for when you wake up in the middle of the night

  • Don't make the classic mistake of stressing about it. This will keep you up. Sleep quality is not significantly decreased by waking once or twice at night to pee. Avoid looking at the clock when you awake. 
  • Drink a cold glass of water - this will cool your body down (as above).

Sleep Induction Techniques

Most people have racing thoughts, worries, aches or pains that "prevent" them from falling asleep. Trying to force these thoughts, feelings or worries to stop only serves to activate your brain and make it even harder to fall asleep. Instead, some savvy clinicians have realized that diverting attention to a sleep-inducing concentration can be very effective.

I learned this technique from Richard Shane PhD - the idea is to mimic the sensation of falling asleep, which is universal in humans. Thus the term "falling" asleep. 
  1. Pick A Sleep Position. Find the most comfortable position you can to fall asleep and commit to staying in that position for 20 minutes without tossing and turning.
  2. Allow Your Tongue to Relax. Notice the position of the tongue? Is it pressing hard against the roof of your mouth? Allow it to relax a tiny bit and press less hard. You don’t need to move the tongue.
  3. Allow Your Throat to Relax. Notice if your throat is tight or open. Imagine the sensation of yawning or a relaxed neck and throat. You don’t need to move your throat. 
  4. With One Hand Over Your Heart, Notice a Falling Sensation of Your Chest When You Breath Out. Pay attention to falling in and down sensation as the chest wall cradles the heart space every time you breath out. Your breathe will often be shallow and will pause at the end as you are falling asleep. This is normal. You don’t need to change your breathing. Just pay attention to the falling sensation...and keep your attention there.
Wishing you all sweet dreams and restful sleep.

Tuesday, January 29, 2013

Contacting Me

Dear Dylan & Other Readers,

Thank you so much for taking time to read my blog. 

If you have specific questions that you would like answered, feel free to email me:

I will do my best to respond, but please understand that my free time is extremely limited. That said, if I can help from a distance, I certainly will. I do wish I had more time to post and do a better job of organizing this blog.

If you have a request for a blog topic, feel free to email those too.

Wishing you all good health and happiness,

image source:

Saturday, September 15, 2012

Why SOME people struggle with a vegan diet

Is a vegan diet for everyone?

If consciously crafted, a vegan diet has profound health advantages and allows us to best care for our environment and live in alignment with our innate compassion. So yes, a type of vegan dietary pattern could be ideal for the vast vast majority of humans. And yet, we can't deny that some people (read: the minority) struggle to make a vegan dietary pattern work for them.

Why do SOME people not thrive on a vegan diet? And what can you do about it.

Frankly, this question hasn't been well researched and is poorly understood. But here are a few hypotheses that are worth considering if you or someone you know is not doing well on a vegan diet.

1. Not Enough Calories

One great advantage of a vegan diet is lower calorie density.  People often lose weight when they go vegan. This is super awesome for the majority of people, but not necessarily for relatively-thin, highly-active young people who are also very health conscious. Chances are these people have less appetite-drive and don't absorb calories as well as others. They probably avoid food when they are anxious/stressed and avoid binging on calorie-rich foods. They tend to choose the least calorically dense foods possible because these are healthier - like raw veggies and brown rice.

For some of these folks, they simply will not always be meeting their caloric/energy needs and they might feel more fatigued then usual overtime. Perhaps this is the brain's way of saying "slow down, there just isn't that much food around to support all this extra activity". They might feel better when they return to eating animal products, simply because they begin eating more calories and have a less restricted diet.

Rather than adding back the animal products, a better solution is do some creative meal planning and figure out ways to add back the missing 500 or so calories. There are lots of ways to do this, from emphasizing fat rich foods (e.g avocado, nuts, seeds, coconut) to making food more dense (e.g. smoothies, dehydrated foods/food bars, nut butters, dried fruit) to even sometimes choosing more processed foods (e.g. white rice) and including more protein-concentrated foods (e.g. seiten).

2. Junk-Food Vegan

On the opposite side of the coin is the junk food vegan that lives off vegan pizza, tofutti, french fries, soda, vegan cupcakes, etc. This we know: just because it's vegan, doesn't mean it's healthy. Believe me, I <3 my vegan junk food on occasion. But the problem here is no different from the standard american diet: you are crowding out the nutritious life-sustaining food and stuffing yourself silly with crap.

3. Social Isolation Syndrome

It amazes me how poorly we appreciate the effects of social isolation. Watch this video to see how physiologically powerful physical and social isolation can be. Being vegan doesn't mean you have to be socially isolated, but for a few it can make them feel more isolated. This is not a recipe for optimum health.

Early adopters have to cope with a little isolation, but one idea how is to cultivate a greater sense of compassion for human-animals who eat other animals. They are just as flawed as you are and there's no reason they can't be your friend, share meals with you, be your lover, etc. In fact, if you really want to influence the world, the more you hang out with these creatures the better. (unless of course you're a miserable conspiracy-lover who refuses to shower and thus has the effect of decreasing the odds that other people will move to a vegan diet. Apologies for the rant.) 

4. It's Not The Food

Food makes a huge impact in health. Ok. But just because you're vegan doesn't mean that really bad stuff can't happen to you. And it doesn't mean that every health problem you have has something to do with your diet.

Genetics, horrific bad luck, mood/psychology, drugs, infections, and many other factors can trump diet. It's always wise to considering whether your diet caused the problem or can contribute to healing it, but you've got to be open to the idea that it might have nothing to do with what you eat.

Also remember that many people became vegan because their health was not optimal to begin with. Those same underlying issues might not go away on a vegan diet, and some might get worse over time.

