The Lyon Diet-Heart Study: Implications

There's something ironic about the Mediterranean diet used in the Lyon diet heart study, the one that dramatically reduced participants' risk of heart attack and all-cause mortality relative to the prudent diet control group: it wasn't actually a Mediterranean diet.

The concept of the Mediterranean diet as protective against heart disease may have originated in Dr. Ancel Keys' Seven Countries study, in which he compared the food habits and cardiovascular mortality statistics both between and within seven European countries. Countries surrounding the Mediterranean, and in particular the Greek island of Crete, had the lowest cardiovascular death rates. The Cretan diet is high in monounsaturated fat, relatively low in saturated fat, low in omega-6, and high in omega-3 fatty acids, including fat from seafood and the plant omega-3 alpha-linolenic acid. It also includes abundant green vegetables. This became the inspiration for the modern American concept of the "Mediterranean diet". The part about low omega-6 tends to be omitted.

Of course, if you look at modern heart attack mortality statistics by country, France is the lowest in Europe. France is a Mediterranean country, yet happens to have a very high intake of saturated fat per capita. So the cardiologist-approved version of the Mediterranean diet isn't exactly accurate.

The Lyon study departs even further from the traditional Mediterranean diet. Neither the Cretan nor the French diet are low in fat, yet participants were encouraged to reduce their fat intake. The Cretan diet includes some animal fat and eggs, while Lyon participants were encouraged to avoid these. And finally, the margarine. You could be guillotined for using margarine instead of butter in France, and I'm sure the Cretans aren't too fond of it either. Yet the margarine used in the Lyon study was rich in omega-3 alpha-linolenic acid, a critical factor.

Previous intervention trials such as MRFIT, the Women's Health Initiative (WHI) dietary modification trial, and others, exhaustively tested the hypothesis that reducing total fat intake reduces cardiovascular mortality. It doesn't. A dozen trials have also tested the idea that reducing saturated fat reduces cardiovascular mortality. It doesn't. Increasing fiber doesn't, according to the DART trial. Increasing fruit and vegetables modestly doesn't, according to WHI.

So what's left that's unique about the Lyon trial? It was the only trial to dramatically reduce omega-6 consumption, to below 4% of calories, while increasing omega-3 consumption from plant and seafood sources. In my opinion, that combination is the only plausible explanation for the large reduction in heart attacks and total mortality. That combination also happens to be a consistent feature of the real Mediterranean diet. In both Crete and France, omega-6 intake is relatively low, and omega-3 intake is relatively high. They also eat more real food than processed food in general, a factor that I don't underestimate.

Where do we go from here? Obviously I'm not going to recommend eating omega-3 enriched margarine. Mediterranean countries don't need industrial goop to avoid a heart attack, and neither do you. Anyone who's been to France knows they don't deprive themselves over there. They eat real food and they enjoy it.

The way to preserve the essential elements of the Mediterranean diet without becoming an ascetic is to eat fats that are low in omega-6, and find a modest source of omega-3. That means eating full-fat dairy if you tolerate it, fatty meat if you enjoy it, organs, seafood, olive oil in moderation, coconut oil, butter, lard, and tallow. Along with a diet that is dominated by real, homemade food rather than processed food. Some people may also wish to supplement with small doses of high-vitamin cod liver oil, fish oil or flax. I consider the latter to be inferior to animal sources of omega-3, but it can be useful for vegetarians.

Pastured Eggs

Eggs are an exceptionally nutritious food. It's not surprising, considering they contain everything necessary to build a chick! But all eggs are not created equal. Anyone who has seen the tall, orange yolk, viscous white, and tough shell of a true pastured egg knows they're profoundly different. So has anyone who's tasted one. This has been vigorously denied by the American Egg Board and the Egg Nutrition Council, primarily representing conventional egg farmers, which assert that eggs from giant smelly barns are nutritionally equal to their pastured counterparts.

In 2007, the magazine Mother Earth News decided to test that claim. They sent for pastured eggs from 14 farms around the U.S., tested them for a number of nutrients, and compared them to the figures listed in the USDA Nutrient Database for conventional eggs. Here are the results per 100 grams for conventional eggs, the average of all the pastured eggs, and eggs from Skagit River Ranch, which sells at my farmer's market:

Vitamin A:

• Conventional: 487 IU
• Pastured avg: 792 IU
• Skagit Ranch: 1013 IU
  

Vitamin D:

• Conventional: 34 IU
  
• Pastured avg: 136 - 204 IU
  
• Skagit Ranch: not determined
  

Vitamin E:

• Conventional: 0.97 mg
• Pastured avg: 3.73 mg
  
• Skagit Ranch: 4.02 mg

Beta-carotene:

• Conventional: 10 mcg
  
• Pastured avg: 79 mcg
  
• Skagit Ranch: 100 mcg
  

Omega-3 fatty acids:

• Conventional: 0.22 g
  
• Pastured avg: 0.66 g
  
• Skagit Ranch: 0.74 g
  

Looks like the American Egg Board and the Egg Nutrition Council have some egg on their faces...

Eggs also contain vitamin K2, with the amount varying substantially according to the hen's diet. Guess where the A, D, K2, beta-carotene and omega-3 fatty acids are? In the yolk of course. Throwing the yolk away turns this powerhouse into a bland, nutritionally unimpressive food.

It's important to note that "free range" supermarket eggs are nutritionally similar to conventional eggs. The reason pastured eggs are so nutritious is that the chickens get to supplement their diets with abundant fresh plants and insects. Having little doors on the side of a giant smelly barn just doesn't replicate that.

A New Way to Soak Brown Rice

I've been looking for a way to prepare whole brown rice that increases its mineral availability without changing its texture. I've been re-reading some of the papers I've accumulated on grain processing and mineral availability, and I've found a simple way to do it.

