Epilepsy’s Big, Fat Miracle …

… is the title of a New York Times Magazine article about the ketogenic diet, a treatment for childhood epilepsy, which I’ve blogged about several times (here, here, here, here, here). It’s a very-high-fat diet. It interests me for two reasons: (a) It connects a high-fat diet with proper brain function, as my self-experiments have done. A curious feature of the ketogenic diet is that it isn’t permanent. After several years the child can go off it. My self-experimentation suggests that Americans eat far too little of certain fats. Perhaps eating enough of these fats would prevent childhood epilepsy. (b) It shows how someone who cares enough — in this case, Jim Abrahams, whose son had epilepsy — can be more effective than professional researchers and doctors. Abrahams rediscovered the diet. He saw its value, the professionals didn’t. I’ve argued that this is part of why my self-experimentation found new solutions to common problems: because I had those problems. I cared more about finding a workable solution than researchers in those areas, who had several other concerns (publication, funding, acceptance, etc.).

The details of the article reminded me of something I learned in the BBC series The Story of Science. For hundreds of years, medical students were told, following Aristotle, that the liver has three lobes. It doesn’t. You might think that examination of thousands of actual livers would have dispelled the wrong idea, but it didn’t. The article contains many examples of doctors ignoring perfectly good evidence in favor of nonsense they read in a book or heard in a lecture. Epilepsy is easy to measure. If a child has 100 seizures per day, and has been having them at this rate for years, and this goes down to 5 shortly after he starts the ketogenic diet, and goes up again when the child goes off the diet, there is no doubt the diet works. As early as the 1930s, this had been observed hundreds of times. This was overwhelming evidence of effectiveness. Doctors ignored it, probably based on the modern equivalent of the three-lobed liver. They complained, according to the article, that there was “no evidence it worked” or that the evidence wasn’t “controlled” or “scientific” (whatever that means). A study published in 2008 “answered doubts about keto’s clinical effectiveness” — as if doctors needed the equivalent of a very-large-type book to be able to read what most of us can read with normal-sized type.

According to the article, “by 2000, more people were asking about keto, but most pediatric neurologists still would not prescribe it” — as if the parents needed the approval of their doctor to try it. You don’t need a prescription to buy food.

Thanks to Tim Beneke, Michael Bowerman, Alex Chernavsky, David Cramer, and Peter Couvares.

How Wonderful is Lipitor?

John Cassidy, a staff writer at The New Yorker, understands clearly the poor judgment of economics professors. In How Markets Fail he said the Nobel Prize in Economics has made things worse, because it has often been given for worthless work. Outside of economics, however, he can write this:

during a period in which American companies have created iPhones, Home Depot, and Lipitor, the best place to work has been in an industry [the financial industry] that doesn’t design, build, or sell a single tangible thing.

That such a smart well-informed non-party-liner can believe Lipitor is wonderful shows Orwell was right: with enough repetition, people can be convinced war = peace. Here is the truth about Lipitor:

Statin therapy is extremely efficient in lowering cholesterol numbers, but unfortunately not without adverse effects on the body. To prevent a first heart attack, for every life that is saved – 1% over 10 years of use – statins cause an equal number of adverse deaths due to accidents, infection, suicide and cancer — 1% over 10 years’ use and significantly greater levels of serious side effects and suffering. . . . In a study to see the effects of raising the Lipitor levels from 10 to 80 mg (more sales) on patients, those taking 80 mg had increased liver problems, that is the rate of raised liver enzymes was six times higher than those given 10 mg of Lipitor. Even though the total deaths due to CVD in the 80 mg group was fewer (126) than in the 10 mg group (155), the total deaths due to other causes was higher in the 80 mg (158) than the 10 mg (127) group. There was no difference in the overall mortality rate.

Lipitor, the miracle drug. Taken by millions at a cost of billions. This is what happens when you — such as those in charge of health care — have little understanding of a problem: You aren’t good at solving it.