5. Unmasking Effects & Rare Genetic Disorders

Changing your lifestyle can, in rare cases, unmask hidden problems. For example, fructose malabsorbtion - a not too uncommon issue whereby eating concentrated fruit sugar causes irritable-bowel like symptoms and is associated with depression. If you suddenly start eating fruit-juice sweetened desserts and more fruit and fruit juice, then these symptoms will get worse. The solution is a plant-based diet that favors vegetables over fruit and avoids concentrated fruit sugar and juice and minimizes refined sugars.

Another example is diabetes in a long-time Atkins-style eater. If you eat no carbohydrates but are very overweight and have insulin resistance, switching to a more carb rich plant-based diet may initially make blood sugar control worse.  The answer is weight loss, avoiding processed carb-rich foods, eating only healthy fats, exercise, minimizing/moderating fruit, along with a high-fiber vegan diet.

Finally, there is also at least one type of rare genetic disorder involving carnitine transport which can be mitigated by carnitine-rich foods (i.e. meat). However, this is better treated with high dose carnitine supplements then with meat. Dr. Greger has a great post on this

6. Under Supplemented

Yes, it would be ideal if we got all our nutrients from our diet. Frankly, there are just some cases where this is not possible (vitamin D, vitamin B12). And there are some individuals who need higher levels of some nutrients (iron, zinc, omega-3s) because they don't absorb them well for whatever reason. This is true for meat-eaters too.

Sometimes, you've just got to add some supplements to your diet. Some vegans have a ridiculous hang-up about taking an "unnatural" supplement. While I applaud their idealism, they are doing themselves and our movement a huge disservice.

People ask me what I take: Vitamin D 1000 IU to 2000IU with food (most days, but especially in the winter); B12 (I buy a bottle a few times a year to boost my body stores); occasionally I get paranoid and buy a bottle of algae-based DHA/EPA. And I regularly eat some nutritional supplements: flax oil, fortified soy milk, chia seeds, flax meal, hemp seeds, nutritional yeast, marmite (because I was born in South Africa and it's delicious ok!).

At the same time, I'm super skeptical of the functional/orthomolecular medicine folks who advocate massive supplement regiments to cure everything.

7. High-Fiber Exercise-Deficiency

We did not evolve to blog. Or read blogs or work at a desk. Sitting is one of the worst things for your health, and we do it all day. My sense is that our guts function way better when we are regularly active and that exercise becomes even more important when you increase your fiber intake.

A very high-fiber diet with a sedentary high-stress lifestyle can set you up for a lot of bloating and gas pain. The solution is daily movement/exercise and plenty of water.

8. Beat By Cravings

Our understanding of cravings is amateur. Just because your brain craves something doesn't mean you have a deficiency. Craving chocolate does not mean you are magnesium deficient. Craving meat does not mean you are iron deficient and need to go back to killing animals for sustenance.

It's not to say that cravings can't have true information embedded in them, it's just that it's complex. For example, we make psychological associations with food. When we are stressed, we seek comfort, and food is one way to get comfort. Thus when stressed I might crave my comfort food, not because I need the nutrients in the food but because I need to be comforted. Your comfort food is probably different from mine - not because we have different blood types (or other such nonsense) but because of the different exposure to comforting food we had as kids.

Another random psychological nuance: the more one tries to avoid thinking about something, the more likely one is to think about it. If you are obsessed with avoiding meat, you are more likely to think about it and to crave it. We are funny creatures that way.

One last example, dissection lab -- the formaldehyde has been known to illicit cravings for meat. You can imagine how disturbing that is to an unaware vegan med student, on many levels.

Point being -- cravings are complex and often misinterpreted. Take them with a grain of salt. Roll with them and focus your attention elsewhere when the craving defies common sense.

What Else? & What if My Problem isn't on this list?

This is not an exhaustive list, and admittedly it is a list of hypotheses, but chances are the reasons people don't thrive on a vegan diet are fairly small in number and have a feasible solution if there is a will, an understanding and a few good measures of creativity.

Sometimes it can be hard to figure out (or you lack a doctor who can help you figure it out), and sometimes adding back some animal-products seems to make the difference and provide a sense of well-being that was missing. In that case, think of the animal-products as supplements - not to be eaten at every meal, but in the smallest dose possible. You'll still be eating a predominantly plant-based diet and doing a lot for your health and the world.

Tuesday, July 3, 2012

I'm at One Medical Group

I've joined One Medical Group in San Francisco, where I'm practicing lifestyle medicine and helping to design lifestyle medicine programs for common lifestyle-related conditions, like overweight and metabolic syndromes, stress and anxiety, smoking and alcohol addictions, etc.

We actually have a few vegan and vegan-friendly primary care physicians on staff, such as Margit Dijkstra MD. So if you're looking for high quality primary care or specialized nutrition and lifestyle help, we'd love to help you.

You can sign up for One Medical here. Primary care appointments can be made online. For appointments with me, you'll need to call to request an appointment.

Sunday, January 29, 2012

Obesity: A Tale of Success Gone Awry

Source: flickr/tjmartins
There are now 1 billion overweight or obese humans on earth. Why is that?

Well, it's not because 1 billion people are lazy, incompetent fools.

Here's a blog I wrote for with my historical perspective and one big piece of the obesity puzzle.

More posts on the topic to come...

Monday, December 19, 2011

Obesity and The First Law of the Jungle

Check out my first blog on

Obesity has to be viewed through many lenses.

