Kurt Harris MD

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« Fruit order in the 12 steps | Main | The argument against cereal grains II »
Friday
Mar122010

12 Steps update Mar 2010

I first wrote it on the back of an envelope before sending it as an email to by brother-in-law Jason.

I have done a minor update of the 12 steps with no carefully-thought-out anal-retentive logic, just using the same kind of gestalt, impressionistic process I first wrote it with.

The fact that there is 12 steps is totally arbitrary, obviously. The point is to avoid the neolithic agents. It is written from the standpoint of a north american starting with the SAD.

There is no particular significance to the re-ordering. It was and remains a roughly-sketched heuristic and not some kind of dogma or ritual.

I have added some disclaimer-type language about macronutrient ratios, as the silence of the 12 steps on eating non-grain starches, as well as my own lack of tolerance for same, is often misconstrued as some kind of doctrinal aversion to glucose in all forms. This is not any kind of change, just a clarification.

In this case, neutral silence really is a neutral silence.

PaNu has always stressed the three horsemen of wheat, linoleic acid and fructose as important deviations from the EM2 and prime suspects in the diseases of civilization (DOCs), including epithelial cancers, degenerative diseases, cardiovascular disease and autoimmune disorders.

Inasmuch as 2/3 or more of the carbohydrate content of the SAD is nothing but sucrose equivalents or wheat flour, I still feel Gary Taubes was spot-on using the phrase “Easily digestible carbohydrates” to describe the putative cause of the DOCs and the obesity epidemic. Whether insulin or leptin or adiponectin or PPAR gamma or NF KB or a bajillion cytokines are the proximate mediators of obesity or atherosclerosis is hardly the point, is it? "Easily digestible carbohydrates" certainly includes added fructose and wheat flout, doesn't it?

Taubes rekindled dormant knowledge of how evolutionarily novel forms and amounts of food intake can cause disease. GCBC is not just about insulin or the metabolic advantage. It is a narrative that destroys Keys (deserves a Nobel prize just for that) and redirects us to look at the neolithic agents.

I believe that for those trying to lose weight or who have a “broken metabolism” that close attention to macronutrient ratios is important, along with other tweaks as listed in “How to Lose Weight”.

That said, far too much attention has been paid to macronutrient ratios elsewhere and maybe here as well. I respect Kwasniewski but cannot believe the human organism requires tight ratios of anything (outside of minimizing poisons) in order to be healthy. So maybe stop obsessing over protein ratios as well as carbohydrate (if you are).

If you have transitioned from the SAD and are now eating 10% of calories as carbs after eliminating sugars and wheat flour, I see no reason to change that. You will not “ruin your metabolism”.

If you have no idea what your ratios are and you feel fine, why measure them?

If you want, for whatever reason, to eat 50% of calories as carbohydrate and it does not make you gain weight, knock yourself out.

Eat yams and sweet potatoes, or limited amounts of white potatoes or white rice.

Starch or glucose per se are not Neolithic agents.

I would sooner eat three potatoes a day than a tablespoon of corn oil.

If you do eat a higher carb diet, infrequent meals or some IF may be in order. I still think that spending some part of your life (more than the SAD) in or near ketosis is part of the EM2. That's easier to achieve on VLC. Ketosis being a more frequent part of the EM2 is just a working hypothesis for now.

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Reader Comments (29)

Kurt, solid re-write. I'm curious as to why, other than for those with allergies to lactose or casein that won't go away even after letting the gut heal from the on-slaught of wheat and fiber, dairy avoidance is worth putting on the list of steps? My understanding is that you still consume dairy and there isn't much evidence against raw, organic milk & cheese of which I am aware.

Being deployed has made it hard to cut out linoleic acid. There is not a drop of real cream or a pad of butter on this base, but vegetable oil is on everything. I don't even want to think about how the meats were raised. Come April, though, I'll be experiencing the "joy of cooking" PaNu-style. Farmer's markets suddenly sound interesting. If anyone knows nearby sources of pastured animals in eastern Kansas (45 min west of Topeka), I'd greatly appreciate it. I've ordered things from Pop's Grassfed Meats for people I know, but some items like liver just don't do well if frozen, apparently.