Cardiologists believe that high cholesterol causes heart attacks. Their depth of understanding was illustrated by the cardiologist at my Quantified Self talk about butter who said that the Framingham study showed that diet caused heart attacks (no, it found new correlations between heart disease and “risk factors” such as cholesterol — see also this) and that the recent reduction in heart attacks is evidence of our improved understanding (e.g., the science behind Lipitor). That a thousand other things changed over the same time period he apparently hadn’t considered. He simply couldn’t defend — at least then — his core belief that butter was bad. A cardiologist! How many thousands of people has he told to eat less butter?

Cassidy’s article about the harm done by the financial industry, from which that quote was taken, is excellent.

Effect of Flaxseed Oil on Arithmetic

After I moved to China in September, I was surprised that my arithmetic speed went down. (That is, I got faster.) I had lowered it from about 630 msec/problem to 600 msec/problem by eating lots of butter. I had no idea how to lower it further. I didn’t deliberately change my diet in China but it was quite different. I kept some things the same: the amount and brand of butter/day, the amount and brand of flaxseed oil/day.

I failed to figure out why I had gotten faster. I reduced the amount of flaxseed oil from 3 T (tablespoons) per day to 2 T per day. It made no difference. (In the beginning of my interest in flaxseed oil, change from 2 T/day to 3 T/day had made a difference.) Perhaps because of the butter.

Surprised that the change from 3 T/day to 2 T/day hadn’t made a difference, I went down to 1 T/day for two weeks, then back to 2 T/day. Both changes made a difference:

2010-11-16 2T vs 1T flaxseed oil

Each point is a separate test. Each test had 32 arithmetic problems (e.g., 3+4, 11-3). In the beginning of the data shown in the figure I tested myself once per day. After 12 days I started doing two tests/day, one right after the other. I was curious about the repeatability of the numbers; it wasn’t hard; it was a way to get better measurements. Averaging over the tests for each day to get one value per day, combining the 19 2-T/day (before) days and the 11 2-T/day (after) days, and comparing the combination to the final 7 1-T/day days, t(38) = 6.5. If you’re not familiar with t values, t = 2 is a barely reliable difference, t = 4 is a very clear difference.

This is more evidence that flaxseed oil improves brain function. It interests me because it implies the optimum dose is close to 2 T/day. It cost about $20 and took 1 person-month. In contrast, the DHA-Alzheimer’s study I mentioned two days ago cost about $1 million and took about 7000 person-months. And used (a) a cruder something-versus-nothing comparison, b) a less-sensitive between-subjects comparison, and (c) a more ethically-problematic placebo-controlled design.

Stroke and Saturated Fat

A 1997 epidemiological study, which I just learned about, found that increases in saturated fat intake were associated with a lower risk of stroke. Sampling from among the papers that cited it, this study found a non-significant change in the same direction. This study found a significant change in the same direction in Japanese, who eat a low amount of saturated fat. This is especially interesting because many people assumed that the high rate of stroke among Japanese was due to high salt intake. This finding suggests it is due to low saturated fat intake.

As I said in a recent post, this sort of consistency across studies on a question of enormous interest argues against the severest critics of epidemiology, such as John Ioannidis.

Why Small Change = Big Deal (revised)

Last week a journalist asked me why the 5% improvement in arithmetic speed produced by butter was important. In an earlier post I said I’d given a poor answer.A few days later I figured out what I should have said. The article was delayed, it turned out, so there was time to use my new strategy. I answered the question like this:

I was excited by this discovery because it was so big and unexpected. Someone once found a correlation between IQ and reaction time. The higher your IQ, the faster your reaction time. I don’t know what the exact function was but a decrease of 30 milliseconds might correspond to 10 more IQ points. I felt a little bit smarter. It was so unexpected because hardly anyone was going around saying butter is good for you — and thousands of people were saying it is bad for you. The only ones saying butter is good for you were the followers of Weston Price, and they had almost no evidence for what they were saying. Compared to their evidence, my evidence was crystal clear. Among mainstream nutritionists, butter is universally scorned. Yet my data suggested exactly the opposite — that it had a large amount of an important nutrient I wasn’t getting enough of. If mainstream nutrition advice could be so wrong, it would have big implications for what we eat. Maybe other things we are constantly told about what to eat are also wrong.

