'A CALORIE IS A CALORIE' IS AN AMBIGUOUS PHRASE. IN ONE SENSE IT IS TRIVIALLY TRUE, AS IN GERTRUDE STEIN'S FAMOUS PHRASE, 'A ROSE IS A ROSE IS A ROSE IS A ROSE'. In another sense it is obviously questionable, because it assumes no difference between the energy produced by burning food in a bomb calorimeter and that generated by metabolic processes. It also assumes that as far as effect on body weight is concerned, fat is bad because fat by itself is calorie-dense per unit of weight, and carbohydrate and protein are good because they are relatively low in calories. It further assumes that in terms of weight gained or lost, there is no difference between diets that include the same number of kilocalories say from rice, greens and fish, or from French fries, burgers and cola, or from Danish pastries, frappuccinos and gin slings.¹

Over the last decade, researchers have started looking more closely at assumptions going back more than a century regarding calories and the macronutrients carbohydrate, fat and protein. Most dieters are familiar with calorie counting and long lists of calorie tables for food portions. Indeed, the FDA mandates this information on Nutrition Facts panels and even some dietary supplements have begun to engage in this practice. One problem, as most dieters learn from bitter experience, is that over the long term calorie counting does not work. Other than in starvation mode, a condition under which all calories consumed regardless of their source are metabolized quickly to fill the deficit, the body treats calories from different sources differently and it treats calories according to the combinations in which they are consumed, the time of day, and so forth and so on. Food preparation, meal preparation, dietary patterns, etc., all count. In other words, it is not true that a calorie is a calorie is a calorie.

Eat Fat, Live Longer?
Let's start with an extreme, the effect of a ketogenic diet. In this diet, the preponderance of calories is derived from fats. A University of California, Davis study published early this year, found that a long-term ketogenic diet (89–90 percent of total calorie intake) in a mouse model significantly increased median lifespan and survival compared to controls. Moreover, in aged mice only those consuming a ketogenic diet preserved normal physiological functions (strength, coordination, prevention of age-related markers of inflammation). In short, the ketogenic diet, even though it did not alter the maximal span of life, extended both overall longevity and healthspan in mice.² How much? There was a 13 percent increase in median life span for the mice on a high-fat versus high-carb diet. In humans, that would be seven to 10 additional years with better health along the way.

Another research team, this time at the University of California, San Francisco and associated aging institutes, discovered that a cyclic ketogenic diet, meaning that it was alternated weekly with the control diet to prevent obesity, reduced midlife mortality without affecting maximum lifespan. The researchers observed that a non-ketogenic high-fat diet fed similarly may have an intermediate effect on mortality. A non-obesogenic ketogenic diet improved survival, memory, and healthspan in aging mice according to these finding.³

Note that there was no attempt in the foregoing studies to determine whether a change in the nature of the carbohydrates fed to the animals in a non-ketogenic high fat diet affects outcomes. However, even without a direct study, evidence abounds from indirect studies. Many carbohydrate sources are close to fiber in their influence on blood sugar levels and, in line with this, promote digestive health and gut probiotic diversity. In contrast, the modern American and common Western diets in general are ultra-processed diets. The healthfulness of ultra-processed foodstuffs is quite different from that of foods processed and prepared more traditionally, including, it turns out, from supposedly unhealthful foods.

Ultra-processed Foods
A few years ago, Harry Preuss, MD of Georgetown University and I wrote a chapter for a medical text on the metabolic syndrome. We began by observing.

Throughout the world, many elements comprising the Metabolic Syndrome (MS) such as diabetes, obesity, hypertension, and dyslipidemias are becoming alarmingly common. Although many etiological factors may be involved in this situation, one hypothesis is that a well recognized increased consumption of sugars and refined carbohydrates (CHO) such as sucrose and high fructose corn syrup (HFCS) plays a pivotal role in the increase of these unwanted entities.⁴

An Increasing Content of Empty Calories
Food refining, processing and meal preparation techniques favored in the United States and in much of the Western World, including especially fast and convenience foods, have led to dramatic changes in food quality. Definitions of ultra-processed foods provide clues as to why this should be the case. In one study of dietary intakes of 9,317 participants from 2009 to 2010, food items were classified into unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods.⁵

Ultra-processed foods are formulations manufactured using several ingredients and a series of processes (hence "ultra-processed"). Most of their ingredients are lower cost industrial sources of dietary energy and nutrients, and additives used for the purpose of imitating sensorial qualities of minimally processed foods or of culinary preparations of these foods, or to disguise undesirable sensory qualities of the final product. They are made to be hyper-palatable and attractive by the use of many additives, with long shelf life, and are able to be consumed anywhere, anytime. Ultra-processed foods include but are not limited to soft drinks, sweet or savory snacks, reconstituted meat products, and pre-prepared frozen dishes.

The average content of protein, fiber, vitamins A, C, D, and E, zinc, potassium, phosphorus, magnesium, and calcium in the US diet are decreased significantly in ultra-processed foods, whereas carbohydrate, added sugar, and saturated fat contents are increased. As the degree of ultra-processed food increases as the source of total calories, the overall dietary quality measured in terms of a nutrient-balance-pattern of fiber, potassium, magnesium and vitamin C goes down.