Ian

March 12, 2010 | Unregistered CommenterIan Lucas

awesome!
i agree minimizing poisons should be the focus, rather than dogmatically following a strict macronutrient ratio mandated by someone else.
i am one of those people who love carbs & really don't care for meat, so VLC is really difficult for me, especially if i try to eat too much protein (aka atkins). i have never met a vegetable or fruit that i do not love, & the thought of eliminating these & "being able to eat delicious steak slathered in butter" does not thrill me, but in fact gags me. my biggest breakthrough was switching the focusing to high fat (i love butter & cream!), eating only the amount of protein i feel like eating (not much), lots of vegetables, & some fruit. AND, if i feel like eating a bit of white rice or potatoes or yams i don't go overboard but don't stress either....i usually save this for the end of the day, as it makes me pleasantly sleeeeepppyyyyy.....

March 12, 2010 | Unregistered Commentergmi

sorry if you've already received this; my computer shut down after sending it the first time:

Taubes's phrase is "easily digestible carbs." Potatoes, bananas, rice (even brown) and many other such high carb sources are easily digested even w/o processing. Grains such as wheat and corn need processing into flour and meal or at least are so processed as they are normally encountered in breads and cereals and pasta. I think it's Pollan who rides that "processed" hobby horse. Taubes's concept is more general, inclusive of high carbohydrate sources of all sorts, and therefore better.
Grains are indeed neolithic. The start of their cultivation some 10 to 12 thousand years ago distinguishes the old from new stone ages. But sugar and plant oils other than coconut and olive oils have later arrivals. Sugar in quantity is better dated to modernity when plantation slavery enabled its production and competent seafaring enabled its distribution.
The plant oils (corn, soy, rape and other seed (cotton, grape)) that have introduced such high levels of PUFA sixes are very recent - just a few decades old.

KGH: Text corrected. Would you believe I've read the book 3 times?

March 12, 2010 | Unregistered Commentersss

Why would someone eat white rice instead of brown rice? Isn't brown rice just a little bit the healthier evil?

KGH:

If you are a vegan then there are a few more vitamins in the hull that may be of benefit. PaNu does not rely on any grains for vitamins (animal and non- grains veggies will do) - if we eat a grain it is specifically to get the starch. White rice has the starch. Eat brown if you prefer the taste. I don't.

Brown rice is "healthier" in Ornish-Campbell veganland.

March 12, 2010 | Unregistered CommenterWayne

Dr. Harris,

now I'm confused. I thought that the phytates in brown rice hinder mineral and vitamin absorbtion, if not prepared properly? And what about other anti-nutrients?

thx!

KGH:

They do but you are not basing your whole diet on them and there are phytates in white rice, too.

March 12, 2010 | Unregistered CommenterOliver

I just reread the 12 steps (many of which I largely follow) but found myself confused by this one:

Favor ruminants like beef, lamb and bison for your red meat. Eat some fish.

As opposed to what? Are there other sources of red meat I should avoid? Is this a statement about pork and/or chicken?

Thanks,
Mark

KGH:

As opposed to pork, chicken and turkey. "Favor" means just that. Pork and chicken will not kill you, they just are not as optimal in my view.

March 12, 2010 | Unregistered CommenterMark

I understand pork because of its fatty acid composition. But what's up with the chicken, Doc?

KGH:

same deal - back yard chickens eating bugs are not so bad, but commercial chicken (even if organic, free range) is very heavy in PUFA.

March 12, 2010 | Unregistered CommenterMikael Jansson

Thanks for the clarification.

In that case, I would suggest leaving out the word "red". The way it is written sounds like beef, lamb, bison are favored over other sources of red meat, but "white" meat is not covered.

Thanks,
Mark

KFH:

I am going to stick with the nutritional definition of red meat.

From Wikipedia:

"Nutritional

The main determinant of the nutritional definition of the color of meat is the concentration of myoglobin. The white meat of chicken has under 0.05%; chicken thigh has 0.18-0.20%; pork and veal have 0.1-0.3%; young beef has 0.4-1.0%; and old beef has 1.5-2.0%.3
According to the USDA all meats obtained from livestock are red meats because they contain more myoglobin than chicken or fish.4
In the health discussion below, we assume the nutritional, not the traditional gastronomic, definitions.

