Monday, January 19, 2009

Kwasniewski paper

A friend has emailed me the full text of Pawel Grieb's paper documenting a number of physiological parameters of medium to long term Optimal Diet (OD) eaters in Poland, as pointed out by Flo and Stan. There are a few points worth making. The biggest mistake, BTW, is that the authors claim (correctly) that the OD diet aims for >70% fat with (incorrectly) "no restriction on the type of fat (saturated or unsaturated) or cholesterol level". I think they meant that the OD does not ban saturated fats. This is of course true but the impression given is that the OD allows "healthy" fats, which are, of course, inedible. So the heavy emphasis on saturated fats is missed by the paper. A pity, anyone might be left thinking corn oil is a human food...

The first positive aspect is that this is a multi author study, eleven authors from several medical centres/unversities. So it's not a one man band case report. I like that.

The second is that it is remarkably positive about the findings throughout. Even the elevated LDL cholesterol levels are not taken as extreme and are not trumpeted from the rooftops as the portent of imminent cardiovascular doom. So refreshing!

There aren't really any things in the paper which don't come through in the abstract. The one patient with a marginally elevated HOMA score had both glucose and insulin within lab reference ranges, just both were high enough to get the HOMA score out of the accepted physiological range. I don't think this is a big deal because there is one rather major point which the paper never addressed.

If you read JK about the OD he will point out that it is very rare for an individual to adopt and stick with the OD for the long term unless they have a serious medical problem which forces this. Of the 31 people studied, 22 had actually been on the OD for at least 3 years. So although the researchers express their wish for a comparable group of normal diet eating people, I would personally be much more interested in the lab data of 31 non OD patients, but with a variety of medical problems of sufficient seriousness that they SHOULD be on the Optimal Diet. Then we'd probably see some metabolic syndrome results and statin deficiencies!

Still, anyone seriously considering the OD could do worse than to read through this paper or to present it to their GP if they were getting grief about the risks involved in eating all of that (saturated) fat...



pooti said...

Hey Peter, sorry to be OT on this but I just posted the re-print of Weight Loss; when it's hard over at my blog

Thanks again for letting me post this series!

Paul said...

Hi Peter,

Speaking of ruminating about saturated fat, I am doing serious ruminating right now, and I wondered if I could ask your advice. This is a question about my personal cholesterol measurements, but hopefully it's a topic of general interest.

I have been OD-ing about 1.5 years. My long term cholesterol measurements are LDL in 130s, HDL in 70s, and triglycerides in 30s. I posted around September to say that after the first year OD, I had LDL in 170s and HDL in 80s. At the time you said that the increase in LDL was nothing to be alarmed at.

That was a direct LDL test, with no triglyceride measurement, and I subsequently went for the old cholesterol test so I could get triglycerides measured too. This time, my LDL was 169, my HDL was 98, and my triglycerides were 105.

Well things are all over the place. That's a noticeable increase in HDL over any previous measurement that I have ever had. But my triglycerides have also gone up by a factor of three. This feels like a concern - it's unambiguously bad to have increased triglycerides, correct? So I'm wondering about how to proceed.

Thank you for any advice!

Peter said...

Hi Paul,

It's a bit of a problem for interpreting lab work, but no, trigs are not always bad! Of course you have got to have good (small diameter) and bad (large diameter) trigs... You expected logic from the lipid hypothesis????

Then of course trigs are bad in Sweden but harmless in Kitava!

Now the real question you need to ask is: Are mid normal range trigs for someone on the SAD good or bad in someone eating in the JK style? Hmmmmmm...

Now, thanks to Grieb's paper, I can tell you that the mean trig value for men was 100.9mg/dl with a standard deviation of +/-25.8mg/dl. Which puts you slap bang in the middle of an enormous range...

How do you feel?

Gotta go do some more painting and feed the chickens...


BTW your trigs divided by your HDL-C should be < 3.5 (Polish lab ref range). Yours appears to be 1.1, slightly better than the OD men who averaged 1.6, in fact as good as the OD women at 1.2

Matt Stone said...

I am SHOCKED that Kwasniewski was misrepresented! Ha ha!

It's so funny that he is so specific about his dietary recommendations and then others take such specific recommendations and totally fumble them.

Great to hear that the team of researchers was at least willing to be open-minded about it.

On Kwasniewski's misrepresentation by CBS...

Paul said...

Thanks, Peter, good to hear this. And I had not realised that triglycerides are also (like LDL) a family of molecules, not a single molecule.