The first is "the population lens". We have to understand that weight gain is happening to almost everyone around the world. It's happening because we are biologically programmed to consume food when it is available to us and the food that is now available is more plentiful and energy-dense then ever before in history.

Read more here

Monday, October 24, 2011

Vegetron in the works: Software Engineer Wanted!

Wanted: a capable and passionate, software-engineer co-founder  

There is an urgent need to change the way people eat 

Global meat consumption is skyrocketing and so too are the epidemics of obesity and other chronic diseases caused by a meat-centric diet.

To what extent can the internet and the emerging tools of social-gaming help? That's the question I'm exploring in my latest project:

Vegetron helps people master vegan meals and healthy living

Vegetron is for the vegan-curious and vegan-savvy folks who want to improve their health and do something good for the world at the same time. Vegetron will help people master the basic food and lifestyle skills needed to thrive in the modern meat-centric world.

Fun and easy

Our goal is to make the process of learning (and sharing your own knowledge) about food and lifestyle more fun, more social and more effective. Designing game and social layers into the experience can help us do just that.

The ideal dev partner

Vegetron has enormous potential, in part because it is tackling an extremely challenging problem. So I'm looking for a partner who's skilled at transforming an idea into it a tangible product, realizing there will be many hurdles to jump over along the way.

I seek a talented software engineer who shares a passion for improving health and making the world a better place, who understands the world of game mechanics and dynamics and appreciates human-centered design. Ideally, you live near enough to or in San Francisco and are available to start working part-time now and full-time in January.

If you know of anyone who might be interested in joining our team, please contact me at: 

Monday, July 18, 2011

My NAVS 2011 Talk

I promised I'd share slides from my talks at this year's NAVS Summerfest. Here's the first talk - a background primer on the internet, the importance of social networks, how ideas spread, and why online social games are the next hottest trend... And why the vegan movements needs to jump all over online social gaming.  

Wednesday, April 6, 2011

Soy Concerns?

I get asked about Soy a lot. Is it safe?  

The short answer is yes.
  • Assuming you don't have a soy allergy, moderate consumption of soy is likely to improve your health rather than diminish it. 
  • As with most foods, highly processed varieties of soy are probably less healthful than less processed varieties. 
  • And just as common sense would dictate, basing your diet exclusively on soy is not the best idea, mostly because it will crowd out a large variety of health promoting fresh fruits, veggies, nuts, seeds, whole grains and other legumes.
If you're interested in this topic, I strongly suggest this great post by vegan dietitian Jack Norris,RD who does a wonderful job summing up studies addressing the potential harm from eating soy.

Thursday, December 16, 2010

The Much Awaited IOM Vitamin D Verdict

The IOM's Report on Vitamin D and Calcium
Fellow Vitamin D enthusiasts have been holding their breaths for months, waiting to hear the Institute of Medicine's verdict on how much vitamin D we need.

How much D do we need?

After reviewing all available scientific research, the IOM recommends 600 IUs of Vitamin D per day for the vast majority of people. 800 IUs is recommended if you're over 70.

This is far more than previously recommended (200 IU per day). But it falls short of the 800 - 2000 IU/day that many medical experts and other medical societies have touted.

Cautious Optimism 

Many of us have been reading study after study supporting the benefits of Vitamin D for a wide range of ailments. We've also read numerous reports revealing widespread Vitamin D deficiency or insufficiency even in healthy young adults. But when the IOM summed up all the positive and negative studies they concluded that there is only strong evidence that Vitamin D benefits bone health.  Too little or inconclusive data exists for all the other potential benefits (heart disease, cancer, depression, etc.), they said.

While cautiously optimistic about the role of Vitamin D in overall health, the IOM took a very conservative approach to recommending more supplementation. The past few decades have seen many examples of mega dose supplements of vitamins - beta carotene and vitamin E among them - causing more harm than good. Basically, they don't want to jump to a premature conclusion on "more being better" and get burned. There's some wisdom in that.

More Research is Needed

Apparently it's impossible to write a consensus statement without printing these words. The Vitamin D story is far from over...and it will take many more years for the full truth to emerge. So we'll have to keep our eyes peeled for more research to clarify whether supplemental Vitamin D benefits more than just our bones, and to what degree.

How To Get At Least 600 IUs

Remember, Vitamin D is the sunshine vitamin - our skin makes it naturally when exposed to bright sunshine. But alas, most of us live our lives in the shade (staring at a computer, for example), we wear sunscreen to prevent skin cancer, and we have a strange affinity for winter lands.  So a dietary or supplemental source is typically needed.

A Winter Vegan Vitamin D Sandwich

A multivitamin usually has about 200-400 IUs of vitamin D.  A cup of fortified soymilk has about 120 IU. Most "natural" vegan cereals do not contain added vitamin D, but some might have 100-200 IU.

In other words, it's fairly likely that in winter you will need a vitamin D supplement. Since Vitamin D is fat soluble (meaning you can store some of what you don't use),  I take 1000 IU every second day (or when I remember)! 

You can find the IOM report here.

Wednesday, October 14, 2009

What happened when I nuked my spinach?

Tonight out of shear boredom I nuked a large bowl of spinach leaves.

Initially I was going to make a hearty salad to accompany my dinner. But I had the same meal last night and felt like a change. Plus the spinach was a touch too woody for my liking.

What happened when I nuked my spinach?

60 seconds later I reduced a large bowl of spinach into a very small pile. I added some lemon juice, salt and extra virgin olive oil. 5 bites and 60 seconds later it was in my stomach and I was still quite hungry.

The same bowl of raw spinach last night took me 10 minutes to eat and helped to tip me over into "I'm a little too full to do anything productive" land.