In the 2008 paper "Effects of soaking, germination and fermentation on phytic acid, total and in vitro soluble zinc in brown rice", Dr. Robert J. Hamer's group found that soaking alone didn't have much of an effect on phytic acid in brown rice. However, fermentation was highly effective at degrading it. What I didn't realize the first time I read the paper is that they fermented intact brown rice rather than grinding it. This wasn't clear from the description in the methods section but I confirmed it by e-mail with the lead author Dr. Jianfen Liang. He added that the procedure comes from a traditional Chinese recipe for rice noodles. The method they used is very simple:

1. Soak brown rice in dechlorinated water for 24 hours at room temperature without changing the water. Reserve 10% of the soaking liquid (should keep for a long time in the fridge). Discard the rest of the soaking liquid; cook the rice in fresh water.
   
2. The next time you make brown rice, use the same procedure as above, but add the soaking liquid you reserved from the last batch to the rest of the soaking water.
   
3. Repeat the cycle. The process will gradually improve until 96% or more of the phytic acid is degraded at 24 hours.
   

This process probably depends on two factors: fermentation acidifies the soaking medium, which activates the phytase (phytic acid-degrading enzyme) already present in the rice; and it also cultivates microorganisms that produce their own phytase. I would guess the latter factor is the more important one, because brown rice doesn't contain much phytase.

You can probably use the same liquid to soak other grains and beans.

Paleolithic Diet Clinical Trials Part III

I'm happy to say, it's time for a new installment of the "Paleolithic Diet Clinical Trials" series. The latest study was recently published in the European Journal of Clinical Nutrition by Dr. Anthony Sebastian's group. Dr. Sebastian has collaborated with Drs. Loren Cordain and Boyd Eaton in the past.

This new trial has some major problems, but I believe it nevertheless adds to the weight of the evidence on "paleolithic"-type diets. The first problem is the lack of a control group. Participants were compared to themselves, before eating a paleolithic diet and after having eaten it for 10 days. Ideally, the paleolithic group would be compared to another group eating their typical diet during the same time period. This would control for effects due to getting poked and prodded in the hospital, weather, etc. The second major problem is the small sample size, only 9 participants. I suspect the investigators had a hard time finding enough funding to conduct a larger study, since the paleolithic approach is still on the fringe of nutrition science.

I think this study is best viewed as something intermediate between a clinical trial and 9 individual anecdotes.

Here's the study design: they recruited 9 sedentary, non-obese people with no known health problems. They were 6 males and 3 females, and they represented people of African, European and Asian descent. Participants ate their typical diets for three days while investigators collected baseline data. Then, they were put on a seven-day "ramp-up" diet higher in potassium and fiber, to prepare their digestive systems for the final phase. In the "paleolithic" phase, participants ate a diet of:

Meat, fish, poultry, eggs, fruits, vegetables, tree nuts, canola oil, mayonnaise, and honey... We excluded dairy products, legumes, cereals, grains, potatoes and products containing potassium chloride...

Mmm yes, canola oil and mayo were universally relished by hunter-gatherers. They liked to feed their animal fat and organs to the vultures, and slather mayo onto their lean muscle meats. Anyway, the paleo diet was higher in calories, protein and polyunsaturated fat (I assume with a better n-6 : n-3 ratio) than the participants' normal diet. It contained about the same amount of carbohydrate and less saturated fat.

There are a couple of twists to this study that make it more interesting. One is that the diets were completely controlled. The only food participants ate came from the experimental kitchen, so investigators knew the exact calorie intake and nutrient composition of what everyone was eating.

The other twist is that the investigators wanted to take weight loss out of the picture. They wanted to know if a paleolithic-style diet is capable of improving health independent of weight loss. So they adjusted participants' calorie intake to make sure they didn't lose weight. This is an interesting point. Investigators had to increase the participants' calorie intake by an average of 329 calories a day just to get them to maintain their weight on the paleo diet. Their bodies naturally wanted to shed fat on the new diet, so they had to be overfed to maintain weight.

On to the results. Participants, on average, saw large improvements in nearly every meaningful measure of health in just 10 days on the "paleolithic" diet. Remember, these people were supposedly healthy to begin with. Total cholesterol and LDL dropped, if you care about that. Triglycerides decreased by 35%. Fasting insulin plummeted by 68%. HOMA-IR, a measure of insulin resistance, decreased by 72%. Blood pressure decreased and blood vessel distensibility (a measure of vessel elasticity) increased. It's interesting to note that measures of glucose metabolism improved dramatically despite no change in carbohydrate intake. Some of these results were statistically significant, but not all of them. However, the authors note that:

In all these measured variables, either eight or all nine participants had identical directional responses when switched to paleolithic type diet, that is, near consistently improved status of circulatory, carbohydrate and lipid metabolism/physiology.

Translation: everyone improved. That's a very meaningful point, because even if the average improves, in many studies a certain percentage of people get worse. This study adds to the evidence that no matter what your gender or genetic background, a diet roughly consistent with our evolutionary past can bring major health benefits. Here's another way to say it: ditching certain modern foods can be immensely beneficial to health, even in people who already appear healthy. This is true regardless of whether or not one loses weight.

There's one last critical point I'll make about this study. In figure 2, the investigators graphed baseline insulin resistance vs. the change in insulin resistance during the course of the study for each participant. Participants who started with the most insulin resistance saw the largest improvements, while those with little insulin resistance to begin with changed less. There was a linear relationship between baseline IR and the change in IR, with a correlation of R=0.98, p less than 0.0001. In other words, to a highly significant degree, participants who needed the most improvement, saw the most improvement. Every participant with insulin resistance at the beginning of the study ended up with basically normal insulin sensitivity after 10 days. At the end of the study, all participants had a similar degree of insulin sensitivity. This is best illustrated by the standard deviation of the fasting insulin measurement, which decreased 9-fold over the course of the experiment.