About how I feel, I feel fine on this diet. But I also see that this is a complex scientific area, that there are some strong fault lines of controversy happening right now, and the simple health metrics available to me (blood tests, fitness tests) feel like looking down a straw to understand a jet engine. So I appreciate that you are prepared to share your knowledge about jet engines :)

Hope that painting and chicken-feeding went well,

Arctic said...

Hello Peter, and greetings from Finland.

I've read almost all your posts and I have to say it has an assureing effect on me. I was thrilled to see the study and feel good knowing that Im not blowing up my old ticker with eggs, butter and cream.

I haven't had the chance to read Homo optimus yet but know that potatoes are in the ok list for carbs and I was wondering what other sources would be good. Im not a true OD but it is very inspirational. The problem for me is performance in sports. What sources for carbs would be the least harmful for a person eating 100-150g per day?

Peter said...

Hi Arctic,

I think root vegetables are JKs prefered sources, especially if you have no GI issues. We tend to use a fair amount of carbs on ingredients added to meals, carrots in stews and onions/peppers etc in strir fries. Getting the numbers up could easily be done with potatoes...

Hmmm Findand, almost a second home for the AHA! I've heard that LC is almost an underground movement there!!!!! So yes, the JK paper is useful in its way.


Arctic said...

Hah! You nailed it! Finns have "bad" genes in the aspect of heridatory high colesterol disease, as fairly large precentage supposedly has it here. And that in general has produced a nice "lipophobia" among virtually the whole nation. The only people here who have accepted LC as healthy or at least not lethal are bodybuilders, recreational fitness enthusiasts and dieters who have failed with or got sick by the nutritional guidelines given by the goverment. And of course there is Anssi Manninen M.H.S.

The nutritional guidelines are straight from AHA. Yesterday I was listening to the radio while driving home from work and there was a women from the national health departmen (not sure about the exact translation, but you get the point) worrying about Finnish kids not eating enough fruits, veggies and "soft" fats (plant oils). The only reason mentioned for this was that what you learn young... One good point has actually come across the health depatment and that was that milk fat MIGHT not be as harmful as they have thought. After the sentence naturally they told people adding fat to diet to concentrate on the "good" fats.

One quetion about metabolism if you dont mind? Muscles don't "give" glycogen back to circulation once it is stored in the muscle, right? It has to be used by the muscle? An optimum time to replenish muscle glycogen is when the glycogen is depleted, am I correct? Sucrose from food goes first to muscle, then to liver and then to adipose tissue if everything else is full? If the above holds true wouldn't it be logical to ingest the daily carbs after training or exercise and eat fat and protein the rest of the day? In what relation should the fat and carbs be to not cause problems?

Im sorry about the ramble, I'm a bit enthusiastic.

Zbig said...

recently I witnessed a debate on a Polish forum, the sides were: fans of JK who say they're OK many years into OD vs. "renegades" who seem to have some personal or organizational issues with the doctor but some of them come up with some substantial claims as well.
I wonder what you think of it: the core text (translated by me sounds like:
"What's wrong with OD?
Doctor wrote many times that eating should be adjusted to individual needs but every time it came to concrete things, the stiff rules came back (as ultimate figures for the folks after rebuilding)
P:F:C =1:3:0.3 or 1:3:0.5 or 1:3:0,8 (3 being in the range 2.5 to 3.5) and 0.8g C per kg of due mass and the slogan that fats never do harm and they contain all necessary vitamins and microelements.
Often drastic limitation of protein was imposed to 30-40g with a claim that on the OD less protein is needed than on a traditional diet.

Over many years, all the above recommendation put in place with consequence are wrong.

On the OD you need most protein of all diets, not least.

In fats all important water-soluble vitamins and minerals are lacking.

The proportion P:F=1:3 implies overeating fats and protein shortage.

The right proportion is 1 to 1.5.

The main recepient of glucose in non-sport people is the brain, so it's pointless to make a link between the glucose requirement and body mass.
A 10-kg 2-year old will need almost the same amount of glucose as a 70-kg man."

_flo said...

omg, Zbig, don't even go into that! I follow the forums closely and I can tell you - there is some nasty stuff going on, involving schisms, politics, envy and obviously $$$. There were many people so far trying to improve JK's ON - never with much success. Obviously, there must be some fine-tuning to anyone's needs, but biochemistry laws are the same for everyone.
Also, environmental conditions change continuously, we have to adjust, i.e. Peter's trick with Omega-3 supps...

Ayway, I know exactly which post you mean - by Witold Jarmolowicz.
Don't know much about vitamins and minerals, I don't think anyone knows the exact numbers, we can only speculate...