In another study, "ultra-processed foods were defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations, in particular additives used to imitate sensorial qualities of minimally processed foods and their culinary preparations." In the 2009–2010 National Health and Nutrition Examination Survey of the US diet, ultra-processed foods were found to constitute 57.9 percent of total energy. The content of added sugars in ultra-processed foods (21.1 percent of calories) was eight times that in processed foods (2.4 percent) and five times that in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7 percent). Consumption of added sugars increased linearly as ultra-processed food consumption increased. It went from 7.5 percent of total energy in those in the bottom one fifth of consumption of ultra-processed foods to 19.5 percent in the highest one fifth. A total of 82.1 percent of Americans in the highest quintile exceeded the recommended limit of 10 percent energy from added sugars compared with 26.4 percent in the lowest.⁶

Consequences of Differences in Food Quality
As populations shift from more traditional foods and food preparations, there can be serious consequences. These consequences include increases in obesity and cardiovascular disease. As an example of the first of these, a study of food consumption in nineteen European countries spanning 1991—2008 found a clear pattern. There was a median average household availability of 33.9 percent total purchased dietary energy for unprocessed or minimally processed foods, 20.3 percent for processed culinary ingredients, 19.6 percent for processed foods and 26.4 percent for ultra-processed foods. The average household availability of ultra-processed foods ranged from 10.2 percent in Portugal and 13.4 percent in Italy to 46.2 percent in Germany and 50.4 percent in the UK. As the percentage of total energy from ultra-processed foods increased, so did the rate of obesity. On average, for each percentage point increase in the household availability of ultra-processed foods there was an increase of 0.25 percentage points in obesity.⁷ Estimates suggest that merely cutting in half the amounts of processed and ultra-processed foods consumed as components of the overall diet in the UK could result in approximately 13 percent fewer deaths from cardiovascular diseases by 2030.⁸

Benefits of Traditional Foodstuffs
Ultra-processing is but one issue among several regarding the impact of modern farming, processing and preparation of foods. It does not take into account the benefits of returning to farming practices less dependent on chemical fertilizers, pesticides and fungicides or intensive energy use. It does not take into account the effects of removing genetically modified organisms from the food chain. It does not take into account returning to the use of varietals that produce more protein and minerals per acre and less starch, and so forth and so on.⁹ Nor does it take into account issues such as the negative consequences of the consumption of ultra-pasteurized and homogenized milk nor the move to A1 milk (the A1 protein is actually a histidine-rich mutated form of casein, and is commonly found in US dairy products).¹⁰

Going Organic and Non-GMO
Can such changes be embraced? Much evidence suggests that the answer is "yes" to all points. This includes lower use of pesticides, higher yields in nutrients and experimentally better results from consuming the resulting foodstuffs.^{11,12,13,14,15,16} A significant finding from a 30-year ongoing trial is that organic farming is not less efficient nor inferior in production for many or even most crops. After a 30-year side-by-side trial, a report by the Rodale Institute found:^17,18

• Organic yields match conventional yields.
• Organic outperforms conventional in years of drought.
• Organic farming systems build rather than deplete soil organic matter, making it a more sustainable system.
• Organic farming uses 45 percent less energy and is more efficient.
• Conventional systems produce 40 percent more greenhouse gases.
• Organic farming systems are more profitable than conventional.

Unexpected Benefits of Traditional Foods

In previous Total Health articles, it has been pointed out that a number of "exotic" foods, such as pomegranate, support health in unexpected ways, such as promoting changes in gastrointestinal bacteria. Now, it seems, that food items traditionally found in European cuisines may have similar benefits. For instance, the bacterium Propionibacterium freudenreichii, which is used in the fermentation of Emmentale—the proper name of Swiss cheese, because it came from the Emmental region of Switzerland—benefits health. The bacterium turns lactate into acetate, carbon dioxide and propionate. Acetate and propionate are known to benefit the immune system and propionate supports the health of the lining of the intestinal tract. Other lactic bacteria in Swiss cheese, Weisella koreensis and Weissella cibaria, extend the lifespan by protecting the body against stress and the invasion of pathogens and promoting an anti-inflammatory effect on the immune system.¹⁹ Other aged cheese, such as cheddar, blue, brie, Parmesan, Gouda, Gruyère and some forms of mozzarella, also provide longevity and related benefits in a number of models.

Another route by which gut bacteria improve health is the production of a compound known as indole. Indole is produced by many types of bacteria through breakdown of the amino acid tryptophan.²⁰ Indole and its chemical relatives can be found in plants, especially vegetables such as broccoli and kale. However, tryptophan also is found in eggs, cheese, tofu, salmon, turkey and some nuts and seeds. The key for transformation of the amino acid to indole is the gut bacteria, hence success involves more than merely adding this amino acid to the diet. Likewise, balance is the key: many meats supply tryptophan and thus are healthful in appropriate amounts, yet unbalance gut bacteria if consumed in excess.

Putting It Together
In August 2017, a major British cardiologist, Anseem Malhotra, who holds that cardiovascular disease is caused by inflammation rather than by fats,²¹ put out an interview entitled, "Choose The Pioppi Diet Over Statins To Beat Heart Disease."²² It provides an interesting discussion matching much of the information found above. Here are some of the key recommendations:

• Don't fear fat. Sugar and refined carbohydrates are the real enemies.
• Keep moving. Walk as much as possible.
• Extra virgin olive oil is medicine. Eat some every day. And nuts are important, too. Pioppians eat plenty of hazelnuts, walnuts, and almonds.
• Get seven hours of sleep a night. Adequate sleep is required for good health.
• Stop counting calories. What you eat is more important than how much you eat.
• Eat eggs. Many Pioppians eat 10 a week.
• Pile on the vegetables. Eat big helpings of fresh, organic vegetables in at least two meals a day.