Why did this happen?

Clearly the nuking started digesting the leaves, extracting the water, breaking down some of the structure, freeing up some nutrients to be better absorbed and destroying others.

What's the point?

There is both value and detriment to cooking or processing food.

The value is that cooking and processing allow us to make food more dense and easier to consume. This can be critically valuable to people who struggle for whatever reason to get enough calories or nutrients. You might know a few of these folks.

This is why the processing and cooking of grains are credited for rapid expansion of the human population. It's one reason why we feed frail people liquid diets. And it's why cooked or processed foods can be important for highly active thin or growing folk.

The detriment is that it makes food more dense and easier to consume. This can be harmful to people who are sedentary and live near an over abundance of food. You might know many of these folks.

This is why cutting out soda, juices, smoothies, breads, baked goods, white rice, etc. tends to lead to weight loss. It's yet another reason why increasing our intake of fresh raw fruits and veggies is a good idea.

The more important reminder: food is context dependent.

There is rarely an absolute right or wrong when it comes to food.

Understanding our choices and the context we live in, however, can enable us to see what is right for us and those around us.

Thursday, June 4, 2009

Inspiration from TED

I find myself a little short on time and inspiration for blogging these days, and so will try to experiment with some shorter posts.

I'm also going to cheat a little and borrow some inspiration, often from TED.

STEP 1 - Watch this awesome 15 min TED talk by Dan Ariely:
The first half is entertaining but somewhat less relevant...still, stick it out.

STEP 2. Pause for thought:

The cognitive problems Dan Ariely discusses apply completely to our choices about food and the habits that lead to obesity. As he says, we are "predictably irrational" creatures.

Although there is the prevailing idea that we actually "choose" what we eat, in reality the vast majority of food decisions are not a conscious rational choice.

The "food environment", that is the physical and experiential setting in which food is available to be eaten, is par none the strongest determinant of what we eat. If there is lots of food around, we will eat lots. If there is none, we will eat none. Give us a bigger box of cereal with a bigger bowl and spoon and we will eat more cereal, no matter how hungry we are. If the normal behavior is to finish our plate (or eat meat), we will be much more likely to do that.

Of course, the food and restaurant industry discovered this reality decades ago and has been exploiting it ever since.

Yes, highly motivated individuals can be taught strategies to overcome the influence of the food environment. This is why doctors and nutritionists write diet books and open clinics. This is something we are obligated to do! But, this strategy has and never will work for the majority of people.

To affect change in the majority, we must learn how to change the food environment and the social norms that operate in them. That is our great task.

Friday, October 3, 2008

Avoiding isolation... Influencing social norms

In this post we talk about the need to avoid social isolation and help change social norms.

Let's start with some basic questions:

In North America, why are so few people vegan?
And why are there many people who claim to be vegetarian, but actually eat meat?

The answer to both questions has a lot to do with social norms.
The dietary social norm in America is to eat and enjoy meat, milk and other animal-based products. The vast majority of people in wealthy nations follow this same social norm. And even those who identify with another dietary ideal (e.g. being vegetarian), often still follow this same social norm. Why?

Social norms are incredibly powerful.

Science is gradually waking up to this realization. Sure, we've known for ages that children learn by mimicking others. And we're quick to point out that most people follow trends and behaviors blindly "like sheep", victims of fashion and gadget fads. Strangely, we forgot to notice that even "free thinking and independent" adults cave-in to powerful social pressures, which have a measurable impact on our health and well-being.

Nicholas Christakis, a physician-scientist at Harvard Medical School, along with his colleagues has demonstrated this nicely with several recent studies. One study examined the evolution of a large social network over 30 years in the famous Framingham Heart Study - which revealed that obesity actually spreads through a social network the same way that an infectious disease might spread - i.e. through close contacts and friends. The take home here was that the health behaviors that lead to weight gain are in effect contagious. Ultimately, people do what their friends do because they want to be "normal."

((More recently Christakis and colleagues demonstrated that your happiness is actually influenced by the happiness of your friend's friends. (This by the way is one reason I left Boston and moved to San Francisco!) In other words, emotions are contagious.

More on Christakis's work: an Edge interview; NYT article on happiness study; NYT on spread of obesity))

If you really stop to think about it, you will be forced to agree that the way we think is profoundly influenced by others. The vast majority of what we "know" is knowledge told to us by others. Our language is a product of how those around us speak. And so to our actions. More often than not we do what other people do.

So, it's really not surprising that most Japanese eat Japanese food, that Americans eat very similarly to each other, and that Europeans typically gain weight when they move to America. Social norms exert influence on all humans to some degree.

On vegans and social norms:

Vegans are different. It takes a certain kind of person to be able to say "I don't care what most people think or do, I'm going to do what I think is right and best, even if that makes me different and weird in the eyes of society."

Many vegans, at least those who were not raised as such, share this characteristic. I'm not trying to say that all vegans are the same. Far from it. But by nature of the current dietary social norms, to be vegan is to choose to be different.

My concern is that for some (if not many) vegans, being different from the rest of society lends itself to a certain amount of social isolation. This social isolation may have some costs that we should understand and mitigate. Costs that are probably less than the benefits but which may need to be managed.

Even more importantly: learning to minimize social isolation may be the best tool for helping us change the current societal dietary norms.

On eating and social isolation:

Food is central to almost everything we do. Sharing food is incredibly important for social bonding and maintaining relationships (be they business, intimate or plutonic). This is why saying "no" to eating someone's food (say because it's steak and you're vegan) is often interpreted as a personal rejection even when it's rationalized.

