Book Review

            As I was perusing the shelves of my favorite bookstore (Half-Price Books), I caught sight of The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, written by Nina Teicholz. The cover was, I admit, rather off-putting for me: it features a roast of some sort below a glowing golden halo. However, “fat” is the magic word for me, so I took a gander at the cover blurb. There it was: “With conclusions based on her nine-year investigation, [she] reveals the unthinkable: everything we’ve ben told about fat is wrong. She documents how overzealous researchers allowed weak science to take hold in public imagination and become dietary dogma.” I bought the book and took it home with me.

            Teicholz is interesting in that she is not a nutrition industry “insider”: she is actually a journalist. As a reporter, she was in a far better position to look at current nutritional guidelines with a jaundiced eye. As she explains in her tome, nutritionists who question the long-held conclusions about fat face serious prejudice from their colleagues, up to and including outright refusal to provide funding for or publish studies. Free from concerns about professional blacklisting, she was able to openly question long-held beliefs about the relationships between dietary fat, cholesterol, and heart health.

            Teicholz provides ample evidence to support her conclusion that dietary fat is not the problem many of us have been taught to consider it: she clearly and carefully explains the limitations of observational studies in general and identifies some of the serious flaws of many of the most famous studies upon which the fat guidelines were based. For instance, Ornish, whose studies did show a correlation between lower fat consumption and improved heart health, did not isolate fat consumption as an intervention: his experimental groups were also told to exercise more, reduce their consumption of refined carbohydrates, and quit smoking. Furthermore, they were often provided with tangible support (in the form of smoking cessation support and provided meals), whereas the control group received were entirely free-living. Teicholz also found a study in which the experimental group received two interventions: cholesterol-lowering drugs and a dietary intervention.  The researchers conducting the study concluded that the diet was responsible for the reduction and conveniently downplayed the possibility that the medications (which the control group did not receive) played a role.

            The book is not an “easy read,” but it is interesting. Readers who are familiar with the theories and researchers explored in the books will likely enjoy seeing the other side. Laypeople will appreciate the footnotes that clarify ideas that might be unfamiliar. Teicholz does an excellent job of addressing counterarguments (indeed, the entire book is a rebuttal) and provides numerous citations in support of both her claims and those claims that she seeks to refute.

            An important note: Teicholz directly addresses the issue of meat and ethics in a short note at the end of her book. This thoughtful and direct concession is refreshing in a world in which people tend to ignore the ethical implications of their choices as consumers. Readers who are concerned about these issues (animal welfare, environment, etc.) should begin with the note and understand that Teicholz’s purpose in writing this was to explore which types of fats are the most health-inducing for humans: she did not seek to understand which ones were the most beneficial to the environment or to animals. While the bulk of the book focuses on the history of our nation’s descent into fatlessness, the health consequences of that trend, possible solutions, and the research supporting all of the above, Teicholz explicitly recommends a return to consumption of animal fats, including body fat. The idea of eating body fat is a little bit tough to swallow (yuk yuk) for a vegetarian or a vegan. Anyone who is vegetarian or vegan needs to know that  both tallow and lard make appearances on these pages: don’t let these ideas distract you from the “meat” of the book: fat isn’t the bad guy!

Recipe: Blackberry Almond Clafoutis

Check out this awesome recipe: https://ketodietapp.com/Blog/post/2016/07/19/keto-triple-berry-clafoutis

I adapted it by using all blackberries and replacing the coconut milk with my favorite unsweetened flax milk. Doing so changed the nutrition information and also the cooking time: you'll need to cook it a little bit longer, and when I make this again, I will probably use a water bath. (It takes much longer for the inside to cook.) I might also try to mitigate the wetness by using a bit of coconut flour in place of some of the almond flour. This results 

Updated nutrition for my version: 139 calories; 10.6 g fat; 5.8 grams of carbohydrate, 3.5 of which are fiber (net carbs: 2.3 grams); 6.1 g protein [Note: this is slightly more than 10% carbohydrate; I have mitigated this for myself by serving it with a blob of something fatty, like sour cream or whipped cream]

Keto Post on Progress

I have now been following a ketogenic diet, with about 95% compliance, for six weeks. The Friday before I began tapering down on my carbohydrates, June 18th, I was 129.5 lbs at the end of the day. This morning, I weight in at (a lower-than-usual) 116.5.