I discovered this big effect of butter by substituting butter for pork fat. So the reason butter was so helpful wasn’t anything as simple as animal fat is food for us. I ate plenty of animal fat before I started eating lots of butter. The reason was something more specific.

Why Small Change = Big Deal

Eating a half-stick of butter (60 g) every day apparently improved how fast I can do simple arithmetic problems (e.g., 7-5, 3+1). I improved about 5% — from 630 to 600 msec per problem. My scores had been at 630 msec for months. They suddenly dropped.

A reporter said to me that a 5% improvement isn’t much. You couldn’t notice it. Why did this matter?

I did not reply “what good is a newborn baby?” I said it mattered for three reasons:

1. You cannot easily produce such an improvement. I was already doing very well. For example, I had already lowered my scores a lot via omega-3. Imagine the world record for the 100 meter dash suddenly dropping 5% due to eating something you can find in a supermarket.

2. A 5% improvement is just the beginning. There is room for optimization — better dosage, better timing of taking the butter, and so on.

3. The brain is a mirror of the rest of the body. Learning the best diet for the brain, at least in terms of fat, will help us learn the best diet for the rest of the body, just as learning what house current is best for one electrical appliance is a guide to what other electrical appliances are designed for. They’re all designed to work with the same house current.

Alas, this is not just a poor answer, it’s what I actually said. I give myself a C+. Reason 1 is almost gibberish. Reason 2 is technocratic. A good answer is more emotional. Reason 3 is okay, if not very clear.

At Berkeley I knew a student who had transferred from a junior college. He is/was black. He had probably gotten into Berkeley because Berkeley administrators wanted to admit more black students. He complained one day that he got C’s on his essays even though “all the words were spelled correctly.” It was frustrating, he said. I am in a similar situation here. My answer is poor but I cannot easily do better.

Will Eating Half a Stick of Butter a Day Make You Smarter?

To my pleasant surprise, Mark Frauenfelder posted this call for volunteers. Will eating half a stick of butter per day or a similar amount of coconut fat improve your performance on arithmetic problems? Eri Gentry is organizing a simple trial to find out. The trial is inspired by my recent Quantified Self talk. Study details.

During the question period of my talk, I responded to a question about a trial with 100 volunteers by saying I would suggest starting with 2 volunteers. A reader has written to ask why.

What’s your reasoning behind suggesting only 2 volunteers to test the eating more butter results? You seem highly convinced earlier in the video, but if you were so convinced why not have a larger trial?

Because the trial will be harder than the people running it expect. If you’re going to make mistakes, make small ones.

This is my first rule of science: Do less. A grad student in English once told me that a little Derrida goes a long way and a lot of Derrida goes a little way. Same with data collection. A little goes a long way and a lot goes a little way. A tiny amount of data collection will teach you more than you expect. A large amount will teach you less.

My entire history of self-experimentation started with a small amount of data collection: An experiment about the effectiveness of an acne medicine. It was far more informative than I expected. My doctor was wrong, I was wrong — and it had been so easy to find out.

This may sound like I am criticizing Eri’s study. I’m not. What’s important is to do something, however flawed, that can tell you something you didn’t know. Maybe that should be the first rule, or the zeroth rule. It has the pleasant and unusual property of being easier than you might think.

Thanks to Carl Willat.

Dairy Consumption and Health

Two studies of the effect of dairy consumption on health have recently appeared. Both suggest it is healthy. One of them— a prospective study where about 1500 people were followed for 16 years — found no association of dairy intake with overall mortality but did find a protective effect of full-fat dairy against heart disease. The study considered lots of possibilities and the authors write ” it is important to take into account the large number of comparisons considered in this study and thus we cannot rule out the possibility that the protective association between full-fat dairy intake and cardiovascular mortality was due to chance.”

I mentioned this study earlier. It gains more credence because of the other study, which is a meta-analysis. The second study found protective effects of dairy products on several outcomes, including overall mortality:

Meta-analyses suggest a reduction in risk in the subjects with the highest dairy consumption relative to those with the lowest intake: 0.87 (0.77, 0.98) for all-cause deaths, 0.92 (0.80, 0.99) for ischaemic heart disease, 0.79 (0.68, 0.91) for stroke and 0.85 (0.75, 0.96) for incident diabetes.