Long time readers of TotalHealth will recognize that Dr. Malhotra's recommendations based on his study of Pioppi longevity look quite similar to the Okinawan dietary pattern in many respects. Along with an only moderate intake of carbohydrates (much less rice than is typical of the Japanese diet generally) and plenty of fish and eggs, the Okinawans consume bitter melon similarly to how the Pioppians consume extra virgin olive oil, which is to say, routinely or even daily. The evidence is that these types of dietary practices coupled with exercise and other healthful habits reduce most of the elements that we have come to associate—wrongly—with declining health in advancing years.²³

References:

1. Monteiro CA, Cannon G. Calories do not add up. Public Health Nutr. 2015 Mar;18(4):569 .70.
2. Roberts MN, Wallace MA, Tomilov AA, Zhou Z, Marcotte GR, Tran D, Perez G, Gutierrez-Casado E, Koike S, Knotts TA, Imai DM, Griffey SM, Kim K, Hagopian K, Haj FG, Baar K, Cortopassi GA, Ramsey JJ, Lopez-Dominguez JA. A Ketogenic Diet Extends Longevity and Healthspan in Adult Mice. Cell Metab. 2017 Sep 5;26(3):539 .46.e5.
3. Newman JC, Covarrubias AJ, Zhao M, Yu X, Gut P, Ng CP, Huang Y, Haldar S, Verdin E. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice. Cell Metab. 2017 Sep 5;26(3):547 .57.e8.
4. "Potential of Diet and Dietary Supplementation to Ameliorate the Chronic Clinical Perturbations of the Metabolic Syndrome,"h with H.G. Preuss in Nutritional and Integrative Strategies in Cardiovascular Medicine edited by Stephen T. Sinatra, Mark C. Houston. (CRC Press, 2015)
5. Martinez Steele E, Popkin BM, Swinburn B, Monteiro CA. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metr.2017 Feb 14;15(1):6.
6. Martinez Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open.2016 Mar 9;6(3):e009892.
7. Monteiro CA, Moubarac JC, Levy RB, Canella DS, Louzada MLDC, Cannon G. Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr.2017 Jul 17:1 .9.
8. Moreira PV, Baraldi LG, Moubarac JC, Monteiro CA, Newton A, Capewell S, OfFlaherty M. Comparing different policy scenarios to reduce the consumption of ultra-processed foods in UK: impact on cardiovascular disease mortality using a modelling approach. PLoS One. 2015 Feb 13;10(2):e0118353.
9. Mozaffarian D. Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review. Circulation. 2016 Jan 12;133(2):187.225.
10. http://blog.unikeyhealth.com/dos-and-donts-of-dairy-consumption/
11. Chang K. Study of Organic Crops Finds Fewer Pesticides and More Antioxidants. New York Times July 11, 2014.
12. Bara.ski M, Srednicka-Tober D, Volakakis N, Seal C, Sanderson R, Stewart GB, Benbrook C, Biavati B, Markellou E, Giotis C, Gromadzka-Ostrowska J, Rembialkowska E, Skwarlo-Sonta K, Tahvonen R, Janovska D, Niggli U, Nicot P, Leifert C. Higher antioxidant and lower cadmium concentrations and lower incidence of pesticide residues in organically grown crops: a systematic literature review and meta-analyses. Br J Nutr. 2014 Sep 14;112(5):794 .811.
13. Morin R. The Amish Farmers Reinventing Organic Agriculture. The Atlantic October 6, 2014.
14. Chhabra R, Kolli S, Bauer JH. Organically grown food provides health benefits to Drosophila melanogaster. PLoS One. 2013;8(1):e52988.
15. Šrednicka-Tober D, Bara.ski M, Seal C, Sanderson R, Benbrook C, Steinshamn H, Gromadzka-Ostrowska J, Rembialkowska E, Skwarlo-Sonta K, Eyre M, Cozzi G, Krogh Larsen M, Jordon T, Niggli U, Sakowski T, Calder PC, Burdge GC, Sotiraki S, Stefanakis A, Yolcu H, Stergiadis S, Chatzidimitriou E, Butler G, Stewart G, Leifert C. Composition differences between organic and conventional meat: a systematic literature review and meta-analysis. Br J Nutr. 2016 Mar 28;115(6):994 .1011.
16. Šrednicka-Tober D, Baranski M, Seal CJ, Sanderson R, Benbrook C, Steinshamn H, Gromadzka-Ostrowska J, Rembialkowska E, Skwarlo-Sonta K, Eyre M, Cozzi G, Larsen MK, Jordon T, Niggli U, Sakowski T, Calder PC, Burdge GC, Sotiraki S, Stefanakis A, Stergiadis S, Yolcu H, Chatzidimitriou E, Butler G, Stewart G, Leifert C. Higher PUFA and n-3 PUFA, conjugated linoleic acid, α-tocopherol and iron, but lower iodine and selenium concentrations in organic milk: a systematic literature review and meta- and redundancy analyses. Br J Nutr. 2016 Mar 28;115(6):1043.60.
17. 30 Year Old Trial Finds Organic Farming Outperforms Conventional Agriculture. Permaculture Magazine June 10, 2015 with a link to the full study at http://rodaleinstitute.org/assets/FSTbooklet.pdf
18. The Organic Watergate—White Paper—Cornucopia Institute. May 2012. https://www.cornucopia.org/USDA/OrganicWatergateWhitePaper.pdf
19. Swiss cheese found to contain powerful probiotic that promotes longevity. Natural News
20. Sonowal R, Swimm A, Sahoo A, Luo L, Matsunaga Y, Wu Z, Bhingarde JA, Ejzak EA, Ranawade A, Qadota H, Powell DN, Capaldo CT, Flacker JM, Jones RM, Benian GM, Kalman D. Indoles from commensal bacteria extend healthspan. Proc Natl Acad Sci USA. 2017 Sep 5;114(36):E7506 .E7515.
21. Malhotra A, Redberg RF, Meier P. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions. Br J Sports Med. 2017 Aug;51(15):1111 .2.
22. http://doctoraseem.com/choose-pioppi-diet-statins-beat-heart-disease/
23. Preuss HG, Mrvichin N, Clouatre D, Bagchi D, Preuss JM, Perricone NV, Swaroop A, Kaats GR. General Lack of Correlations between Age and Signs of the Metabolic Syndrome in Subjects with Non-diabetic Fasting Glucose Values. J Am Coll Nutr. 2017;6(7):556 .64.