The meaning is unchanged with our without chicken thighs. Pork is red meat.

March 12, 2010 | Unregistered CommenterMark

Wayne et al -
Not only is brown rice not a health food b/c of the phytic acid but interestingly enough the traditional rice eating cultures have always eaten white rice- not brown. Obviously either way no one here is interested in eating rice as a staple food, but it is interesting to me. Perhaps Asian cultures would not be considered such a pinnacle of health if they had been consuming anti-nutrient filled brown rice all these years.
Contrary to popular belief- in my experience traditional Asian food is meat and/or seafood heavy, not the California style vegetarian brown rice crap. Think lots of the nasty bits i.e. organs, fatty cuts etc. (mmm... Korean beef short ribs...) This probably balances out a lot of their rice consumption and I feel THAT has a lot to do with their historically being a healthy culture- not their supposed vegetarian rice consumption.

KGH:

The asian preference for polished rice is about aesthetics and flavor AFAIUI. The white rice is fortified to compensate for the lack of vitamins.

Lets' be clear - I view white or brown rice the same way I would a glucose solution. If you want Kwasniewski ratios and don't tolerate potatoes or you are working out a lot or "refeeding" or whatever - 50g a day of either kind of rice is not going to kill you. If you are worried about phytic acid or whatever, just don't eat it. Have a tuber or a slab of butter.

March 12, 2010 | Unregistered CommenterHannah

I eat about 200-300 calories of oatmeal a day on top of an otherwise paleo diet (I don't do well with fruits and tubers). Would white rice be preferable to oatmeal? My main concern is most white rice is enriched, and I'm hesitant to eat something that's had synthetic vitamins sprayed onto it. What's your opinion on rice flour?

Thanks for the great site. This has become one of the main paleo blogs I read.

Cheers,
Jordan

KGH:

I don't know much about oatmeal. It do know it is claimed there may be peptide sequences with homology to the gluten proteins in wheat and it oats are often contaminated with gluten in processing.

March 12, 2010 | Unregistered CommenterJordan

I've been having a lot of success on a higher-carb version of PaNu without dairy. Not high-carb, just higher than what most low-carb diets prescribe. I've already lost 43 pounds out of the 59 pounds I need to lose, not to mention numerous health benefits (no more GERD, regular periods, better skin). I just can't stick to a strict low-carb diet. I've already tried several times and I ended up falling off the wagon every time. Carb restriction leads to binge eating for me; higher carb makes me much happier and supresses the urge to binge much better than high fat. I emphasize animal foods over plants in my diet, but I still enjoy fruit (even high GI ones, my guilty pleasure), plenty of vegetables and sometimes sweet potatoes. I think it's important to get enough high-quality protein, but other than that, I'm not sure macronutrient ratios matter at all.

KGH: what else besides sweet potatoes and what % carbs?

March 12, 2010 | Unregistered CommenterCFS

Re: KGH: what else besides sweet potatoes and what % carbs?

All the carbs I eat come from fruits (low and high GI, 2 to 4 pieces every day -- yeah, I know, too much 'candy from a tree', but fruits are so yummy), vegetables (every day), sweet potatoes (not every day) and nuts. I don't know what % carbs, sorry.

March 12, 2010 | Unregistered CommenterCFS

Doc....

Is it ok to roll with the fat off of grass pasture beef, bison and "other red meat" beasts?

How about wild turkey and other wildfowl? I really beat up the local goose population in the fall and eat alot of goose jerky.

THanks!
Don't forget to lift heavy things once and awhile!

March 12, 2010 | Unregistered CommenterChuck O

Back to the chicken for a moment, Dr Harris. What about the "free range, organic" eggs? Inside the carton, it clearly says that these eggs are from chickens which have been raised on a "vegetarian diet" of grains; eggs from pastured hens are a "no show" in Los Angeles, CA. What, then, can adjust the PUFAs consumed from eating these "vegetarian diet" eggs, a gulp of CLO? I usually eat about four eggs a day now. A solution, please.

KGH:

Don't pay extra for eggs unless the chickens eat bugs. Chickens are not vegetarian and the free range organic eggs are almost always vegetarian. Even if they are factory eggs they still are not too bad, though. A gram of DHA/EPA a day should compensate.