Here's what this suggests: different people have different degrees of susceptibility to the damaging effects of the modern Western diet. This depends on genetic background, age, activity level and many other factors. When you remove damaging foods, peoples' metabolisms normalize, and most of the differences in health that were apparent under adverse conditions disappear. I believe our genetic differences apply more to how we react to adverse conditions than how we function optimally. The fundamental workings of our metabolisms are very similar, having been forged mostly in hunter-gatherer times. We're all the same species after all.

This study adds to the evidence that modern industrial food is behind our poor health, and that a return to time-honored foodways can have immense benefits for nearly anyone. A paleolithic-style diet is a very effective way to claim your genetic birthright to good health. Just remember to eat the organs and fat. And skip the canola oil and mayonnaise.

Paleolithic Diet Clinical Trials
Paleolithic Diet Clinical Trials Part II
One Last Thought

Cranial Development in Nepal, etc.

I saw a great movie on Saturday called "The Sari Soldiers". It's a documentary about the bloody three-way struggle between the Nepalese monarchy, Maoists, and political parties that ended with the dissolution of the monarchy in 2008. It's shot from the perspective of several very strong women affected by wartime atrocities.

I was getting on my friend's nerves during the movie because I couldn't stop commenting on the beautiful teeth, broad faces and great skin nearly everyone had. These were not actresses, they were regular people. They almost all had straight teeth and broad dental arches. I came to realize during the movie that people who have a great smile typically have a broad dental arch. There's something about seeing that wide, straight row of front teeth that attracts us. Here's a shot of one of the main characters (click for a larger view):

The Maoist army claimed to be 40% women. They were marching with heavy sacks and rifles all over the countryside, fighting the royal Nepalese army. That's no job for the feeble.

Of course, I had to look up Nepalese food as soon as I got home. It centers around rice, legumes and dairy, with a few spices, some vegetables and a modest amount of meat. Their primary fats are ghee (clarified butter) and yak butter. The national dish is called dal bhat, which means "lentils and rice". Here's one of the first recipes I found in a Google search:

Plain Rice (Bhat)
2 cups rice (Basmati or Long grain preferred)
4 cups (1 lt) water
1 tsp butter (optional)

Lentils (Dal)
1½ cups lentil (any kind)
4 to 5 cups of water (depends preference of your consistency of liquid)
½ tsp turmeric
1 tsp garlic, minced
6 tbsp clarified butter (ghee)
3/4 cup sliced onions
2 chillies (dried red chilies preferred) (depends on your preference)
Salt to taste

OPTIONAL
¼ tsp (pinch) asafetida
¼ tsp (pinch) jimbu
1 tbsp fresh ginger paste

Rice:

Wash rice and soak for 5 minutes.

Wash rice and soak for 5 minutes.

Boil the rice over medium heat for about 10 -15 minutes. Stir once thoroughly. Add butter to make rice give it taste as well as make it soft and fluffy.

Turn the heat to low and cook, covered, for 5 more minutes until done

Lentils:

Wash lentils and soak lentil for 10 minutes.

Remove anything that float on the surface after it and drain extra water.

Add drained lentils in fresh water and bring to a boil again. Add all spices.

Reduce the heat and simmer, covered, for 20 to 30 minutes until lentils are soft and the consistency is similar to that of porridge.

In a small pan heat the remaining of butter and fry the onions, chilies and garlic.

Stir into the lentils few minutes before you stop boiling. Serve with rice.

Did you catch the quantity of butter it calls for? 6 tablespoons of ghee and a tablespoon of butter! By my calculations, that's 784 calories worth of dairy fat for a 3,124 calorie dish, or about 25% butter by calories. I'd be willing to bet their butter is not the anemic industrial variety. With the amount of vitamin K2 MK-4 their diet is providing, it's no wonder their dental arches and teeth look so good. I'm sure not everyone can afford to eat that quantity of butter, but it's clearly a staple food in Nepal.

That recipe would typically be made with split lentils, which it's not critical to soak (although I still do). Recipes that called for whole lentils typically recommended a long soak before cooking.

Nearly everyone in the movie had great skin as well. Even the older people had nice skin. It was wrinkled, but firm and smooth between the wrinkles. Yet another feature of healthy cultures. Take a look at chief Sealth of the Suquamish and Duwamish tribes at 78 years old (photo taken in 1864). He's the city of Seattle's namesake. He lived most of his life as a hunter-gatherer in the Pacific northwestern United States:

OK, it's not the sharpest picture, but I think it's clear his skin is relatively smooth and firm for a 78-year-old. The object on his knee is the tribe's traditional reed hat.

I'll leave you with a quote from a book I'm currently reading, Paleopathology at the Origins of Agriculture:

Dental crowding should be indicative of nutritional or other chronic, severe stress since teeth will be less affected by chronic stress than alveolar bone size. Widdowson and McCance (1964) have demonstrated this effect in undernourished piglets and Trowell and co-workers (1954) have noted increasing crowding and impacted molars in severely malnourished children. Increased dental crowding may be indicative of severe and chronic stress in archaeological populations. However, we are unaware of the use of this potential indicator in any evaluation of health in prehistory.

So in archaeological sites, dental crowding is "indicative of nutritional or other chronic, severe stress", but in modern populations it's a fact of life? I think this is a testament to how resistant people are to coming to logical conclusions that challenge cultural norms.