Let's be honest. Fat is back big time!

Even Time magazine is in on the newly found love affair with fats. "Eat Butter," was prominently declared on the cover of the June 2014 issue with its larger than life delicious golden butter gracing the entire page! And it's about time. For over half a century, fat has been terribly maligned and misunderstood in the American diet landscape, and our health and expanding waistlines have suffered for it.

Big Fat Fears

The American public has been brainwashed with a big fat lie—a lie that has been told, retold and told again for well over 50 years. What's more, this lie has been extended to cover all fats, not just the hydrogenated, overly refined and genetically modified commercial vegetable oils that actually will harm you.

Truth be told, our fear of fats only began in the 1950s thanks to the work of research scientist Ancel Keys, PhD, who conducted the Seven Countries Study in which he cherry picked data to support his theory that fat consumption led to cardiovascular disease. Although considered "pioneering" back in the day, the study was deeply flawed. Yet, the media ran with it and by 1961 even the American Heart Association issued its first anti-fat guidelines. This resulted in the launching of the no-tolow fat diet dictum that—to this very day—many health experts still recommend and rely upon as gospel.

As I wrote in the first edition of Eat Fat, Lose Weight, since we as a nation have gone fat-free, we have gotten sicker. Here's what happened:

1. Sixty-five percent of the population is now obese.
2. Adult-onset diabetes has skyrocketed and more than tripled in the last 30 years.
3. The incidence of certain kinds of heart disease has increased.
4. Depression has become a widespread epidemic.
5. New health problems have appeared out of nowhere: mysterious low grade ailments such as chronic fatigue, widespread food and environmental sensitivities, leaky gut syndrome, yeast and mold infections, and autoimmune issues.

Thankfully, many other courageous researchers (spearheaded in part by my late friend and colleague, Dr. Robert Atkins) began rethinking the anti-fat dietary guidelines and provided ample evidence and science that the "right" high fat diet was actually healthy and that sugar was the underlying cause for most degenerative disease.

at Phobia

It's a message I have been preaching for a very long time. When Eat Fat, Lose Weight first came out 15 years ago, it was absolute heresy in the age of fat phobia. Before it became mainstream, I was the ONLY nutritionist in the country to write about the importance of the right dietary fats—a very unpopular message, which flew in the face of all conventional dietary wisdom of the 1980s.

The time has finally come to set the record straight with a newer, updated edition that is more streamlined for today's audience, thanks to the results from the latest trials, which have exonerated fats once and for all. These trials have shown that not only was a high fat diet more effective for weight loss, but also greatly reduced the risk of heart disease and diabetes.

Yes, the science now proves it. A high fat diet is a healthier diet.

I know that many of you have already banned trans fats and margarine.

You try to avoid refined polyunsaturated vegetable oils like corn and canola. However, before you start slathering on all that butter or coconut oil, and bringin' home the bacon, it is important to understand that eating all those good fats—what I call the "Smart Fats"—is simply one part of a healthy weight loss equation. You must also learn the keys to making Smart Fats work for you.

Wouldn't it be great if you could eat all the healthy fats you wanted, properly utilize them and look and feel fabulous in your body? You can!

Next month we'll begin our journey into Smart Fats that will keep you thin for life with beautiful glowing skin, healthy hair and nails, energy through the roof, a positive attitude and no more sugar cravings!

Two years ago in this space the topic was the entourage effect and how it differed from nutritional and medical findings involving synergy: "Whereas synergism involves components each of which is active on its own and which in combination yield effects greater than the sum of the individual contributions, the entourage effect may involve components most of which on their own may exhibit little or no benefit or may yield benefits that are otherwise unrelated."¹ In practice, of course, there is more than a little overlap and one finds this all the time with foods and supplements. A good example is the so-called French paradox, generally presented as the supposed paradox between the French consumption of comparatively large percentage of calories as fat, especially as animal fat, and the Gallic low rate of heart disease.