This is good news for me since I eat yogurt and butter every day.

Thanks to Peter Spero.

How to Eat a Lot of Butter

Since I discovered that butter makes my brain work better, I have been eating half a stick (60 g) per day. Usually half in the morning and half in the evening. It is hard to eat by itself but easy to eat with other foods. I’ve tried a dozen ways of doing this. My top three additions:

1. Pu’er tea. The most convenient. As convenient as drinking tea. Put the butter in hot tea, wait till it melts. I can eat at least 20 g of butter in one cup of tea. Butter tea is common in Tibet. Thanks again to Robin Barooah.

2. Cherry tomatoes. The healthiest and fastest. Slice the tomatoes in half lengthwise, eat each half with a similar-sized piece of butter. It is like that classic Italian combination, mozzarella and tomatoes.

3. Thin-sliced roast beef. The most delicious. Wrap a piece of butter with the roast beef. However, I already eat plenty of meat, it is hard to get thin-sliced roast beef in Beijing, and it is so delicious I end up buying a lot of thin-sliced roast beef.

None of these additions affects brain function (measured by arithmetic score), as far as I can tell, although I suppose the tea wakes me up.

New Heart Scan Results: Good News (explanation)

My recent heart scan score was about 50% less than you’d expect from an earlier score. Why the improvement?

During the year between the two tests, I’d made one big change: eat much more animal fat. That’s the obvious explanation. Three things support it:

1. Mozaffarian et al., as I blogged, found a similar result.

2. The animal fat (pork fat and butter) had both produced large immediate improvements when I began to eat them. The pork fat had improved my sleep; the butter, my arithmetic scores. This sort of large immediate effect we associate with the supply of a missing necessary nutrient — giving Vitamin C to someone with scurvy, for example. My brain, at least, needed much more animal fat than I’d been eating. Different parts of the body need different nutrients, sure, but they all must work well with the same set of nutrients. If Nutrient X helps one part of the body, it is more likely to help another part.

3. My initial score put me at the 50th percentile for my age. I’d had an unusual diet for a long time. I stopped eating bread, potatoes, rice, pasta, and dessert 13 years ago. I’d started consuming lots of omega-3 and fermented foods a few years earlier. It was possible that those other changes produced improvement but if so it was a strange coincidence that, as my score got better and better over the years, I happened to measure it for the first time just when it crossed the 50th percentile.

This explanation makes a prediction: If you greatly increase your animal-fat intake, your heart scan score should improve. A commenter said what he’d read on paleo-diet forums supported this prediction: “If you hang out in the paleo/low carb forums, you see this kind of thing a lot.”

New Heart Scan Results: Good News (context)

I posted yesterday that a recent heart scan found my arteries about 50% less calcified than a previous scan predicted. Apparently the improvement was due to eating much more animal fat (pork fat and butter).

In 2004, an American Journal of Clinical Nutrition article found something similar: heart disease progressed less in women who ate more saturated fat. “In postmenopausal women with relatively low total fat intake, a greater saturated fat intake is associated with less progression of coronary atherosclerosis,” the authors wrote. Here’s how they saw this finding:

The inverse association between saturated fat intake and atherosclerotic progression was unexpected. However, this finding should perhaps be less surprising. Ecologic and animal experimental studies showed positive relations between saturated fat intake and CHD risk (8). However, cohort studies and clinical trials in humans have been far less consistent (9 –12). Furthermore, most studies of dietary fat and CHD risk have been performed in men (15, 16). The relations in women—particularly postmenopausal women—are much less well-established, and evidence from dietary intervention trials suggests that diets low in saturated fat may have different effects on CHD risk factors in women (15, 17–22).

In their study, women with the highest intake of saturated fat did not get worse during the study period, whereas women with lower intakes did get worse.