The Fundamentals

I heard an interview of Michael Pollan yesterday on Talk of the Nation. He made some important points about nutrition that bear repeating. He's fond of saying "don't eat anything your grandmother wouldn't recognize as food". That doesn't mean your grandmother specifically, but anyone's grandmother, whether she was Japanese, American or African. The point is that commercial food processing has taken us away from the foods, and traditional food preparation methods, on which our bodies evolved to thrive. At this point, we don't know enough about health to design a healthy synthetic diet. Diet and health are too complex for reductionism at our current level of understanding. For that reason, any departure from natural foods and traditional food processing techniques is suspect.

Mainstream nutrition science has repeatedly contradicted itself and led us down the wrong path. This means that traditional cultures still have something to teach us about health. Hunter-gatherers and certain other non-industrial cultures are still the healthiest people on Earth, from the perspective of non-communicable disease. Pollan used the example of butter. First we thought it was healthy, then we were told it contains too much saturated fat and should be replaced with hydrogenated vegetable margarine. Now we learn that trans fats are unhealthy, so we're making new margarines that are low in trans fats, but are still industrially processed pseudo-foods. How long will it take to show these new fats are harmful? What will be the next industrial fat to replace them? This game can be played forever as the latest unproven processed food replaces the previous one, and it will never result in something as healthy as real butter.

The last point of Pollan's I'll mention is that the world contains (or contained) a diversity of different cultures, living in dramatically different ways, many of which do not suffer from degenerative disease. These range from carnivores like the Inuit, to plant-heavy agriculturalists like the Kitavans, to pastoralists like the Masai. The human body is adapted to a wide variety of foodways, but the one it doesn't seem to like is the modern Western diet.

Pollan's new book is In Defense of Food. I haven't read it, but I think it would be a good introduction to the health, ethical and environmental issues that surround food choices. He's a clear and accessible writer.

Merry Christmas, happy Hanukkah, and happy holidays to everyone!

Real Food X: Roasted Marrow Bones

Bone marrow is a food that has been prized throughout history-- from hunter-gatherer tribes to haute cuisine chefs. It's not hard to understand why, once you've tasted it. It's delicate, meaty and fatty. It's also rich in fat-soluble vitamins, including vitamins K1 and K2, although this will depend on what the animal has eaten.

Roasted marrow bones make a simple appetizer. Beef bones are the best because of their size. Select wide bones that are cut about three inches long. They should be from the femur or the humerus, called the "shank bones". These are sometimes available in the frozen meats section of a grocery store, otherwise a butcher can procure them. If you have access to a farmer's market that sells meats, vendors will typically have bones cut for you if you request it.

Recipe

1. Preheat oven to 450 F (230 C).
2. Place bones, cut side up, in a baking dish or oven-proof skillet.
3. Bake for about 15 minutes, until the marrow begins to separate from the bone, but not much longer because it will turn to mush.
4. Scoop out and eat the marrow by itself, on sourdough rye toast or however you please.
5. Make soup stock from the leftover bones.

Real Food IX: Idlis

Traditional cultures throughout the world went to great lengths to maximize the nutritional value of the ingredients they had. Fermentation is a technique that was widely used for preparing grains and legumes. Humans are not well adapted to grains or legumes, in large part due to their assortment of anti-nutrients (substances that prevent the absorption of nutrients) and other toxins. Fermentation is a very effective way to eliminate anti-nutrients, making grains and legumes more nutritious and easily digested.

Idlis are steamed, naturally leavened cakes made from a fermented mixture of ground rice and beans. They're mild, savory and fluffy, and pair well with nearly any dish. I think they fill in well for bread. Due to the combination of rice and beans, they contain a fair amount of high-quality complete protein. They are also very economical. Idlis have their roots in Southern Indian cuisine more than 1,000 years ago. They may have originated as a fermented bean dish, with rice added to the recipe later in history.

The recipe takes 2-3 days to complete, but actually doesn't require much work. First, the beans and rice are soaked separately, then they are ground and mixed, then they are allowed to ferment for 24-48 hours and steamed. This type of days-long soaking and fermentation process is common in many grain-based cultures worldwide.

The recipe traditionally calls for short-grain white rice and urad dal (split black gram). I've been using short-grain brown rice with good results. You will only be able to find urad dal in an Indian grocer, specialty store or online. If you can't find urad dal, try experimenting with other types of mild dry beans.

Ingredients and materials

• One cup urad dal or other dried bean
• Two cups short-grain brown or white rice
• One teaspoon fenugreek (optional)
• Two teaspoons non-iodized salt
• Filtered or otherwise dechlorinated water
  
• Muffin tray
• Large pot for steaming (optional)

Recipe

1. Soak urad dal and rice separately for 6 hours (longer if you're using a different type of bean). Add fenugreek to the rice before soaking (optional). It's used traditionally to speed fermentation.
2. Pour water off the urad dal and rice/fenugreek mixture. Don't rinse.
3. Grind the urad dal in a food process or or blender with a minimum amount of water until it's a smooth paste. The water must not be chlorinated or it will kill our bacteria! Brita-type water filters remove chlorine, as does boiling or leaving water uncovered overnight.
   
4. Grind the rice/fenugreek mixture coarsely with a minimum amount of dechlorinated water.
   
5. Mix the ground urad dal, ground rice and salt. The salt must be non-iodized, or the batter will not ferment! Pickling salt, kosher salt and unrefined sea salt work well. Add dechlorinated water until it's a thick paste, stirrable but not liquid.
6. Ferment for 24-48 hours. You know it's ready when the dough has risen significantly, and the odor has gone from harsh and beany to mild and savory. Fermentation time will depend on the ambient temperature.
   
7. Fill muffin trays about half-way with batter and steam until a knife inserted into them comes out clean, 15-20 minutes. You can also bake them at 350 F. It's not traditional, but I like them baked almost as much. If you really want to be traditional, you can buy an idli steamer.