March 12, 2010 | Unregistered CommenterTS

TS,

Check out the Saturday morning farmer's market on Arizona in Santa Monica. Amazing pastured eggs from carnivorous hens (no soy, no corn) for $4.50 a dozen from Healthy Family Farms. They do the Beverly Hills market on Sundays, too.

March 13, 2010 | Unregistered CommenterErik Cisler

Thank you for a fantastic website and blog.

I was concerned about your statement that chicken is "very heavy in PUFA." Looking up in the USDA database:

1oz Chicken, broilers or fryers, breast, meat and skin, cooked, roasted contains 395mg of omega-6.
1oz Chicken, broilers or fryers, thigh, meat and skin, cooked, roasted contains 837mg of omega-6.

My typical lunch with 6oz of chicken therefore contains a max of about 5g of omega-6. While certainly higher than beef or lamb, the amount does not strike me as high enough to warrant avoiding chicken thighs and chicken skin. Compare, for example, to 1oz of almonds which contains 3.5g of omega-6, or 1oz of walnuts with 10.6g omega-6.

To maximize the omega-3/omega-3 ratio, I eliminated the 2oz mixed nuts I was eating each day, supplement with 4g of fish oil a day, as well as eat fatty fish 4x a week. Can you please comment?

KGH:

5 g of n-6 is about 45 kcal - this would be 2% of total kcal on 2250 a day. 4 g fish oil about 36 kcal or 1.6% so you are already at 3.6% total calories from PUFA. As long as that is your total for the day, that is pretty good. Sounds like you might be hungry though.

Why take so much fish oil? If you are need that much to balance a bunch more n-6 that I do not know about, then you are almost certainly well above 4% total kcal from PUFA.

March 13, 2010 | Unregistered CommenterO

It could perhaps be advisable to refrain from recommending cod liver oil any longer - see this newsletter over there at the Vitamin-D-Council:

http://www.vitamindcouncil.org/newsletter/vitamin-d-vitamin-a-and-cancer.shtml

Cheers, guzolany

KGH:

I have seen it.

My CLO has 850 IU of A per teaspoon. That is about 17% of the US RDA. I average one teaspoon a day.

Unless you are trying to get vitamin D by taking 50 ml of CLO a day, there should be no hazard to using CLO to get 1-2 g/day EPA/DHA, especially if you do not eat liver, as I don't.

Cheers

March 13, 2010 | Unregistered Commenterguzolany

@Erik Cisler
I just now googled "Healthy Family Farms"..........http://www.localharvest.org/farms/M16881. Are the other news about a "Healthy Family Farms" related? I am just looking for eggs from pastured hens.............I will drop by tomorrow. Thanks.
TS

March 13, 2010 | Unregistered CommenterTS

Following the thought on CLO, then, would a "generous" helping of Coconut Oil work as well or better than the CLO for purposes of balancing out the PUFAs and avoid the Vit A issue?

KGH:

No, there is very little PUFA in coconut but what is there is all n-6. So you would be "balancing" in the wrong direction.

March 13, 2010 | Unregistered CommenterTS

So, then, Dr Harris, nothing from the Plant Kingdom provides N-3; then, more pastured butter with my cooking would accomplish the balancing....

TS

KGH: Plant Kingdom n-3 is more or less useless as it is inefficiently converted and is rather oxidizable. Reduce n-6 then balance with fish oil or sardines.

March 13, 2010 | Unregistered CommenterTS

have you seen this:

http://videocast.nih.gov/Summary.asp?File=15353

start viewing at 12 minutes. if i understand correctly, the speaker is making the case for greatly reducing PUFA 6.

March 14, 2010 | Unregistered Commentersss

You mentioned eating some fish. Is there any reason to avoid eating a lot of fish if I stick to smaller sized fish or shellfish to avoid toxins. All the grass fed beef I have tried except for ground beef is tough as leather, even the most expensive cuts.

KGH:

You need to look for some better sources of grass-fed. Talk to local farmers. Mercury in fish predominates in top of food-chain predators. So sardines, herring, etc are good. I am not a fish expert. I eat cod about once a week, and lately alaskan crab about once a week and maybe one can of sardines. Alaskan crab in melted pastured butter is a meal all by itself.