Does this mean vegans can't have close non-vegan friends or are destined to be lonely? Of course not. Many of my closest and dearest friends eat meat, and they readily support my vegan-ness in any way they can.

Still, one can't help but feel a little isolated when you're eating with friends at a restaurant and everybody else is merrily sharing chunks of animal flesh, talking about this great steak they ate last week and you are in the corner eating something scrumptious but different, sharing only with yourself.

My point: as a vegan, a certain amount of social isolation is unavoidable if you are living among and with omnivores. We can pretend this isolation is minimal or doesn't exist, or we can explore it and learn how to mitigate it.

The cost of social isolation

Is it possible that the cost of social isolation, even if it's subtle, includes decreased health?

Perhaps. It has always seemed curious to me that studies among vegetarians and vegans who are not shunning the social norm - for instance, among large populations of Seventh Day Adventists (SDA) - demonstrate consistent and marked health benefits compared with SDA's who eat meat and other animal products. Whereas there is more variability in the results of studies that assess vegans or vegetarians who are living mostly among non-vegetarians (generally the results are positive, but not often as robust as we'd expect).

Of course, there are many other reasons why epidemiological studies may not show as large an effect (or even no effect) of a vegan diet compared to non-vegan diets. These reasons include methodological factors (e.g. poor sample size, study design, etc.) but they could also be from unknown confounders. (see definition at end*)

Some of these confounders include poor mental health, shunning of other normal health practices (like going to the doctor, or taking vitamins or medication when prescribed), the inability to self-deceive (this is a fascinating concept, perhaps a topic of a future post, but in short people who can pet their dog with one hand, eat a chicken with the other are good self-deceivers. good self-deceivers do better in business and probably in health as well; i.e. in part it's the ignorance is bliss phenomenon), or other genetic or behavioral factors that may be linked with the personality-type that allows people to shun social norms.

Furthermore, social isolation may have a significant impact on whether someone can maintain a vegan/vegetarian diet. I've met hundreds of people who "used to be" vegetarian/vegan. Why did they return to a meat centered diet? "It was too hard." "I felt better when I started eating meat again." "I missed cheese." etc. Some of these folks were experiencing the side-effects of social isolation and how difficult it is do shun the social norm. (As well as some of the addictive properties of animal-foods, but that's for another post!)

Please keep in mind that this is simply an emerging thesis I am describing; one that I think deserves attention and study, but to my knowledge lacks investigation.

Minimizing isolation, changing the social norms:

Think about the small but meaningful changes we have seen in the last 2 decades. Soymilk - once an obscure drink to North Americans - is now mainstream. When a good restaurant served salad it used to be iceburg lettuce, now it's mixed field greens. Tofu and veggie burgers used to be something to make fun of, now it's a question of preference. In a small crowd, foods like quinoa or tempeh will not be new to everyone. Even the word vegan is relatively mainstream and usually no longer denotes someone from an alien planet.

If you've been paying attention, you'll notice that knowledge of these words has spread throughout society and that enjoyment and preference of "new" vegan foods has spread alongside.

How did this happen? It happened because people like you and me decided that it's normal to eat these foods. We purchased them and essentially financed their existence. Other people did the same. Still other people paid attention (consciously or not) to what we were eating, and decided to take a chance on something new. Knowledge and behaviors spread.

The same phenomenon happens in reverse. Red meat, and especially veal, consumption has slowly but steadily declined over the past few decades in North America. Why? Again, because the idea that red meat is unhealthy, inhumane and environmentally disastrous has slowly spread. In short, because it is becoming less normal to consider red meat good or desirable.

The point is this: everything you do influences people around you, whether you like it or not. If you decide to lock yourself in your home, not patronize restaurants that serve meat and avoid delusional meat-eaters then you lose the opportunity to influence them. You also risk maximizing the downsides of social isolation.

Although I don't know this for sure, my guess is that the more normal, happy, successful and healthy you appear to others, the more they will look to mimic your behaviors, be they lifestyle, political or social behaviors. Yes "radical" people do influence others, but perhaps their main function is to stretch the boundaries of known behavior. If you have 100 body piercings, then suddenly someone with 2-4 piercings seems pretty normal.

As we grow older and evolve, we need to decide what role is the most meaningful and enjoyable for each of us to play. No one can tell you how radical or different from the norm you should be. My only hope is that you consciously weigh the pros and cons, and that the concept of social isolation is something you consider.

To be clear: I don't believe social isolation is a reason not to be vegan. I just think it's something to manage.

Along the way, remember that your actions can help "nudge" people to one day do the same thing. And this can happen without "preaching" or revealing your judgment on their behaviors. The more you understand other people, the more they will understand you.

Granted, there's always a time and place when you have to be vocal about your beliefs and convictions. But it's nice to know they are influencing other people even when you are not trying.

* A confounder is something that could appear to be causing an effect/result/outcome, but is really only linked with the outcome for some other reason. For example, people who buy large size clothes tend to gain weight more than people who buy small size clothes; therefore, a misguided person could say "don't buy large clothes because it will cause you to gain weight". It's easy to see how in this case the shopping habit (buying large clothes) is not the cause of weight gain, but actually the result of it. Buying large clothes is a confounder in this analysis.

Wednesday, September 10, 2008

How can vegans be overweight?