Is the French Paradox Explained by Nutrient Synergies?
Sardonic observers sometimes remark that Americans count calories with neat little categories for carbohydrates, fat and protein whereas the French are only concerned with how food tastes and how the meal looks, its "presentation." Assuming that the consumption of animal fat matters, a point increasingly in question, the French classically have not cared while enjoying enviable levels of health, hence, by Anglo- American lights, the paradox. The traditional French diet is >42 percent fat, much of it either saturated or monounsaturated. The French (traditionally, at least, maybe still) drink red wine daily, yet outlive Americans (81.6 years versus 78.8 years, as of 2015, other statistical bases giving similar results).² The French also suffer from fewer cases of coronary heart disease and, in actuality, remain ambulatory and self-sufficient much longer than do Americans, meaning that statistics of relative life expectancy should be balanced by a close look at morbidity statistics. According to the 2014 World Health Organization data set, the French rank second in the world, behind South Korea, for having the lowest mortality rates from coronary heart disease. America? We rank 44th.³ Significantly, in France they consume almost no sugary drinks and eat very little sugar in any form. These dietary practices should be contrasted with those in the States.⁴

A new report from the USDA says Americans are eating less fat than we did 30 years ago. Here's the opening from an online article about the report:⁵ On average, Americans are eating 10g less fat per day today than they were in the late 1970s, according to new research. In a report comparing food consumption patterns in 1977–78 versus 2005–2008, Biing-Hwan Lin and Joanne Guthrie from USDA's Economic Research Service found that on average, Americans consumed 75.2g of fat in 2005–08 compared with 85.6g in 1977–78. Meanwhile, the percentage of total calories derived from fat also declined substantially from 39.7% to 33.4% between 1977 and 2008, said the authors.

Of course, there is no paradox if the long-standing condemnation of the role of fat and saturated fats in cardiovascular disease is mistaken, as discussed in last month's column and previously in Heart Matters Do Statin Drugs. However, let's assume that there is a connection and that the paradox, as often suggested, is a result of the French love of red wine. Is wine's protection from a single magic phytonutrient, resveratrol, or is the combination of ingredients the key?

Many who argue that there is a paradox suggest that the phytochemical known as resveratrol is responsible for the low rates of cardiovascular disease. Critics argue that this is nonsense because there simply is not enough of the compound present to exert any effect. In fact, just this point was the focus of an exchange back in 2008 in which a colleague, Joseph Evans, and I were participants.⁶ Subsequent findings decisively have proven that Evans and I were correct and our interlocutor mistaken in both his evidence and his arguments.

The skeptic's argument went like this: "The potency of most of the nutritional supplements labeled as resveratrol is in the range of 30 mg to 100 mg. This is 30 to 100 times lower than doses thought to be in the range for therapeutic effects in humans." Our response was that red wine is a widely studied source of the combination of resveratrol and quercetin and that significant health benefits are associated with men it was demonstrated that "the platelet antiaggregatory effect of de-alcoholized red wines could be computed...from its concentrations of resveratrol and quercetin."⁷ Similarly, the combination of resveratrol and quercetin exerts a powerful synergy in the inhibition of inducible nitric oxide (the form linked to inflammation).⁸ In animals fed a high-cholesterol diet, the human equivalent of 210 mg resveratrol per day improved endothelial function.⁹ However, more was not better, with animal experiments demonstrating that, in human equivalent amounts, approximately 360 mg per day led to greater life expectancy than approximately 1,565 mg per day.¹⁰ Finally, there is experimental evidence that the combination of nutrients such as pterostilbene, quercetin, and resveratrol might be more active than any one of these alone at much higher dosages with research showing that subeffective doses of combinations of anti-inflammatory compounds can inhibit, for instance, carcinogenesis.¹¹

In contention was whether relatively modest amounts of resveratrol in combination yield significant health benefits for humans despite the amounts being ineffective on their own. A recent clinical study provides an instance of proof that is in line with other studies published since 2008.¹² In a randomized, placebo-controlled crossover clinical trial with 29 overweight and obese subjects, trans-resveratrol and hesperetin taken together were effective in altering a marker related to insulin resistance and improving metabolic and vascular health. (Hesperetin is a flavanone, a particular type of flavonoid.) Treatment was one capsule daily for eight weeks and a washout period of six weeks with 90 mg resveratrol and 120 mg hesperetin and placebo. Neither resveratrol nor hesperetin was efficacious by itself, whereas together they significantly decreased fasting and postprandial plasma glucose, increased the oral glucose insulin sensitivity index and improved arterial dilatation.¹³ In other words, combining these nutrients is pivotal in promoting their benefits.