I began to take measurements and calculate and record my body fat percentage three weeks ago. I used what is supposed to be a very accurate online calculator: it combines a few different methods and involves a number of measurements. Each Saturday morning, I measure the following circumferences: waist, navel, hips, thigh, forearm, bicep, wrist, neck, calf, rib, and bust. The first week, I did not measure them all; when I entered everything, I had to guess on some. My calculated body fat percentage was around 21%. The next week was the same. The week after that, my estimated body fat percentage went down to 20.67%. This week, it was apparently 18.94%. I am guessing that part of the fluctuations are due to my lack of experience in taking measurements. It’s really hard to measure forearms and biceps! Still, I see evidence that I am losing body fat in other ways, namely in the fit of my clothes and how much muscle I can see in the mirror.

For one thing, my average weight has been fairly stable, but my strength is improving. The week of July 16th, my average weight was 119.5. The next week, it was 119.4. Last week, it was 117.9. Part of the dramatic fluctuation is that I have not been completely consistent with how often I weigh myself. The scale at the gym is not accurate, so I stopped using it in my at-home calculations. (I do use it to track on MyFitnessPal.)

Link to the calculator: https://www.healthstatus.com/calculate/body-fat-percentage-calculator

Keto Bread, version 1.0

Calories per serving (1/12th of a 9-inch loaf): 129

Fat grams: 8.3; Carbohydrate grams (5.4, 2.2 of which fiber); Protein grams: 9.9

Ingredients: 

1 c. Vital wheat gluten

2 T. Milled flaxseed

4 T. Coconut flour

8 T. Almond flour

1 T. Active dry yeast

1 c. Warm water

2 T. Coconut oil

2 T. Olive oil 

Optional (will change macros): 4 T. Hulled hempseed

Stir the yeast into the water. Let it sit for about five minutes while you get everything else ready. 

Mix together the flours, flax, and vital wheat gluten. Stir in 2 T. Melted coconut oil. Add the yeast and water. Stir well; the dough might fight you. 

Knead for a couple of minutes. Knead in the hemp seeds if you're using them. (The dough will fight you; it's high in gluten.) 

Grease an 8- or 9-inch loaf pan with 1 T. Of the olive oil. Using your hands, shape the dough into a log that fits in the pan. Cover the pan with a dish towel and put somewhere moderately warm. Let it rise for about an hour. 

When the dough has risen, bake at 350-375 degrees until done. (It took mine about 30 minutes. My oven's thermostat is a bit off, so I need to check with a thermometer to get an accurate temperature for you.)

Adventures in Ketogenic Baking

Anyone who has known me for awhile knows that I love to bake, especially breads and cakes. Obviously, regular flour is out while eating ketogenic food. (Way out.)

Clearly, there are some obvious potential solutions: nut flours and seed meals work well in baked goods. Of course, they are often at least moderate in carbs, so it's important to use other ingredients as well. Many of the ketogenic recipes for bread alternatives involve a ton of eggs and fuss. (See "Oopsie Rolls" as an example.)

My latest adventure has involved trying to figure out how to get more baked love into my life, along with mashing in as much fiber as I can. Thus far, I have been largely successful.

Thus far, I've made Gluten Buns (a bit strange, but edible and a great way to get in some extra protein and fat), Peanut Butter Cookies, Maple-Pecan Flax Muffins, and Keto Bread. The Gluten Buns, Peanut Butter Cookies, and Maple-Pecan Flax Muffins all came (or were slightly adapted) from recipes on other blogs, but the Keto Bread is mine all mine! It is still higher in carbs than I would like, but I'm working on it. Recipes, links, and resources to follow in upcoming posts.

Recipe: Tofu-Veggie Bowl in Coconut Broth

No photos at this time, as I can't get them to post from my darned iPad. Once I AirDrop them over to my laptop, I'll update the post.