March 14, 2010 | Unregistered Commenterkris

@Jordan,

A good article on oatmeal by Dr. Davis. Maybe it will change your mind:
http://heartscanblog.blogspot.com/2010/03/oatmeal-good-or-bad.html

Cheers

KGH:

Oatmeal is nutritionally empty, like all starchy grains, but is actually pretty benign compared to wheat. It will not boost your blood sugar any more than equivalent amounts of other starchy grains. Davis is probably just debunking it as many of his readers think it is "heart healthy". We don't labor under the lipid hypothesis much here, so PaNu eaters hopefully are not eating oatmeal to "lower their cholesterol".

March 14, 2010 | Unregistered Commentercmab

I just discovered the option to purchase beef spleen on the US Wellness Meats website. Does anyone have any experience or knowledge about consuming this organ meat? (Also, Kurt, I wanted to mention something I posted several days ago on the latest Diabetes blog you wrote. I don't know if you saw it, but if you have any inclination I'd love a response!)

March 14, 2010 | Unregistered Commenterstevehecht

Thanks for the attention, Dr Harris. Dropped by the Hollywood, CA Farmer's Market this am and picked up some pastured hen's eggs from Healthy Family Farms. They offered some pastured meats and chicken as well. Thanks, Eric Cisler. The Vons Pavillon grocery stores have Organic Grass Fed Ground Beef for the last 3 months or so; it is distributed by Organic Prairie Family of Farms from La Farge, WI.

Check out LA Times today for treatment of diabetics.

Outstanding site, Dr Harris!

March 14, 2010 | Unregistered CommenterTS

I don't understand why you ask 'O' "Why take so much fish oil?", when you recommend taking a teaspoon of CLO - which, at standard tsp of 5g to get 1g of n-3, weighs in at 45 calories - 1g more than O is actually supplementing with.

Minor quibble aside, love the site and have been reading it from the beginning.

KGH: Because I assumed she meant 4 g total of DHA/EPA, as who measures out 4g of oil? 4 g is 4 × 1 gram, no?

March 15, 2010 | Unregistered CommenterDavid

I see, didn't think of it that way, thanks for clearing it up. I have 1000mg CLO capsules, so you can easily take 4 = 4g. Only O can say whether they measure out 4g of actual oil...

KGH: I'm not sure which she meant, but you get the point...

March 15, 2010 | Unregistered CommenterDavid

Thank you for the reply.

To clarify the fish oil: I take 4 gel caps of fish oil 1g each. The total EPA in those 4 gellcaps is 720mg, and the total DHA is 480mg. They also contain 400mg of other n-3. The source of the oil is anchovies, mackerel, sardines. So total n-3 is 1.6g .

Besides the chicken I mentioned, I also eat 3 omega-3 eggs for breakfast and a chicken sausage. Each egg contains 1.4g PUFA out of which 1.2g is n-6. The sausage is the Trader Joe's one, which is fairly lean with 7g of total fat. So I estimate the total PUFA in the sausage to be similar to that in 1-2 eggs.

I use coconut oil and butter for cooking, and eat cheese and other meats for the rest of my meals so no other significant PUFA sources remain.

All this would bring up the total PUFA to: 6g (chicken) + 4g (fish oil) + 6g (eggs and sausage) = 16g. The total n-3 is 1.6g (fish oil) + ~1g (omega-3 eggs) = 2.6g .

My daily maintenance calorie intake is about 3000 kcal (this is accurate as I have calculated it in Excel, need to add PUFA details though). It contains 170g of total fat (about 50%) out of which 70g are saturated. I am a muscular and lean male (visible 6-pack abs, about 10% bodyfat), lift weights at high intensity for about 1.5 hrs 4x a week.

Therefore the PUFA is about 4.8% of calories, but the n-3 / n-6 ratio is not so hot at 1:6.

I wonder if I should make further modification in my diet to better this ratio? Throw away the yummy roasted chicken skin? Eat less chicken?

March 15, 2010 | Unregistered CommenterO

A comment for Ian, wondering about the availability of pastured meat in central Kansas, it looks like there is a Weston A Price Foundation chapter in Lawrence, they might be able to provide some resources, they have contact info on the WAPF web site.

March 18, 2010 | Unregistered CommenterMary Beth
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