Regarding protein needs, I'm guessing WJ makes the same assumptions as Michael Eades - 120g of glucose for brain. Actually, Eades says 200g, some ketone bodies and the rest of it from proteins.
According to JK (and apparently to new editions of biochemistry textbooks) brain doesn't burn glucose or ketones at all, all it needs is ATP and oxygen. You can read more about it here:
and here:

Regarding too much fat - in my opinion too much of anything cannot be optimal.

_flo said...

Well, about the brain fuel again - you'll see it's more complicated than how I put, when you read those links. And still not clear.
The point is, an axiom like that changes the whole theory and leads to its success or failure.

Peter said...

Hi Arctic,

Yes, I can see the logic to this and I think people have gone this route generally. The insulin response to post exercise carbs should be anabolic and useful. But here you are getting in to subtleties on exercise physiology about which I'm not too well informed.There are a number of people on the net with much more interested in diet/exercise/muscle gain than me. I usually push people towards Chris as a good portal...

Peter said...

Hi Zbig,

Obviously a diet with the ratios of the OD is the OD, once you get the protein to fat ratio up to 1:1.5 you are not on the OD and you are then on your own in terms of logic and opinion about requirements for minerals and vitamins. Clearly any LC diet will be better than the food pyramid and it's then a matter of who is correct in the refinement of LC, and I don't see anyone doing studies to differentiate one style of LC from another. Just getting any work done with LC is an achievement.

So we are then in to pure opinion and biochemistry. What drives me to accept JK is the parallel with fasting. In fasting your requirement for non storable vitamins is zero. You run fine with fat and muscle catabolism. Simply replacing this plus a little carbohydrate to mimic the usual small store of glycogen in the liver gives you pretty close to the OD. We run fine in fasting without oral B vits every day..

Re brain fuel. Glucose yes, ketones, lactate, glutamine too and now we have JK suggesting ATP, but he is a bit mysterious about this and I think we have a long time to wait for the research about this aspect. But once people start telling me I need X grams of protein and Y grams of glucose as minimums, and I am sitting here with half their totals on my plate, I have to ask myself whether my brain is working. Hee hee, maybe it's not!

Re children, interesting point. I do not limit my son to the OD, he has never been exposed to the problems of modern eating, so I encourage him to eat real food, as high in saturated fat and cholesterol as practical and as real in nature as practical. My personal feeling is that kids tolerate carbs and protein better than elderly metabolic syndrome sufferers.

Hi Flo,

Interesting to hear the politics in LC, Poland as everywhere. I'm really bad at fora, I never have the time and I read some of the problems Emma has struggled with on Failsafe fora, and how little thanks she has had for her time... Well, people must make up their own minds, we only get one shot at life. I'm interested in information, not trying to convince people of anything. Read stuff here at Hyperlipid, click on the refs. If folks think I'm correct, fine, if not, fine. Making your own decisions on the basis of a little extra information is what matters. Without the info we're just guessing.

Peter (who lives in a hole and only ventures out to read pubmed... Ok, plus a few other places)

Zbig said...

Peter, thanks for your reply, the reasons I asked for your opinion is that you are competent and at the same time distant from the "political games".
And during the winter I switched more to high-fat, almost no-veggies mode and wanted to see those critics' opinions in a new light.

elizabeth said...

Hello Peter,

A quick one - I wanted to ask your opinion on stearic acid and its possible impact on health, joints etc. Is it associated with joint pain at all and inflammation? I know you enjoy eating dark chocolate as do I.
I saw this comment recently:

"Magnesium Stearate or Stearic Acid is basically a toxin; a combination of hydrogenated oils that gets into your body and starts killing cells almost immediately"

Thanks for any feedback -

Please can you let me know if I should limit consuption of this acid

Peter said...

Oh well, that's me and any other cream/chocolate eaters done for.

It's almost my favourite fatty acid, lonf chain, fully saturated and metabolically stable. Now if you had said flax oil...

Where on earth do people get these ideas from?


LPrice said...

The quote posted about Magnesium Stearate and Stearic Acid typically comes from supplement producers who do not use these products to produce their supplements.
They are used as lubricants by most companies in the the production of supplements so the idea is that if you are taking a multitude of supps daily, you are ingesting alot of this stuff.

Peter, off topic
Thot. I would forward this link regarding the implications of taking "excessive" vitamin D . . re: magnesium

elizabeth said...