An editorial about this study described some of the evidence that supports the “article of faith” that “saturated fat . . . accelerates coronary artery disease”:

One of the earliest and most convincing studies of the better efficacy of unsaturated than of saturated fat in reducing cholesterol and heart disease is the Finnish Mental Hospital Study conducted in the 12 y between 1959 and 1971. In this study, the usual high-saturated-fat institutional diet was compared with an equally high-fat diet in which the saturated fat in dairy products was replaced with soybean oil and soft margarine and polyunsaturated fats were used in cooking. Each diet was provided for 6 y and then the alternate diet was provided for the next 6 y. After a comparison of the effects of the 2 diets in both men and women, the incidence of coronary artery disease was lower by 50% and 65% after the consumption of polyunsaturated fat in the 2 hospitals.

My results make the results of that earlier study exceedingly puzzling. I found a large change in one direction; the Finnish study found a large effect in the opposite direction. Given the huge effect (50% or 65% reduction) observed in the Finnish study, it is hard to understand why “cohort studies and clinical trials in humans have been far less consistent”.

New Heart Scan Results: Good News

One and a half years ago, in February 2009, I got a heart scan. It’s an X-ray measurement of how calcified your arteries are. Persons with high scores are much more likely to have a heart attack than persons with low scores. Scores in the hundreds are dangerous. Tim Russert, who died at age 58 of a heart attack, had a score of about 200 ten years before his death. Above age 40, the scores typically increase about 25% per year. That puts Russert’s score when he died at around 2000.

A few weeks ago I got another scan, at the same place with the same machine. Here are my scores. February 2009: 38 (about 50th percentile for my age). August 2010: 29 (between 25th & 50th percentile). In other words: 47% lower than expected. The earlier scan detected 3 “lesions”; the recent scan detected 2. The woman who runs the scanning center — HeartScan, in Walnut Creek, California — told me that decreases in this score are very rare. About 1 in 100, she said.

The only big lifestyle change I made between the two scans is to eat much more animal fat. After I found that pork fat improved my sleep, I started to eat a large serving of pork belly (with 80-100 g of fat) almost every day. Later I switched to 60 g of butter every day. The usual view, of course, is that to eat so much animal fat is v v bad and will “clog” my arteries. In fact, the reverse happened. Judging from this, the change was v v good.

More Saturated Fat, Less Stroke

This recent study from Japan found that middle-aged men and women who ate more saturated fat had a lower risk of stroke. The rate of strokes was 30% lower in the highest intake quintile compared to the lowest quintile. There was a non-significant reduction in heart disease.

Other big differences were correlated with saturated fat intake. For example, those in the highest quintile had more college education than those in the lowest quintile and were more likely to do sports >1 hr/week. These data by themselves won’t convince anyone that saturated fats are beneficial. But they should push you in that direction. Contrary to what you’ve heard a million times.

As far as I can tell, eating lots of butter has lowered my blood pressure. High blood pressure is associated with greater risk of stroke.

Although pig fat certainly helped me (I slept better), I’ve found butter is even better. Butter has considerably more saturated fat than pig fat.  The fat in butter is  60% saturated fat, whereas pig fat is 40% saturated fat. My consumption of 60 g/day of butter gives me 36 g/day saturated fat. In this study, persons in the highest quintile of intake averaged 20 g/day. The highest intake in the whole study (60,000 people) was 40 g/day. In addition to butter, I eat cheese, whole-fat yogurt, and meat, so I’m surely higher than that.

Via Whole Health Source.

Pork Belly News

I am a big fan of pork belly. Whenever I see it on a menu I order it. The mayor of Chongqing (population 32 million) recently made headlines with a speech whose main point was

改善民生不只是吃红烧肉穿漂亮衣服

Which means: Better living standards is not just eating hong shao rou wearing beautiful clothes. Hong shao rou is pork belly braised in a red sauce. Maybe my favorite Chinese dish. Supposedly Chairman Mao’s favorite dish. I’m glad he said “not just” rather than “not”.

Arithmetic and Butter (continued)

At my Quantified Self talk I described data that suggested butter improved my mental function. During the question period, a cardiologist in the audience said something about me killing myself — butter is unhealthy. The usual view.

I said I thought the evidence for the usual view was weak. He said, “The Framingham studies.” That was epidemiology, I said. It is notoriously hard to understand. My data was from something like an experiment. Much easier to understand. (And the Framingham study is a terrible example of the supposed evidence. To quote from it: “In the period between the taking of the diet interviews and the end of the 16-year follow-up, 47 cases of de novo CHD developed in the Diet Study group. The means for all the diet variables measured were practically the same for these cases as for the original cohort at risk.”) He replied that the reduction in heart disease in recent years was more support for the usual view. I said the recent decline in heart disease could have many explanations other than a reduction in animal fat intake. Many things have changed over the last 20 years.