Recently I visited Portland OR, a wonderful city that is especially vegan friendly. I found myself returning again and again to same vegan restaurant/yoga studio a few blocks from my hotel. And every time I went, I was reminded of a question I ponder often:
Why are many progressive, health-conscious, yoga-doing vegans overweight?
Before I offer my answer, let me point out two basic facts. First, on average vegans weigh less than lacto-ovo vegetarians who weigh less (on average) than omnivorous humans. A vegan dietary pattern can protect people from some excess weight gain but it's obvious that many vegans (including raw-foodists) are still overweight. On the other hand, it's fair to presume that these folks are probably a few pounds (if not many) lighter than they would be if they were not vegan.
Second, almost everyone in the US is gaining excess weight. Over two-thirds of US adults are overweight and the entire population weight distribution has shifted drastically over the past 4 decades. This means that even "normal weight" people probably weight 5-10 pounds more than they would had they been born 40 years earlier. Vegans aren't exempt from this phenomenon. We live in a world that makes it easy to eat a lot and hard to expend much energy.
So the main reason why vegans struggle with their weight is the same reason why most people in developed countries are struggling with their weight. (Actually it's a set of reasons which deserve a separate blog or perhaps a book to address)
Let's touch on a few factors that are particularly relevant for vegans:
Vegan Restaurant Portions. If you eat too much healthy food you will gain weight. Vegan restaurants consistently offer mammoth portions. I've eaten at Vegan restaurants in a few dozen cities. One meal typically provides me with enough leftovers for another 1-3 meals. Granted, I am one of those rare cursed folks who has a real hard time eating an enormous volume of food in one sitting. Most people (vegans included) don't have this problem. Think about some of the vegan animals you know (gorillas, elephants, hippos, cows, pigs) and you'll conclude that given ample food any vegan animal can grow enormously large.
Why do vegan restaurants serve so much?! Well, the same reason most restaurants do - economics. Large quantities for little money is considered "good value" by consumers and the cost of the extra portion of food is usually much less than the small additional price increase of the meal. Cheap food means a higher volume of consumers which means more profit. Vegan restaurants often cater to students who are particular sensitive to the value proposition of restaurant meals. And larger portions may broaden the amount of people willing to eat at an all vegan restaurant. Hey Joe Omnivore, want to check out this new vegan restaurant with me? They give you tonnes of food and it doesn't cost much.
Optimistic bias and health halos. Two fun psychological concepts worth understanding. In the context of eating, optimistic bias means you don't think anything bad will happen to you because of your food choices. Other people might gain weight from vegan food, but not me. (This is the same phenomenon that leads most people to think they are not going to die from a heart attack, even when they know that most people do die from heart attacks). We have an intense innate need to feel in control and routinely fool ourselves into believing that is the case. It's hard for us to imagine that a healthy whole foods vegan meal could contribute to weight gain, even in ample quantity.
What's a "health halo"? Here's an example to explain - you see the word "organic" on the front of a cereal box and then throw it in the shopping basket without scrutinizing the nutritional facts or ingredients. The label "vegan" acts as a health halo, magically transforming anything vegan into a healthy food. Vegan smoothie. Healthy! Vegan pizza. Healthy! Vegan donut. Can't be too bad!
In no way am I trying to say you shouldn't be choosing the vegan option. What I'm saying is that all of us are prone to overestimating how good it is for us because it fits a small (albeit valid) list of requirements (no animals killed, organic, etc.). This is particularly true when it comes to calorie content and weight management. We are likely less stringent about portion sizes and calorie monitoring for vegan food then we would be for non-vegan food. And this applies to health conscious vegans too. I do yoga everyday for 2 hours and eat only vegan food. I shouldn't be overweight.
More Options. There are many reasons why a vegan diet causes less weight gain. One simple reason is that it restricts the sheer volume of convenient, readily available calorie heavy food options. At one point this seemed like a bad thing. What do you actually eat? It must be really hard to eat out. My friends used to say this all the time 10 years ago. That's less and less the case, which makes me happy. But in terms of weight management, the more vegan calorie-dense foods available the more vegans will struggle with their weight. Of course, I rejoice at the launch of a new brand of vegan cupcakes, but there is a down side for some.
Basic energy expenditure. We are living in an age of unprecedented calorie-density (e.g. 1200 calorie smoothies) and technological advancement (I have sat unmoving for the past 3 hours only lifting my fingers, but I can honestly claim to be "working"). For most, it's so easy to eat more calories than you use. Adding one hour of exercise a day will make you healthier and happier but it may not fully protect you from weight gain, even on a vegan diet.
A concluding thought.
It is possible for us to create a vegan-friendly world that makes it easier for us all to have a healthy weight. If you are struggling with your weight, adopting a whole-foods vegan diet can be a great step in the right direction. But our work does not stop there.

Sunday, June 15, 2008

Vitamin D Must Knows

As you are reading these sections please keep in mind that the science of measurement and definitions of normal vs. optimal levels for these substances is still evolving. Plus there is incomplete standardization of these tests in the US - meaning the reference normal range may be different from one lab to the other. But these few paragraphs will give you a good background with which to interpret new discoveries and opinions as they emerge!

Vitamin D

The sunshine vitamin. The emerging science of vitamin D is beginning to paint D as a "master vitamin". In short, the effects of vitamin D go way beyond building and maintaining strong bones and normal calcium levels, but may even protect us against certain cancers and help keep our moods bright.

There is little naturally occurring vitamin D in vegan food (although, I have heard that UV exposed mushrooms which then contain vitamin D will soon be on the market), and only a few rare sources of D in animal foods (fatty fish for example). Get this - our skin makes vitamin D (well the precursor to D which is then activated in the liver and kidneys) in response to UV from the sun. Yay for the sun! and skin!
You see the problem. Many of us live where the sun don’t shine. And rates of vitamin D deficiency even in healthy young adults (especially those who live north of the 42th parallel, say in Boston for example, where this blog was written) are alarmingly high - 30% in some series. Vegan and non-vegan alike are at risk for vitamin D deficiency if you avoid or get little sun exposure throughout the year. For instance, it's thought that from November through February, the sun north of the 42th parallel is too weak to stimulate D production.