Hi Peter,

I was querying the Stearic acid becasue I have such sore elbows and inflammed fingers below the nail. I am trying to isolate what it could be from. I have a considerable amoun of the 90% chocolate and wondered if it could be that. I am not having gluten or dairy right now so it cannot be that. Amhaving some eggs, a little olive and avocado oil, healthfood shop coconut oil and lots of fish and meat. So, I wondered about the stearic acid. I wondered if it was too much acid and that was the cause. I thought you might be interested to know that when I eat foie gras (which is ideal in terms of fat too protein and carb ratios etc) the joints are are more painful the next morning and I thought the link could be an acid related thing somewhere along the line. Abit lke uric acid which I know is rather high in offal and liver etc.

Thanks, enjoy your lovely home grown eggs.. how lucky you are.


Mr Secret said...

about the dark chocklade, i also read on the forum that the fat from the dark chocklade wasnt good because it was plant fat and not animal fat. what do u think of that peter?

wattlebird said...

"I think root vegetables are JKs prefered sources, especially if you have no GI issues."

AND if you do have GI issues??

Stan (Heretic) said...

Zbig wrote: "The right proportion is 1 to 1.5."

Hi everybody,

I struggled with this dilemma myself. I found that I simply cannot consume 3g of fat per 1g of my ideal body weight (65kg,age 52,m) or I would feel totally stuffed! Too much calories for me. My metabolism is such that I have plenty of energy and maintain my weight automatically without any conscious control, on 1500kcal (summer) to about 1800kcal per day in the winter. That works out at about 150g of fat per day, and makes it more like average 2:1 rather than 3:1 as per standard OD prescription. I simply had to conclude that I am slightly different than most patients of Dr. Kwasniewski (note: he worked as a military doctor in the 1960-ties, fighter pilots and military personel in their 20-ties, typically).

Re: reducing protein to 30-40g/day.

I think that is a bad idea! Recently I saw a case of a lady in her early 60-ties who had all sorts of problems on a low protein diet with probably 90% fat. All of that disappeared when she returned to a more orthodox OD with decent protein contents and carbs, and slightly less fat.

I am sure there are many things that need to be tweaked. However I learned to trust Dr. J.K. more than his opponents, even within the LC sphere.

Stan (on OD since 1999)

Peter said...

Hi Mr Secret,

Bit subtle for me and I like chocolate!

Hi Wattlebird,

You could start with asparagus, brussels sprouts, broccoli, cabbage, cauliflower, celery, cucumber, aubergine, kale, onions, peppers spinach, squash, runner beans, tomatoes and monosaccharides (glucose powder in Optimal ice cream). You only need enough to keep just out of ketosis...

Stan, yes, I can see there is the potential for problems on what is essentially a full blown medical ketogenic diet... These certainly are not problem free...


peebix said...

I started using raw cacao powder in my diet after reading about the benefits of epicatechin. I thought that this would avoid a problem of sugar content in dark chocolate. Am I missing any good nutrients by using chocolate powder instead of chocolate?

Sam said...

Hi Peter, I've been meaning to ask this question for awhile since I haven't been able to find a post that answers it explicitly.

You recommend eating just enough carbohydrates to keep out of ketosis. Why is that? What do you see are the problems with continuously ketogenic diets?

Thanks for your excellent blog. Between you and Stephan we're getting really superb analyses of dietary research.

Peter said...

Hi Paul,

I look at this choice in slightly differing terms. To me 85% cocoa chocolate is a delicious form of stearic acid, contaminated with a plant chemical which transiently suppresses my own in built antioxidant systems until my liver can excrete it as rapidly as it can.

It was green tea polyphenols which led to the study here which is core reading for anyone looking to improve their antioxidant status... I doubt that cocoa compounds are very different.


Peter said...

Hi Sam,

Yes, I should put a post up. I've had a number of people tell me that they have developed cardiac rhythm abnormalities during marked ketosis which could be attributed to the rise in sympathetic nervous system tone and plasma noradrenaline associated with this.

One commenter was using serious ketosis for weight loss and had a fasting blood glucose of 8mmol/l. Exceptional but possible through physiological insulin resistance, just gone too far.

And finally there is a well recognised rise in cortisol which is unlikely to be beneficial.

Plus you do actually need some glucose. Why spend money buying extra meat and using metabolic energy converting protein to glucose when a potato a day will do the job, or perhaps the flavouring vegetables in a nice casserole?

That's how I see it now, but the original idea came from JK... And of course the other long timers all use 50-72g/d carbs too. Food choices are pretty unlimited if you eat this way, and I'm in it for life.


H. said...

Peter, would you mind stating what the outcome of the green tea-antioxidant trial was? I looked at the full text and it looks as though the outcome was, that a diet without fruits and vegetables decreases oxidative damage, and that the green tea extract only helps just after one eats it, not in the long term. I think I've missed something.

Thanks very much.