Underappreciated Nutrient Combinations

Magnesium and Potassium
Not usually considered as an aspect of the French diet that separates it from American nutrient intake is the ingestion of minerals important for blood pressure and blood sugar regulation, such as magnesium and potassium. Americans notoriously do not consume green vegetables, primary dietary sources of both minerals. This is a shame because dietary potassium regulates vascular calcification and arterial stiffness, which is to say, two major factors determining cardiovascular health.¹⁴ There is much noise made about lowering sodium intake, but it is the ratio of sodium to potassium in the diet that determines blood pressure, not the simple amount of sodium.¹⁵

The combination of magnesium and potassium arguably is particularly efficacious for a number of reasons. For one, the development of insulin resistance impedes the proper uptake of potassium.¹⁶ Magnesium deficiency inclines subjects toward insulin resistance. There is considerable evidence that inadequate magnesium predisposes individuals to potassium deficiency and makes this deficiency difficult to treat with potassium alone. Magnesium, which is a natural calcium channel blocker, controls the flow of sodium and potassium across the cell membrane and therefore potentiates cellular replenishment of potassium.¹⁷ Significantly, Mildred Seelig, the great magnesium researcher, pioneered an approach in which the ingestion of a potassium and magnesium salt with fixed ratios of the two minerals and a certain minimum per day proved to be adequate to reverse and control moderate hypertension.^18,19

Improvement in bone health is another benefit that long-time readers of these TotalHealth articles may recall is associated with an adequate consumption of magnesium and potassium. In older individuals an increased intake of animal protein (but not plant) in conjunction with a significant intake of green vegetables, i.e., sources of magnesium and potassium, is associated with better bone health.

How About Food/Nutrient Combinations?
Some quite simple food combinations easily improve nutrient uptake. For instance, today there is much hype about the development of "golden rice" via genetic modification as a means of overcoming vitamin A deficiencies in poorer regions of the world. Not mentioned in this hype is that these areas are so poor that they have no fats or oils available with which to cook food and that the mere cooking of vegetables in oil largely resolves the vitamin A issue. In fact, the same approach is true for improved nutrient bioavailability in developed countries. In one trial, merely adding soybean oil in salad dressing improved carotenoid and fat-soluble vitamin bioavailability in salad vegetables.²⁰ Similarly, co-consuming cooked whole eggs is an effective way to enhance carotenoid absorption from other carotenoid-rich foods, such as a raw mixed-vegetable salad.²¹

A word of caution on oils: Recent research strongly suggests that olive oil and coconut oil are preferable to soybean oil. "Rich in unsaturated fats, especially linoleic acid, soybean oil is assumed to be healthy, and yet it induces obesity, diabetes, insulin resistance, and fatty liver in mice."^22,23 Moreover, in general the US diet exhibits an excessive and unhealthful ratio of omega-6 to omega-3 fatty acids.²⁴ Butter, by the way, after years of condemnation, appears to be neutral as a fat for most purposes. A recent systematic review and meta-analysis suggests relatively small or neutral overall associations of butter with mortality, CVD, and diabetes.^25,26 Any worries would appear to be easily overcome by simply eating more leafy green vegetables to increase daily magnesium intake!²⁷

HCA and a Largely Unknown Positive Combination
One of the more interesting compounds available in the American health food market, albeit of highly variable and often suspect quality, is (–)-hydroxycitric acid (HCA, always sold as a salt) (extracted from Garcinia cambogia, G. atroviridis, G. indica and other G. species).²⁸ Medically, HCA has been shown to exhibit potential additive effects of with, for instance, atorvastatin treated hyperlipidemic patients.²⁹ Almost never pointed out by the marketers of HCA is that the compound's mechanism of action is inhibited by diets that are very high in fats and/or alcohol just as the mechanism is not operational under fasting conditions. Just as an inadequate level of intake or the intake of poor quality salts leads to a failure to achieve benefits, so does intake under improper conditions.^30,31,32 One approach to preserving benefits even in the face of high fat and/or high alcohol intake is to ingest HCA along with the phytonutrient known as caffeic acid. Caffeic acid is found in quite small amounts in some, but not all green coffee bean extracts; it should not be confused with chlorgenic or caffeoquinic acids.^33,34 Effectively using HCA with a coffee extract to reduce the reverse effects of fat and alcohol is patented.³⁵

Two Bad Combinations Typical of the American Diet
Just as there are "good" nutrient combinations, such as examined above, there are "bad" nutrient combinations. Sugars and refined carbohydrates increase the absorption of fats from meals while reducing the oxidation of fats for energy. The evidence against coupling refined carbohydrates and fats is clear and unambiguous. Similarly, there is an unfortunate interplay between the consumption of sugars/ refined carbohydrates and table salt leading to impaired blood pressure regulation.³⁶

• Low glycemic index diets improve glycemic (blood sugar) response and variability as well as promote the metabolism of fat for energy; they may promote long-term health.^37,38
• Taken in a milkshake, fructose (30 g) increased postprandial lipemia by 37 percent compared with control; glucose (17.5 g) increased postprandial lipemia by 59 percent.³⁹ (Lipemia is the presence in the blood of an abnormally high concentration of emulsified fat, meaning primarily triglycerides, not cholesterol.)
• In Syndrome X/insulin resistant subjects (BMI of 30), glucose consumption (50 g) led to a 15.9 percent greater glycemic response and a 30.9 percent greater insulin response than did fructose (50 g). This is true in part because fructose is processed in the liver and then released later as glucose and/or converted into fat.
• On an energy balanced diet in these same subjects, fructose compared with glucose increased carbohydrate oxidation 31 percent, but decreased fat oxidation by 39 percent.⁴⁰
• Low-fat/high-carbohydrate diets in Syndrome X individuals reduce levels of HDL cholesterol and increase triacylglycerol concentrations.⁴¹
• Sucrose is glucose + fructose; lactose is glucose + galactose; grape sugar (dextrose) is glucose.