In the US, dairy milk is always fortified with vitamin D - so this remains the main source for non-vegans, but even this effort has not proven effective at boosting D levels for some northerners. (Granted, rickets (aka osteomalacia in adults) - a consequence of severe vitamin D deficiency - is much more rare than a century ago)

So here's what you should do:
1/ Make sure you have a regular source of D
Your two main options are fortified soy or rice milk plus a daily multivitamin (which will typically have 200 IU of vitamin D), or a vitamin D supplement (which is often coupled with calcium). Cereals and "cliff"/or equivalent granola bars are often fortified as well. Vitamin D is a "fat-soluble" vitamin so it will be better absorbed if taken with some fat containing food.

The exact amount of vitamin D to aim for is a matter of debate. But with the exception of B12 and perhaps a few others, more is not necessarily better and does have potential for harm. In extreme megadoses for example, vitamin D is toxic. Most experts suggest aiming between 400IU and 800IU total per day. That said, some have recently advocated for higher doses (up to 1200 IU) follow the news and your docs advice for updates to these guidelines. The IOM is expected to issue comprehensive revised guidelines mid 2010.

2/ Get your D levels checked once (preferably during the winter), if you live where there is a winter or don't get daily sunshine (you use sunblock or avoid the sun like the plague). The name of the vitamin D we test for in the blood is 25-hydroxyvitamin D.

Just like B12 there is some debate about whether having a low but "normal" level of 25-hydroxyvitamin D is good enough. Typically we say below 20 ng/mL is deficient, below 12 is severely deficient, and 20-30 is low normal. It will take more science for us to know what is "ideal", but based on what is known now I aim to be near 40 or above.

3/ Respect the sun. I detest the word moderation - that meaningless cop out - so I'll say respect. There are probably important benefits of sunshine (vitamin D production being one), but sun burning undoubtedly causes skin cancers, which kill many many people each year. So avoid the summer sun in the mid-day hours when it is strong, but enjoy the early morning and late afternoon rays. Obviously, if you have a high risk for skin cancer this advice does not apply to you - use sunscreen always (and more importantly avoid the strong sun) and get your vitamin D the modern way - through fortified food or vitamins.
Please note - light therapy (aka full spectrum) lights which are wonderful for SAD (seasonal affective disorder, aka the "winter blues") do NOT give off UV rays or stimulate vitamin D production.

Vitamin D Summary - find a daily reliable source - sunshine or a fortified item. This is especially important if you live north of the 42nd latitude (think of a line between northern California and Boston) or if you avoid the sun - and in either case: do get your levels checked one time (preferably in the winter).

Note: since a vitamin D test can cost up to $200, an alternative strategy to testing once is to take a relatively high-dose daily supplement (e.g. 800-2000 IU).

For those seeking a great and thorough medical review on vitamin D search the New England Journal of Medicine for "Vitamin D Deficiency" by Michael Holick : N Engl J Med 2007; 357:266-81.

As always, this blog does not provide individualized medical advice - for that you should find a good doctor.
If any of the above is unclear, please feel free to post related questions.

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Monday, May 26, 2008

Moving Beyond Carb Confusion

In this post we talk about the need to refresh our approach to carbohydrate rich foods; and more specifically to reduce intake of "simple" and "refined" carbs.

First, a little perspective.

Carbohydrates are not evil. They have been the backbone of humankind since the dawn of civilization. The large scale cultivation of carbohydrates (e.g. cereal grains) provided the vast amounts of energy (calories) that fueled the growth and eventual urbanization of humans. They have also been important sources of protein, fiber, vitamins, minerals and essential fatty acids.

Throughout our evolution, humans (like all herbivors) have needed sugar and other carbohydrates to survive. Funnily enough, we still do. Of course, the dominance of cereal grains as the provider of carbohydrates is a relatively new phenomenon (10-15 thousand years). And the advent and supremely high intake of refined carbohydrates is extremely recent (within the last 50 to 100 years).

With all the media attention carbs have gotten recently, you would think our grain intake had reached historics highs. Actually, we eating less grains then we did 100 years ago.

Per Capita Grain Consumption.
Source: Putnam & Allshouse. U.S. Per Capita Food Supply Trends. Food Review. Sept. 1998

So why all the bad press? The reason is that our intake of refined grains has indeed skyrocketed: see the recent upslope in the graph above (a 50% increase in grain intake since 1973), the vast majority of that increase is from refined grains.

And study after study continues to point a damming finger at people who eat the most refined grains - revealing they have higher rates of obesity, heart disease, diabetes and so on.

What is refined or processed?
Most grains come from grasses. Each stalk of grass yields numerous berries or seeds -these are the nutrient and energy dense bundles that can generate entire new grasses. Fortunately for us, they are also edible.

To a certain degree all grains require some "processing" - harvesting, removing the outer husks from the grainseed and then sprouting or cooking. Yes, some grains like corn can be eaten raw. But most become more digestible and valuable when soaked, sprouted or cooked.

However, when we talk about "refining" we're talking about processing the grain even further by removing the outer layers (the bran + germ) from the grainseeds.