There is epidemiological evidence that saturated fat is bad, yes, but it is not the Framingham study nor the recent decline in heart disease. And it really is difficult to interpret. The butter-is-bad interpretation could easily be wrong. The obvious problem is that, after people are told butter is bad, people who try hard to be healthy avoid butter. And they do a lot of other things, too, to be healthy. So butter consumption ends up confounded with a dozen other variables believed to affect your health. When I was growing up, my parents avoided butter because margarine was much cheaper. So butter consumption is confounded with income, another problem.

My tiny experiment, whatever its problems, was much easier to interpret.

Arithmetic and Butter

On Tuesday I gave a talk called “Arithmetic and Butter” at the Quantified Self meeting in Sunnyvale. I had about 10 slides but this one mattered most:

It shows how fast I did simple arithmetic problems (e.g., 2*0, 9-6, 7*9) before and after I started eating 1/2 stick (60 g) of butter every day. The x axis covers about a year. The butter produced a long-lasting improvement of about 30 msec. Continue reading “Arithmetic and Butter”

Butterfat Good?

I eat a lot of butter because I believe it makes my brain work better. A new paper says it may help me in other ways. From the abstract:

Compared with those with the lowest intake of full-fat dairy [= “whole milk, cream, ice cream, yogurt, full-fat cheese and custard”], participants with the highest intake (median intake 339 g/day) had reduced death due to CVD (HR: 0.31; 95% confidence interval (CI): 0.12–0.79; P for trend = 0.04) after adjustment for calcium intake and other confounders.

70% reduction is huge — so large it makes the idea of direct causation (butterfat lowers CVD risk) more plausible. (However, there is a lot of uncertainty in the estimate.) The alternative is that butterfat intake is correlated with the true cause — a behavior difference, say. But that correlation would have to be very high, which isn’t terribly plausible. Measured differences between the high-fat group and the low-fat group were small.

Stephan Guyenet reviews other evidence that supports the idea that this reduction is no fluke. Other studies have found similar effects.

Thanks to Paul Sas.

Butter: New Antidepressant?

Ever since I found that pork fat improved my sleep, I’ve tried to eat a substantial amount every day. A few months ago, I knew I couldn’t eat any that day so I had a lot of butter at lunch (about 30 g). About 1-2 hours later, I felt in an unusually good mood — in particular, unusually calm. I hadn’t noticed such an effect with pork fat, perhaps because it is digested more slowly. (It’s easy to see that pork fat melts more slowly than butter.)

Now a friend has reported a similar effect:

My mood is better with the Straus butter, but I am concerned about my cholesterol, so maybe I’ll just use it when I feel depressed.  But it does work.

I’d guess that Straus Family Creamery butter, which is from grass-fed cows, has more omega-3 than other butter but I haven’t noticed mood elevation from flaxseed oil, so I doubt that’s involved. Moreover, I’ve always been drinking plenty of flaxseed oil so I doubt I’m omega-3 deficient.

Maybe this has something to do with why certain food is “comfort food”.

A new study found that consumption of unprocessed meat was not associated with more risk of heart disease but that consumption of processed meat (such as bacon) was associated with greater risk of heart disease. The whole American fear of animal fat (including butter) may be due to an unrecognized confounding: those who ate more animal fat also ate more bacon.

Gouda Cheese Did Not Stimulate Immune System

A recent study in Finland found that cheese with added lactic acid bacteria (sold commercially) stimulated the immune systems of elderly subjects. Earlier studies had found similar effects when the bacteria were put in milk or yogurt. To me, the most interesting result was that the cheese alone (Gouda, a fermented cheese) had no detectable effect. I take that to mean that some fermented foods contain too little bacteria to make a difference. I’m going to have to stop using my umami hypothesis as an excuse to eat cheese — although cheese may also be good for the fat it contains.

Thanks to Anne Weiss.