Here are photos of my last batch. Soaking the urad dal and rice:


Batter, pre-fermentation:


Batter, post-fermentation (48 hours). It more than doubled in volume. The color didn't actually change, that's just my camera.


Ready to steam or bake.


After baking. One escaped! Into my belly.


Thanks to Soumya dey and Wikipedia for the top photo

Winterize Your Diet

As winter approaches, there are steps you can take to preserve your health and well-being. Here's a list of things I find useful:

-Eat in season. Root vegetables like beets, turnips, rutabagas and potatoes are in season and make a satisfying dish. Try baked beets with raw garlic, sage and butter. Winter squash are tasty, nutritious and colorful. They make excellent soups and mashes, and can be baked or steamed. My favorite varieties are butternut, kabochas, delicata and gold nugget. They pair well with sage or nutmeg. In some places, hardy greens such as kale and collards are available in winter. Many fruits such as apples, pears and citrus are in season during the winter (or stored from fall).

-Prepare soup stocks. There's nothing like a long-simmered bone broth to drive away the winter chill. They are also rich in minerals and gelatin, which aids digestion and soothes the digestive tract.

-Make sauerkraut or other fermented vegetables. Fermentation was once used as a means to preserve flavor and nutrition for the winter. Fermented vegetables are a powerful digestive aid. After the first frost, cabbage is at its sweetest. Sweet cabbage makes the best kraut.

-Keep your vitamin D level high. This may protect against the typical winter ills, including flu and seasonal depression. Unless you live in a warm climate and spend time outside in the winter regularly, it's wise to seek out vitamin D. High-vitamin cod liver oil, pasture-raised animal fats, shellfish and fatty fish are good sources. Some people may wish to supplement with vitamin D3.

Beef Tallow: a Good Source of Fat-Soluble Vitamins?

Suet is a traditional cooking fat in the US, which is a country that loves its cows. It's the fat inside a cow's intestinal cavity, and it can be rendered into tallow. Tallow is an extremely stable fat, due to its high degree of saturation (56%) and low level of polyunsaturated fatty acids (3%). This makes it ideal for deep frying. Until it was pressured to abandon suet in favor of hydrogenated vegetable oil around 1990, in part by the Center for Science in the Public Interest, McDonald's used tallow in its deep fryers. Now, tallow is mostly fed to birds and feedlot cows.

I decided to make pemmican recently, which is a mixture of pulverized jerky and tallow that was traditionally eaten by native Americans of many tribes. I bought pasture-raised suet at my farmer's market. It was remarkably cheap at $2/lb. No one wants it because it's so saturated. The first thing I noticed was a yellowish tinge, which I didn't expect.

I rendered it the same way I make lard. It turned into a clear, golden liquid with a beefy aroma. This got me thinking. The difference between deep yellow butter from grass-fed cows and lily-white butter from industrial grain-fed cows has to do with the carotene content. Carotene is also a marker of other nutrients in butter, such as vitamin K2 MK-4, which can vary 50-fold depending on what the cows are eating. So I thought I'd see if suet contains any K2.

And indeed it does. The NutritionData entry for suet says it contains 3.6 micrograms (4% DV) per 100g. 100g is about a quarter pound of suet, more than you would reasonably eat. Unless you were really hungry. But anyway, that's a small amount of K2 per serving. However, the anonymous cow in question is probably a grain-finished animal. You might expect a grass-fed cow to have much more K2 in its suet, as it does in its milkfat. According to Weston Price, butter fat varies 50-fold in its K2 content. If that were true for suet as well, grass-fed suet could conceivably contain up to 180 micrograms per 100g, making it a good source of K2.

Tallow from pasture-raised cows also contains a small amount of vitamin D, similar to lard. Combined with its low omega-6 content and its balanced n-6/n-3 ratio, that puts it near the top of my list of cooking fats.

We're Starting to Get It

I just read an interesting post on the Food is Love blog.

According to the USDA (admittedly not always the most reliable source of accurate information, but we’ll go with it for the moment), the number of farmers markets in the US has risen significantly in the last ten years, from 2,746 in 1998 to 4,685 in 2008. If we get another 580 markets, an increase possible in the next year or two if trends continue, we’ll have tripled the number of recorded markets since 1994.

Furthermore,

Plenty of farmers markets don’t get tallied in official lists, of course. Valereee, over at Cincinnati Locavore, points out that the USDA database only lists a quarter of the markets in her hometown. I see a few missing on the Seattle list as well.

People are slowly starting to get it. We're realizing that the processed food industry does not look out for our best interests. We're realizing that the frailty of modern children as well as our own health problems are due to the outsourcing of agriculture and food preparation. We're realizing that local farms and markets build strong communities.

We're realizing that a return to traditional, wholesome food is the only path to whole health and well-being.


Further reading:
My Real Food manifesto.

Hunting

Like 99.9% of the world's population, I am mostly dependent on agriculture for my food. It's fun to pretend sometimes though. I enjoy foraging for berries, mushrooms and nuts.

Last week, I went crabbing in the San Juan islands. We caught our limit of meaty dungeness crabs every day we put the pots out. If we had been working harder at it (and it was legal), we could easily have caught enough crabs to feed ourselves completely. We cooked them fresh and ate some the same day. We extracted the meat from the rest, and made an amazing crab bisque using a stock made from the shells, and lots of cream.

Here's a "hunting photo". No smiling allowed; I had to look tough...

Real Food VIII: Ghee

All this talk about butter is making me hungry. Richard mentioned in the comments that he bought some ghee recently and has been enjoying it, so I thought I'd post a recipe. Ghee is the Hindi word for clarified butter. It's butter that has had everything removed but the fat. Rich in fat-soluble vitamins and lacking the sometimes problematic lactose and casein, ghee has rightfully been considered a health food in India since ancient times.