Layers of a whole grain.
Image Source:

Grains, either in whole or refined form, can also be crushed or milled into flour or ground into meal. However, refined grain flour has been stripped of so many nutrients that they sometimes add back a small handful of the vitamins and minerals lost to the end product, called enriched flour. (Depending on the grain, processing it into a flour or meal also further strips it of some protein, fiber and nutrients.)

What is wrong with refining and processing grains?

Well, as mentioned, it turns out that most of the valuable nutrients, fats, and fiber are in the outer parts of the grain. Refining leaves us mostly with starch (long chains of sugar), a bit of protein and a few nutrients - we call this package a refined carbohydrate. So if you eat only refined and processed grains then you're missing out on most of the beneficial properties of the whole grain.

In the absence of fiber, these refined "carbohydrates" are rapidly absorbed from your digestive system - giving you a blood sugar spike. Eating refined grains raises your risk for diabetes; eating more whole grains lowers it.

Because fiber is (by definition) not absorbed, fiber-free grain (i.e. refined grains) is also more energy-dense. You'll eat more calories of a bowl of white rice then you will brown rice. Eating more refined grain will make you heavier; eating more whole grain will help you stay leaner.

A brief tangent. What's the difference between simple sugar and refined carbohydrate?
Sugar can be called simple or complex depending on how it's packaged. One or two sugar molecules by themselves = simple sugar (e.g. table sugar). Many sugar molecules chained together = complex sugar (e.g. starch inside grains or potatoes). For reasons you might guess, it's not too useful to talk about simple vs. omplex sugars because complex sugars by themselves are easily broken down into simple sugars. What matters is the whether the sugar is packed in fiber and nutrients - i.e. is it refined or unrefined?

Finally, refining grains into sugar makes them more addictive. This may be true of both simple (e.g. high fructose corn syrup) and to a slightly lesser degree complex sugars (e.g white wheat flour) refined from grains. This is a controversial point, but the emerging evidence is pointing in this direction. Sugar acts on the brain in a manner similar to many drugs. And refining makes all drugs more addictive, for at least two basic reasons. First, the active ingredient is vastly more concentrated and second it gets to the brain quicker, setting up a stronger cycle of high-withdrawal-high. Think: cocaine vs whole coca leaf tea; intravenous morphine vs. opium poppy milk.

Of course, we can take this comparison too far, but it is certainly possible that the addictive properties of sugar explain why so many of us have a hard time 'moderating' our intake of refined grains.

But you said sugar wasn't evil.

It's not. We all need sugar. But too much is bad. And slow-release sugar (i.e. sugar coupled with fiber and healthy fat) is arguably much better for us.

Refined grains are everywhere.
Cereal. Pasta. Bagels. Muffins. Rice. Crackers. Candies. Soda. Cakes. Pastries. Bread. The majority of these foods are made with refined grains today. Take a close look around and you will see how dominant refined grains are in the food supply.

Most of us are eating several of these foods everyday. They fill us up, preventing us from eating more nutrient dense foods. And as everyone knows, it's very easy to eat too many of them.

How to spot refined grains:

Refined grains are now the norm, so you will never see the word "refined" or "processed" in the ingredient list. Instead you need to recognize all the terms that code for refined:
-flour (or enriched flour)
-rice (or rice syrup)
-corn syrup (or high-fructose corn syrup, aka HFCS)
-corn or rice starch
....And so on.

Another route is to realize that if the grain is still in its whole form then it will be labeled as such: the words "whole" or "unrefined" will be put in front of the grain name. e.g. whole wheat.

There are a few exceptions to know about: corn and oats are always "whole" grain. But they can be processed to one degree or another. Oat groats are much less processed than the steamed and squashed "instant oats", and therefore better for you. Whole grain rice will usually be called "brown rice" or "whole grain brown rice".

How to eat more whole grains:
1/ Start with your staples:
start by looking at the foods you eat almost everyday. For example, many people eat a grain based breakfast (e.g. cereal, toast, muffins). Making sure these breakfast staples are 100% whole grain is a great start.

Likewise, many people eat rice or pasta almost every day. Switch to brown rice (I suggest investing in a rice maker). Experiment with the large variety of whole grain pastas (brown rice, quinoa, spelt, whole wheat) - some taste better than others, so keep on trying different ones until you know which you like best.

2/ Give yourself a few weeks to acquire the taste and habit. For example, some people love brown rice the instant they eat it, but for others it takes 3-4 weeks (or more) of frequent attempts before it starts tasting good. But in time, most people come to prefer brown to white rice.

3/ Create demand. We are creatures of habit and convenience. Ask for whole grains at restaurants and stores and soon enough you will start seeing them everywhere. We're already seeing this happen...

How to eat less refined and processed grains:

The first step is to switch your staple foods to whole grain varieties, as above.

Beyond that you will probably need to cut back on foods you probably shouldn't be eating on a daily basis - cookies, pastries, cakes, muffins, crackers, pancakes, waffles, crepes. These are treats, not everyday foods.

Yes, you can and should look for whole grain varieties of these foods. But chances are you will find varieties that might have some (but not all) whole grains in them. For instance, let's talk about cake:

Cake, even if made with whole wheat flour, is going to have a good amount of sugar (essentially the equivalent of maximally refined and processed grains) - otherwise it's just not a cake!
Sugar comes in many forms - honey, agave, concentrated fruit juice or jam, brown rice syrup, brown sugar, molasses, cane sugar, beet sugar, high fructose corn syrup, maple syrup. Yes, some of these are slightly "better" forms of sugar than others, but they are still sugar - a touch is good, a lot is not.
In summary, whole wheat vegan double chocolate cake is a fantastic creation when made well. It should be thoroughly enjoyed, but not everyday.