Note: this is more moderate carb. I had it at the end of a day during which I was a.) way under my maximum carb intake and b.) dying for something that was colorful.

Tofu-Veggie Bowl in Coconut Broth

Trader Joe’s sprouted tofu
30 g raw spinach (a couple of handfuls)
30 g red bell pepper (around a quarter of a pepper)
30 g baby Bella mushrooms (around half a cup)
One clove of garlic
4 g ginger
About half a T of chopped scallion
1 t. Low-sodium Tamara
1 t coconut oil
2 t canola oil
1 t sambal oelek
1 c. Unsweetened, unflavored coconut milk drink
Lime juice
Spices: ground coriander, ground cumin, cayenne, pepper, Himalayan salt, etc.

Press the tofu for a couple of hours. I did the entire package; I have the other ones waiting for some sort of yummy project later. (It wound up being "breaded" nuggets, and I am so glad I made them.)

Here are the ingredients, minus the aromatics:



Dice the peppers, tofu, and mushrooms. Put them aside. Mince the ginger, garlic, and scallions.



Heat the oils over medium heat in a large, nonstick skillet. Add the ginger, garlic, and scallions and stir until it starts to smell good. (If it gets sticky, no worries, just add some more oil.)

Add the tofu and mushrooms. Stir.



When the mushrooms start to get soft, the tofu starts to get crisp, and the aromatics are looking pretty toasty, add the peppers and the spinach. Stir. Add the tamari.



Pour in the coconut milk. Add the sambal oelek. Turn the heat down and let it simmer. It wasn’t quite as pretty as I would have liked at this point, so I put in some cayenne and crushed red pepper, but that certainly isn’t necessary. (If you aren’t a spice fan, definitely don’t do that.)



Once it has reduced a bit and the favors are blended, pour it into a bowl. Squeeze some lime juice on it, add salt if needed, and eat up. It’s good!

Keto 10: Losses, Gains, and Ch-ch-ch-changes!

            My weight has been a bit up and down over the past few months. After my recent trip (belated diary posts and photos to be posted eventually), I was a little bit up there. No need to go into details about my average weight, etc., but I was so not thrilled with the weight and the way that I looked that I didn’t record weight or photos in MyFitnessPal for a couple of weeks. I eventually decided to suck it up on June 18^th, when I clocked in at a cool 129.5 lbs. This is perfectly healthy for my height, but I also felt like I could do better.  I knew that it wasn’t muscle, and I knew that it wasn’t just water weight. I had brought home a foreign food love child.

            June 18^th happens to mark the weekend that I had begun transitioning to a keto diet. [Ratios.] I had hoped that making a slower transition would make it easier. Unfortunately, one cannot “ease into” ketosis. Summer camp began Monday, June 20^th, and it was not entirely pleasant. I started running out of glucose on Tuesday or Wednesday. Evenings were rough the entire week. Fast-forward to now. On a full stomach, I just weighed in at 121 lbs. I’ve been weighing myself first thing (well, after my cherished Diet Dr. Pepper and a good pee) for the last several days. I’m averaging around 119. This still has me in the healthy weight range, at least according to the dubious BMI scale.

            But it gets better: my body fat percentage is obviously going down. I can see the shadow of a four-pack. I am clearly gaining muscle. Today, when I leaned my elbow on the counter, I could see my bicep slide down the inside of my arm when I relaxed. It wasn’t fat; it was my darned bicep! I am beginning to see little muscle dimples show up on my back.

            I didn’t mention this on my blog at all earlier, but back in March, I got a DEXA scan done. According to the DEXA, my body fat percentage was 31.2. Yikes! (That was pre-trip; I was 124.3 lbs. then.) That means that almost 40 pounds of my body was fat.

            I’m not going to go in for my next one until September (I figure 6 months is a good amount of time to see about my recomposition), so I’ve been relying on other methods for gauging my body fat. I’m too cheap (and pinch-averse) to buy calipers, so I looked at the free options. There are two: visual estimate and measurements. According to a handful of sites (all of which probably refer to one of those sites), in order to begin to see an outline of abs, a woman needs to be somewhere in the ballpark of 15%. This is clearly not the case for me. Okay, plan B. My gym friend M. told me that she does estimates based on measurements. This past Saturday, I decided to take my measurements. (I wound up needing to take more in order to fill in all fields, but never mind.) The estimate based on the online calculator? I’m at 21% body fat. It still seems low, but wow! That’s still better than I expected. 