Another advantage of ghee is its high smoke point, which is higher than butter because it doesn't contain any protein or sugars. Consequently, food sauteed in ghee has a clean, rich taste.

The recipe is simple but touchy. I recommend using the best butter you can get your hands on. 100% grass-fed, unsalted cultured butter is the best.

Ingredient and materials

• Butter (1 lb minimum)
• Wide-mouth glass jars
• Cheesecloth
• Rubber bands
  

Recipe

1. Place the butter in a saucepan and turn the heat to medium until it's melted.
   
2. Once it begins to boil, turn the heat down to low. It's very important to calibrate the heat correctly. Typically, you will want the burner on its lowest setting. The idea is to evaporate the water without burning the oil. It should boil, but slowly.
3. The melted butter starts out cloudy but gradually clears up as the water evaporates. At the same time, a crust will form on the surface of the ghee and the bottom of the pan. Keep the heat very low.
   
4. Push a portion of the top crust to the side with a spoon to see inside of the saucepan. When the butter looks clear and bubbles only rise from the bottom every few seconds, it's done. You have to be very careful because once the water has evaporated, the fat heats up quickly and burns the crust. This gives the ghee an acrid flavor and color. Make sure to handle the pot cautiously, because hot oil can give severe burns.
   
5. Allow the ghee to cool until it's warm but not hot. Place a piece of cheesecloth over the lid of your jar. Secure it with a rubber band. Pour the ghee through the cheesecloth, into the jar.
   
6. Store ghee in the refrigerator or at room temperature. It keeps much longer than butter.

The picture above is of my last batch of ghee.

Foraging

Debs and I went hunting for morels today in the Wenatchee forest. There was only one on the entire mountain, but we managed to find it:


We also found two "spring kings": spring-fruiting boletus edulis, also known as porcini or cepe. Firm and nutty, without a trace of bugs:


Raw is my favorite way to eat a good spring king. Here's an older one that was 6" across. Too old for me so I left it for the amateurs:

Real Food VII: Lentils

Lentils are a healthy food that comes with a few caveats. They have more protein and less carbohydrate than any other legume besides soybeans and peanuts. In fact, the ratio of protein to digestible carbohydrate is almost 1:1. The carbohydrate in lentils is slow-digesting, giving them a relatively low glycemic load. They also contain a remarkable array of vitamins and minerals, particularly B vitamins. One cup delivers 90% of your RDA of folate, so between lentils and liver there's no need for those sketchy prenatal vitamins.

Lentils must be properly prepared to be digestible and nutritious! I can't emphasize this enough. We did not evolve eating legumes, so we have to take certain steps to be able to digest them adequately. As with all beans and grains, proper soaking is essential to neutralize their naturally occurring toxins and anti-nutrients. Anti-nutrients are substances that interfere with the absorption of nutrients. Soaking activates enzymes in the seeds themselves that degrade these substances. It also cuts down substantially on cooking time and reduces flatulence.

Phytic acid is an anti-nutrient that's abundant in beans, grains and nuts. It can dramatically reduce the absorption of important minerals such as iron, calcium, magnesium and zinc, leading to deficiencies over time. It may be one of the main reasons human stature decreased after the adoption of agriculture, and it probably continues to contribute to short stature and health problems around the world.

Lentils and other seeds also contain trypsin inhibitors. Trypsin is one of the digestive system's main protein-digesting enzymes, and seeds probably inhibit it as a defense against predators. Another class of toxins are the lectins. Certain lectins are able to bind to and damage the digestive tract, and even pass into the circulation and possibly wreak havoc. This is a short list of a few of the toxins found in beans and grains. Fortunately, all of these toxins can be reduced or eliminated by proper soaking. I like to soak all legumes for a full 24 hours, adding warm water halfway through. This increases the activity of the toxin-degrading enzymes.

Here's a method for preparing lentils that I've found to be effective. You will actually save time by doing it this way rather than cooking them without soaking, because they cook so much more quickly:

1. 24 hours before cooking, place dry lentils in a large bowl and cover with 2" of water or more.
2. After 12 hours or so, drain and cover the lentils with very warm water (not hot tap water).
3. Drain and rinse before cooking.
4. To cook, simply cover the soaked lentils with fresh water and boil until tender. I like to add a 2-inch piece of the seaweed kombu to increase mineral content and digestibility.

many thanks to *clarity* for the CC photo

Olive Oil Buyer's Guide

Olive oil is one of the few good vegetable oils. It is about 10% omega-6 (n-6) fatty acids, compared to 50% for soybean oil, 52% for cottonseed oil and 54% for corn oil. Omega-6 fatty acids made up a smaller proportion of calories before modern times, due to their scarcity in animal fats. Beef suet is 2% n-6, butter is 3% and lard is 10%. Many people believe that excess n-6 fat is a contributing factor to chronic disease, due to its effect on inflammatory prostaglandins. I'm reserving my opinion on n-6 fats until I see more data, but I do think it's worth noting the association of increased vegetable oil consumption with declining health in the US.

Olive oil is also one of the few oils that require no harsh processing to extract. As a matter of fact, all you have to do is squeeze the olives and collect the oil. Other oils that can be extracted with minimal processing are red palm oil (9% n-6), hazelnut oil (10% n-6) and coconut oil (2% n-6). These are also the oils I consider to be healthy. Due to the mild processing these oils undergo, they retain their natural vitamin and antioxidant content.

You've eaten corn, so you know it's not an oily seed. Same with soybeans. So how to they get the oil out of them? They use a combination of heat and petroleum solvents. Then, they chemically bleach and deodorize the oil, and sometimes partially hydrogenate it to make it more shelf-stable. Hungry yet? This is true of all the common colorless oils, and anything labeled "vegetable oil".