Conclusion
The benefits of foods and the nutrients that they supply, as also is true of supplements, is highly dependent on food and nutrient combinations. Many nutrients that clinically are inactive on their own, including even at large levels of intake, are beneficial when consumed with appropriate partners. Resveratrol, so often associated with red wine and the French paradox, is but one example of this phenomenon. Many other everyday combinations, such as magnesium and potassium, similarly exhibit positive dose relations. Contrarily, certain combinations are not good if habitually practiced. The combination of sugars/refined carbohydrates with fats, such as the far too widely consumed omega-6 fatty acids found in, for instance, soybean oil, is one example of a pairing that, if consumed regularly, tends to impair aspects of metabolism, including the oxidation of fats for energy. Likewise, consumption patterns that couple sugars with salt can lead to health consequences, such as blood pressure dysregulation, not typical of either nutrient consumed by itself.

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Radical Metabolism doesn't have to be time consuming or expensive—here's how you can save both time and money on the plan.

It's no secret that eating healthy and taking nutritional supplements is an excellent investment in your health and for your weight loss goals, but sometimes the budget or a busy schedule can get in the way of your best intentions. Over the past four decades, I've worked with thousands upon thousands of men and women looking to improve their health and slim their waistlines, and I've taken notes on the creative solutions they've come up with to fit my plans into their hectic lifestyles and tight budgets.

While at first glance, Radical Metabolism may look like it's full of expensive, exotic ingredients, I can assure you that I created this plan with options in mind just for people like you. I'd like to share with you my comprehensive Top 10 Tips to keep this plan within your budget and save on time.

1. Don't Skimp on Supplements
This may sound like a strange way to save money, but hear me out. Inexpensive supplements that seem to "fit the bill" for this plan are not always all they're cracked up to be, and not worth the investment in my opinion. Several retailers were investigated in 2015, and the worst was found to have only four percent of their products contain the DNA of the ingredients listed on the label (read more about this here). This is why I'm so careful about the manufacturers I recommend to you, and I believe their quality is worth the investment. If you follow the tips I'm giving you, I assure you it will free up some room in your budget to invest in a few high-quality supplements to enhance your success on this plan.

My must-haves for this plan include Weight Loss Formula, Bile Builder, and CLA-1000, all from UNI KEY Health.

2. Menu Plan
Ever heard the phrase "failing to plan is planning to fail?" It's especially true when it comes to your diet. It's important to plan out your meals and snacks and make your weekly grocery list from that plan. Plan at least a week at a time to really make your budget work for you. By sticking to your list and buying only what you need, you'll avoid the added expense of buying foods you won't use that eventually spoil in your refrigerator. Even though I've included a sample menu plan in my book for the three weeks of the Radical Reboot, you are welcome to create your own if it doesn't suit your tastes or your budget. Make sure you keep track of which recipes you and your family enjoy, so you have a list to pull ideas from later on when Radical Metabolism becomes a lifestyle for you.

3. KISS (Keep It Simple, Sister)
If you're like me, when a plan like this comes your way, you flip right to the lists of allowed foods to see what you're going to be eating. Radical Metabolism has a wide variety of foods, from everyday vegetables that are probably already in your refrigerator, to decadent treats you haven't even thought to buy for yourself. When you're on a budget or have limited time, it's important to keep your ingredients list short and simple.

The three foods I've seen questions about in my Radical Metabolism Facebook group, are watercress, daikon radish, and celeriac (celery root). If you have trouble sourcing any ingredients in the plan, substitutions can always be made, just choose from the list in the book and be sure you aren't using a more starchy carb or vegetable. For watercress, substitute arugula or rocket, or another bitter green. For daikon radish, substitute red or icicle radishes, or simply omit the radish altogether. My favorite substitute for celeriac is cauliflower, which is widely available and easy to find on sale.

When looking at the healthy fats, choose only a couple of budget-friendly options to start with. My recommendations for the best bang for your buck are hempseed oil, sunflower seeds, pumpkin seeds, chia seeds, bone broth, and ghee. Look at your menu plan and see which of these fabulous fats fit with what you plan to cook.

Radical proteins are another investment to consider. At first glance, they may all seem out of reach, but I assure you, this is not the case. Choose the most versatile proteins that can provide more than one meal. My choices would be grass-fed soup bones, grass-fed hamburger and whole pastured chickens.

When looking at fruits and vegetables, except for the juices, frozen alternatives can be considered for both cost savings and convenience. It's such a treat to put frozen pineapple in the blender for a sorbet-like dessert to get your serving of fruit in for the day. Or cover frozen berries in fresh cream and sprinkle with a little Flora-Key probiotic for a sweet, almost ice cream-like treat. Also look at which vegetables will give you more than one day's worth of servings. Cooking one butternut squash and freezing into the ½ cup portions you will need, yield at least a week's worth of starchy carbs you can use in many recipes.

4. Buy in Bulk
Even if it's only food for one person, you can still take advantage of bulk bargains. For instance, if your favorite grocery store has organic blueberries on sale, they will give you a discount if you buy by the case, and you can take them home, wash them, and freeze what you know you can't eat within the time they're fresh. The same goes for cases of pastured chicken breasts, grass-fed hamburger, and even nuts and seeds.