            Update regarding general health: I know that the blood pressure cuff stations aren’t the most reliable, but I still wanted to post my latest results: 103/68, with pulse pressure of 35, mean arterial pressure of 80, and pulse of 95. Considering the fact that I’d just been wandering all over the grocery store trying to remember what I’d wanted to buy (it was milk for a recipe), that’s not too bad.

            I’ll keep track of this and intermittently post more progress.

Cheesy Poblano Chik'n Skillet

Note: this is relatively high-carb, so be sure to eat with something fatty. I could have increased the cooking oil quite safely, but I’m posting the recipe as I made it for the sake of clarity.

Makes 2 servings

Ingrediens:

1 Quorn Chik’n Naked Cutlet, thawed

50 g zucchini, diced

50 g poblano pepper, diced (I left seeds and membrane out)

2 g garlic (I used one clove)

1 t. olive oil

1 t. canola oil

1 t. coconut oil

2 T. sour cream

4 T. hot salsa (I used Herdez brand Casera Hot)

¼ c. shredded cheddar and jack blend

1. Prep all ingredients: dice the zucchini, peppers, and Quorn. Mince the garlic. Put that on one saucer/plate. Measure out your cheese and sour cream. Put it on another plate or in a ramekin or something. Do the same with your salsa.

2. Heat the oil in a large skillet on medium to medium-high. I used my cast iron; non-stick would be fine, too. Just don’t use something thin that gets hot spots.

3. Dump in the veggies and Quorn. Cook until everything is done to your liking: if you like things brown around the edges, cook until then. If you just want it heated through, cook until then.

4. Dump in the salsa and stir to distribute evenly.

5. Dump in the cheese and sour cream and stir until the cheese is melted and everything is nicely coated. It will not be especially pretty, so don’t make this for something you’re trying to impress with pretty food.

The second portion was really good with half an avocado (mashed up with Veganaise and milled flaxseed). 

Per serving (calculated by MyFitnessPal; excuse errors):

205 calories, 15.3 g. fat (7.5 saturated, 1.4 polyunsaturated, 4.1 monounsaturated) 8.8 g. carbs (1.4 fiber, 3.9 sugars)

10.6 g. protein

Other nutrients: 25 mg cholesterol, 542.2 g. sodium, 61.2 mg potassium, 11.8% Vitamin A, 52.6% Vitamin C, 3.6% Calcium, 2.6% Iron

Keto 7: Mo Fat, Mo Problems

            Now, I realize that I haven’t brought this up. Keto, like any dietary restriction, has a few complications that arise when it comes to etiquette. I am not “out” to everyone. Most of the people in my life aren’t going to understand it, and a few will be quite opposed. I’ve already had some who, not knowing why I was turning down food, try to push stuff on me. I think some of them mean well, but others are definitely baffled at my decision to not eat the bread, crackers, cupcakes, cookies, whatever.

            There are also the people who see me eating anything with carbohydrates and immediately jump on it, as though eating a food that contains carbohydrates means that I am not actually doing a ketogenic diet. This obviously makes about as much sense as taking a person who is eating a lower-fat diet to task for having something that contains egg, jumping on a person who is trying to up his protein intake for eating a carrot, or “calling out” someone who is eating more fiber for drinking coffee instead of Metamucil. It’s rather idiotic. Most, if not all, diets that are based on nutrients are about the bigger picture… high protein does not mean only protein, low fat does not mean no fat, high fiber does not mean only fiber, etc. A ketogenic diet is not about never having carbs, ever. (Doing so would be not only difficult, but also very limiting… one would have to stop eating anything other than meat and pure fat. Not even eggs and dairy can claim zero-carb status. Incidentally, this would very likely result in boredom and nutritional deficiencies, unless one ate organ meats.)