Olive oil is great, but don't run out and buy it just yet! There are different grades, and it's important to know the difference between them. The highest grade is extra-virgin olive oil, and it's the only one I recommend. It's the only grade that's not heated or chemically refined in any way. Virgin olive oil, "light" olive oil (refers to the flavor, not calories), "pure" olive oil, or simply olive oil all involve different degrees of chemical extraction and/or processing. This applies primarily to Europe. Unfortunately, the US is not part of the International Olive Oil Council (IOOC), which regulates oil quality and labeling.

The olive oil market is plagued by corruption. Much of the oil exported from Italy is cut with cheaper oils such as colza. Most "Italian olive oil" is actually produced in North Africa and bottled in Italy, and may be of inferior quality. The USDA has refused to regulate the market so they get away with it. If you find a deal on olive oil that looks too good to be true, it probably is.

Only buy from reputable sources. Look for the IOOC seal, which guarantees purity, provenance and freshness. IOOC olive oil must contain less than 0.8% acidity. Acidity refers to the percentage of free fatty acids (as opposed to those bound in triglycerides), a measure of damage to the oil. Fortunately, the US has a private equivalent to the IOOC, the California Olive Oil Council (COOC). The COOC seal ensures provenance, purity and freshness just like the IOOC seal. It has outdone the IOOC in requiring less than 0.5% acidity. COOC-certified oils are more expensive, but you know exactly what you're getting.

Thanks to funadium for the CC photo

Real Food V: Sauerkraut

Sauerkraut is part of a tradition of fermented foods that reaches far into human prehistory. Fermentation is a means of preserving food while also increasing its nutritional value. It increases digestibility and provides us with beneficial bacteria, especially those that produce lactic acid. Raw sauerkraut is a potent digestive aid, probably the reason it's traditionally eaten with heavy food.

Sauerkraut is produced by a process called ‘anaerobic’ fermentation, meaning ‘without oxygen’. It’s very simple to achieve in practice. You simply submerge the cabbage in a brine of its own juices and allow the naturally present bacteria to break down the sugars it contains. The process of ‘lacto-fermentation’ converts the sugars to lactic acid, making it tart. The combination of salt, anaerobic conditions, and acidity makes it very difficult for anything to survive besides the beneficial bacteria, so contamination is rare. If it does become contaminated, your nose will tell you as soon as you taste it.

Store-bought sauerkraut is far inferior to homemade. It's soggy and sterile. Ask a German: unpasteurized kraut is light, crunchy and tart!

My method is inexpensive and requires no special equipment. I've tested it many times and have never been disappointed.

Materials

• Wide-mouth quart canning jars (cheap at your local grocery store)
• Beer bottles with the labels removed, or small jars that fit inside the canning jars
• Three tablespoons of sea salt (NOT iodized table salt-- it's fatal to our bacteria)
• Five pounds of green cabbage

Recipe

1. Chop cabbage thinly. Ideally the slices should be 2 mm or so wide, but it doesn’t matter very much. You can use a food processor, mandolin or knife.
2. Put all the cabbage together in a large bowl and add the salt. If the salt is not very dense (sometimes finely ground sea salt can be fluffy), you can add up to 5 tablespoons total. Mix it around with your hands. Taste some. It should be good and salty.
3. Let the salted cabbage sit in the bowl for 30 minutes or so. It should be starting to get juicy.
4. Pack the cabbage tightly into the canning jars. Leave 2-3 inches at the top of the jar. When you push on the cabbage in the jar, you should be able to get the brine to rise above the cabbage. Try to get rid of air bubbles.
5. Put water into the beer bottles and place them into the canning jars. The weight of the bottles will keep the cabbage under the brine. It’s okay that some of the brine is exposed to the air; the cabbage itself is protected.
6. Let it sit for 2 weeks at room temperature! As the fermentation proceeds, bubbles will form and this will raise the level of the brine. This is normal. You might get some scum on top of the liquid; just check for this and scrape it off every few days. It won’t affect the final product. If the brine drops to the level of the cabbage, add salt water (1 tsp/cup, non-chlorinated water) to bring it back up.
7. Taste it! It should be tart and slightly crunchy, with a fresh lactic acid flavor. If fully fermented, it will keep in the fridge for a long time.

Here are some photos from making sauerruben, which is like sauerkraut but made with turnips:

Real Food IV: Lard

Your great-grandmother would have told you that natural, homemade lard is an excellent cooking fat. It has a mild, savory flavor and a high smoke point. It's well suited for sauteing and frying foods, and it makes the flakiest savory crust. It's also cheap to buy and easy to render. Rendering lard is the process by which fat tissue is turned into pure fat. I buy the best quality lard available for $2/lb at my farmer's market, making it far cheaper than butter and olive oil of equivalent quality.

The best place to buy lard is at a local farmer's market. Look for pigs that have been "field-raised" or "pasture-raised", and are preferably organic. This ensures that they receive sunlight and have been treated humanely. The "organic" label by itself simply means they have been fed organic feed; the pigs will often not have had access to the outdoors. I recommend avoiding conventional (non-organic) pork at all costs, because it's profoundly inhumane and highly polluting. This is where I buy my lard.

If you don't have access to good quality local lard, there are a couple of sources on the Local Harvest website. Look for "leaf lard", which is the fat surrounding the kidneys. It's lowest in polyunsaturated oil and thus has the highest smoke point and the lowest omega-6 content. It's also practically pure fat. You will recover 90% of the pre-rendering volume from leaf lard. On to the recipe.