5. Don't Limit Yourself to the Grocery Store
There are nationwide coops, local buying clubs, farmers markets, and you can even go direct and get to know your local farmer to get deep discounts on excellent quality meats and produce. Timing is everything when it comes to farmers markets and local farmers. Hitting the market at the end of the day often means deep discounts so the farmer doesn't have to take their produce home. Farmers offer CSA memberships or if you go directly to the farm, they may have cuts of meat that don't sell well you can get for a steal, or you can exchange work on the farm for your monthly share of produce.

Azure Standard is an organic coop that has monthly drop sites around the country. You simply place your order online, choose your pickup site, show up at the appointed time, load your food, and go. Apples keep a long time when refrigerated properly and they often sell organic by the case for less than $1 per pound. Bountiful Baskets is a bi-weekly produce delivery with organic options, and there are many others that are similar. Local buying clubs take advantage of deep discounts on foods and nonirradiated spices offered by companies like Frontier Coop.

If you stick with the grocery store, it pays to shop around. Stores like Sprouts and Aldi are popping up all over the country and sell grass-fed beef, pastured poultry, and organic produce for much less than conventional grocery stores. And don't forget Costco. Their frozen organic vegetables and fruits are some of the best deals I've found.

6. Make It Yourself
Whenever possible, cook from scratch and make it yourself. Whole, natural foods prepared from scratch, full of love, are the healthiest thing you can do for yourself and your family. It not only saves money but tastes so much better than store-bought alternatives. It doesn't have to be time-consuming if you plan ahead.

Ghee is simply clarified butter, which can be made from regular butter in your oven. Buying dried beans in bulk and cooking in an Instant Pot breaks down lectins and is healthier and more budget-friendly than canned alternatives.

Save the peels from your vegetables in a bag in the freezer and add to the bones from your chicken and make your own bone broth. Freeze in individual serving sizes to save time later when life is too hectic for much meal prep. Throw frozen vegetables, pre-cooked meat, and frozen bone broth into a pot and heat, add Radical spices, and you have a quick and flavorful soup that cooks itself while you are busy doing other things.

7. Meal Prep Ahead of Time
On the weekend (or whenever your days off happen to be), prep and cook foods for the week. Make Radical Lemon Cubes, and wash and cut the fresh vegetables you need for the snacks and recipes you'll be using during the week. Store in labeled containers in the refrigerator in the portions needed for each recipe you're using that week. Cut vegetables like jicama, carrots, and celery make great crunchy snacks and store well in water in a wide mouth, quart size glass canning jar while saving space in the refrigerator.

8. Batch Cook to Save Time and Money
For a while, crockpot meals were all the rage. You do the meal prep all at once, freeze the meals in gallon-sized bags, then thaw one the night before, throw in the crockpot in the morning, and have dinner when you get home. While this is a great option for soups and stews, some vegetables don't freeze well and these meals often share the same texture, which can feel repetitive after a while. Batch cooking is another timesaving alternative that gives you a wide variety of options.

When you buy pastured chicken, it's usually whole, which is good for our purposes. Depending on how many mouths you have to feed, roast one or two (or even three) whole chickens in the oven, then pick the meat off the bones and put in individual serving sized containers. Use the bones to make bone broth for many of the Radical Metabolism main course recipes. One chicken can be used for three meals or more, even in a large family.

Brown several pounds of grass-fed hamburger at once and freeze in the portions you need to make taco salads and a variety of other recipes. Reheating the meat in a little water with dried spices on the stove will actually infuse the flavors you're looking for better than it would if you were adding them to raw meat.

9. Grow It Yourself
I know this sounds daunting, but it's much easier than you think. Microgreens, especially from sunflower seeds, are some of the most expensive greens served in fine dining establishments. You can grow them on a tray in a sunny window and harvest in less than a month for just a few dollars.

If you are feeling more adventurous, you can grow most vegetables and herbs in a pot or even in a bag of soil, or try your hand at gardening. A packet of seeds is less expensive than even one head of organically grown lettuce, and yields so much more, in a surprisingly short amount of time. There are a variety of gardening techniques that are simple and time-saving, and your county extension office has free information available and even a master gardener who will consult with you for free to get you started or help you problem solve.

There are also a lot of "weeds" that are edible and pack a big nutritional punch. Dandelions are a great example of this; the greens can be used in salads while the root can be roasted for a delicious tea. Make sure they haven't been sprayed with herbicides or insecticides before harvesting. It takes time to learn friend from foe, but learning to "eat your weeds" can be fun.

10. Enlist the Help of Friends
There's a new type of gathering emerging, and it's pretty—exciting meal prep parties. At these gatherings, participants either pay a fee to the organizer, or it's done potluck-style, where each member brings an ingredient or part of the list of ingredients, and everyone gets together and assembles the same meals for the week. If you have friends you want to introduce to Radical Metabolism, this is a great way to do it! You can start with a 4-Day Cleanse party, split the list of ingredients between friends and do all the juicing and make the soup together, then share your weight loss successes at the end.

For most of you, this isn't your first "diet rodeo." You've searched for years and tried a variety of plans, only to end the day still feeling fat and fatigued, struggling with an "over forty" sluggish metabolism. On top of that, it seems like your thyroid problem is progressively getting worse, not better. If this is you, then get ready for Radical Metabolism to breathe new life into that tired thyroid and recharge your stalled metabolism!

You can purchase Radical Metabolism at: www.radicalmetabolism.com