            It’s tough to find a good balance. I’m obviously very excited about eating this way because it has had such a positive effect on my life thus far. However, few people are especially interested in hearing about what you eat, even when they post pictures of every last meal that they order in restaurants. Still, the main purpose of bringing it up is making sure that people who want to feed you know how to do so. Taking responsibility for one’s dietary restriction might mean bringing something. It might mean declining food (repeatedly). Of course, in a polite world, if you declined something once, that would be the end of it (other than a “Let me know if you change your mind” or a “Is there anything that I can get you?”).

            Alas, we do not live in a polite world. People sometimes want to know why you aren’t drinking or eating. They might that you aren’t enjoying yourself if you aren’t digging into the kale smoothie bowls with sardine puree. (As if you didn’t come for the company?) Sometimes, you get a guilt trip. Since kicking people in the shins is most certainly not polite, you need to find another way.

            I go with the KISS technique, which I employed when I went vegetarian. If a “no thank you” elicits questions, concerns, or any other sort of response, I simply explain that I have started a ketogenic diet and that I eat very low carbohydrate and very high fat.

Keto 7: I don’t believe you.

i8i            You’ll be surprised at how often you hear something like this, though you usually don’t hear it directly. People will say things like, “That doesn’t sound right” or “Eating too much fat is dangerous” or “Epidemiological studies show that [insert ominous thing here]” or “Look at what happened to Atkins on a low-carb diet.” Sometimes, they’re right. The Standard American Diet [SAD] is definitely too high in fat, especially saturated and trans. It is not especially salubrious, and the extra fat (surprise) is usually stored. When your brain runs on ketones rather than glucose, though, the fat isn’t stored. It’s used to feed your brain and muscles. The key here is that you have to stay in ketosis. You cannot use both glucose and ketones. Your body will opt for the glucose. Unless you are basically using the glucose as soon as it goes in, your liver is going to start storing the glucose and using it instead of the fat. You’re going to have problems if you eat high fat and high carb.

            So, they ask, what stupid magazine or blog did you read all this crap on? I’m glad you asked. While I did initially read about it on more general sites, I wound up doing some of my own research as well. (Thanks, Google Scholar!) Most of the existing studies deal with mice, but there was one of particular interest. This was an observational study rather than an RCT, so it is not perfect; however, the results are enlightening.

            Essentially, the trial followed a group of people who were using ketogenic diets to treat their epilepsy. (Ketogenic diets have long been used to significantly decrease the number of seizures that patients have when drug treatments are not effective.) The study spanned 5 years and studied markers like body composition, body fat percentage, bone minerals, [and so on]. The conclusions were that the ketogenic diet did not have an appreciable negative effect on any of the markers. It just cut the number of seizures in half. Unless you believe that epilepsy somehow has a protective effect against fat accumulation in a high-fat, low-carbohydrate diet, then this study indicates that a ketogenic diet in and of itself is not inherently harmful.

            Another group that indicates this is the Inuit. They eat a ton of fat, mostly in the form of blubber, and a very, very low-carbohydrate diet. Still, they tend to be reasonably healthy.

            Now, any idiot can find a study, particularly an observational study, showing that diets higher in fat tend to be associated with poorer health. The problem they have is the same problem that most observational studies have: it’s next to impossible to isolate single characteristics. The observational studies don’t have much of anything to say about carbohydrate intake, or whether or not the people tend to listen to their doctors when making choices about what to do. It’s like many of the other observational studies that have returned results that did not hold up in random-controlled trials: something else caused the results. In at least some cases, researchers speculate that a.) people who adopt one habit said to be healthy (such as eating less fat or eating breakfast) are more likely to adopt other habits said to be healthy (such as eating whole foods, not smoking, limiting alcohol, and getting regular exercise), and b.) one of the latter habits is more likely to be responsible for the health improvements than is one of the former.

            Additionally, recent studies, including random-controlled trials and meta-studies have failed to replicate many of the supposed problems associated with higher fat consumption, particularly when that is coupled with other healthy habits. In fact, some studies have shown the opposite effect.