Ingredients and Equipment:

• Lard
• Cheesecloth
• Baking dish
• Jars
  

1. Preheat the oven to 225 F.

2. Cut off any pieces of meat clinging to the fat.

3. Cut fat into small (~1-inch) cubes.

4. Place them into a non-reactive baking dish and then into the oven.

5. Over the next 2-3 hours, periodically mash the fat with a potato ricer or the back of a large spoon. The fat will gradually separate from the residual protein as a clear liquid.

6. When you are satisfied that you've separated out most of the fat, remove the baking dish from the oven and allow it to stand until it's cool enough to be safe, but warm enough to be liquid.

7. Pour through a cheesecloth into jars. Save the "cracklins", these can be eaten.

8. If you plan on using the lard for crusts, cool it as quickly as possible by placing the jars in cold water. If the lard solidifies slowly, it will have a slightly grainy texture that works less well for crusts, but is irrelevant for other purposes.

Finished lard has a long shelf life but I like to keep it in the fridge or freezer to extend it even further.

The L-word

That's right, ladies and gentlemen: lard. The word alone makes lipophobes cringe like a vampire from garlic. It also makes epicures salivate. But why is lard so unhealthy? Let's take a look.

The fatty acid profile of lard might give us a clue. A major portion of lard is monounsaturated, 40% by weight. This is the same type of fat that predominates in olive oil (73%), and which is widely recommended by mainstream nutrition experts. Another prevalent class of fat in lard is saturated, at 48%. More than one third of this saturated fat is stearic acid, which even the most hardened lipophobe will agree has a "favorable" effect on blood lipids. Then there's the 8% polyunsaturated fat, which has been the darling of mainstream heart disease research for decades due to its ability to lower blood cholesterol (for the record, I believe the polyunsaturate content is lard's least healthy feature). The omega-3:6 ratio depends on how the pig was raised, but is typically skewed more toward omega-6.

So what does that leave us with? 66% fats that we're told are heart-healthy, and 30% non-stearic saturated fats that are supposed to be unhealthy. But if you still believe saturated fats cause heart disease, check out this post, this one and this one.

Lard also contains a small amount of vitamin D. The sun is the best source of vitamin D, since your skin synthesizes it when it's exposed to UVB. But due to the low angle of the sun in winter, and the fact that many people don't spend enough time outdoors even in the summer, extra vitamin D in the diet is helpful.

I think you can see that lard's bad reputation is undeserved. It may be a legacy of the time when hydrogenated vegetable oils were competing with animal fats for the food market.

There is such a thing as unhealthy lard, however. It's the stuff you might find at the grocery store. Store-bought lard is often hydrogenated to make it more shelf-stable. It also comes from confinement-raised pork operations, which aside from being profoundly inhumane, do not allow access to the outdoors. Thus, the fat won't contain vitamin D.

In the next post, I'll talk about how to buy pasture-raised lard and render it yourself.

Real Food III: Yogurt

Fermented milk is regarded by many cultures as a delicious health food. It has cropped up all over the world in different forms: kefir from Caucasia, laban from the Middle East, dahi from India, creme fraiche from Western Europe, piima from Finland, mursik from Kenya, and yogurt from your grandmother's house. But these same people would scarcely recognize the colored, sweetened gel that passes for yogurt in grocery stores today.

Most if not all dairy-eating cultures ferment their milk. Why is this? There are three main reasons. First of all, unpasteurized milk spontaneously ferments at room temperature, usually becoming delicious "clabbered milk"- whereas pasteurized milk becomes putrid under the same conditions. So fermented milk is difficult to avoid. The second, related reason, is that fermentation prolongs the life of milk in the absence of refrigeration. Fully fermented milk is stable for weeks at room temperature.

The third reason is that these cultures know cultured milk is delicious and nutritious. Fermentation with specially selected cultures of lactic acid-producing bacteria and sometimes yeast work to break milk down into a form that is more easily assimilated. They partly (or fully) digest the lactose, which can be a problem for some people, turning it into tangy lactic acid. They also partially digest casein, a protein in milk that is difficult for some to digest. And finally, the lower pH of fermented milk makes its minerals more bioavailable.

Traditionally, milk was fermented in its unpasteurized state, but raw milk is hard to find in many industrialized countries. Raw milk has its complement of enzymes intact, such as lactase and lipase, which aid in its digestion. It also contains lactose-digesting bacteria that make milk easier for some to digest, and contribute to intestinal health. These are all eliminated by pasteurization. Fortunately, fermentation restores some of the benefits of raw milk. It reintroduces lactic-acid bacteria, along with their digestive enzymes. With that in mind, here's a simple yogurt recipe:


Ingredients/equipment:

1/2 gallon whole, raw or pasteurized, cow or goat milk (add extra cream if you wish)
Starter culture (commercial starter or 2 tbsp of your favorite live-culture yogurt)
Thermometer
Glass jars with lids
Cooler or yogurt maker

Recipe:

1. Heat the milk to 110-115 F (43 C). If the temperature exceeds 115 F, let it cool.

2. Add the starter culture. If the starter is yogurt, whisk it into the milk.

3. Pour the milk into glass jars and keep it at about 110 F for 4-10 hours. 4 hours will yield a mild yogurt, 10 will be tangy. If you don't have a yogurt maker, this is the tricky part. You can use a cooler filled with 100 F water to maintain the temperature and spike it with hot water after a few hours, or you can ferment it in your oven with the pilot light on if the temperature is in the right range.


If you want a thicker yogurt, bring the milk to 180 F (82 C) and let it cool to 110 F before adding the starter. Add fruit, honey or other flavors before fermenting. Enjoy!

As a final note, I'll mention that milk simply does not agree with some people. If you've tried raw milk and homemade yogurt, and they cause intestinal discomfort or allergies, let them go.