Rabbit holes: Low Inflammation diets

One of the advantages of coming from a large family is that we can compare notes with regard to health.

I have a GREAT family but most of us have been subject to various "inflammation" and auto-immune issues. That was impressed upon me once again as I spent about four hours in the car with three of my siblings on the trip to the cemetery.

I had heard about something called the "Low Inflammation diet". My sister had tried it and said it gave her partial relief.

Easy enough to look it up on the internet...which turned into a rabbit hole.

It is with great sadness that I must inform you that donut "holes" are not considered a "whole" food.

 On the face of it, a "Low-inflammation diet" seems as non-controversial as apple-pie and motherhood:

• Avoid all refined carbohydrates like sugar, low-fructose corn syrup, white flour and white rice. Use high-fiber alternatives*
  
• Avoid trans-fats and saturated fats. Substitute with poly-unsaturated Omega 3 oil (Linseed or Flaxseed oil being the only economical alternative)
  
• Avoid cured meats and red meats
  
• Eat "whole" foods
• Avoid drinking alcohol 

(Not to be snarky, but not eating fast-foods or in restaurants is a great first-step.)

The devil is in the details.

Nearly all the written-for-popular consumption articles quickly leap to glycemic-index as if that were written in the Ten Commandments. You know, exactly the same way a Progressive will buttress his arguments be randomly weaving in "Climate Change".

I decided I had better get smart about "Glycemic Index". And while G-I has the advantage of being simple, it is a very partial measure of what a given food will do to your glucose level after eating.

G-I is an estimate of what a given food will do to your blood-sugar level two-hours after eating it. It is calculated by taking ten, not-random test subjects and giving them 50ml shot-glasses filled with liquid glucose after a 12 hour fast and then measuring their blood-sugar level two hours later. Then several days later they are given the food being tested and their blood-sugar is again measured two hours later.**

Great care is exercised in choosing subjects that meet certain "representative of the population" criteria and they are given a long list of dos-and-don'ts, one of which is to not exercise the night before

Muscles

The 800 pound gorilla in the room that nobody is talking about is muscle mass.

The typical human liver has the ability to hold about 100 grams of a carbohydrate called glycogen. The usual metabolic model taught to students is that the liver is like the battery in a car. It absorbs carbs when they are abundant and feeds them back into the blood stream when the blood-sugar level flags.

The livers of all mammals store glycogen this way. That is one reason why liver (the food) tastes powdery when it is over-cooked.

The shortcoming of the liver-as-the-battery model is that a typical adult can store 500 grams of glycogen in his/her skeletal muscle mass. That is five times what your liver can store.

How much muscle mass?

This is primarily of academic interest because muscle mass is very, very difficult to measure.

The current research suggests that if you are a man and take your height in inches and square it, and them multiply by 0.0106 that that is a low-end estimate for your skeletal muscle-mass. Below that level you are eligible for a diagnosis of sarcopenia (has nothing to do with a deficiency of sarcasm, trust me). If you are a woman the cut-off is about 0.0078 times your height-in-inches squared.

So, as a man who stands about 5'-9" there is a very good chance that I have at least 51 pounds of skeletal muscle mass. A woman who stands about 5'-4" can be expected to have 32 pounds.

Unlike your liver, you can increase your skeletal muscle mass and increase your body's over-all ability to dampen out high blood-sugar excursions. Just as a point-of-reference, male powerlifters will often tell newbies to expect to add 10 pounds of muscle-mass in the first 4-to-8 months they take up the sport. 

That is not bad, a possible 20% increase in the ability to sponge-up excessive blood sugar and you will look better to boot. All in less time than it takes to get an advanced degree from a for-profit University. Comments from John, TB and the other "lifters" out there will be appreciated.

KEY POINT: That 20% increase in skeletal muscle mass is the full equivalent of what your liver can absorb. It is as if you grew a second liver from a blood-sugar standpoint.

As a point of reference, studies of elite athletes suggest that men have the ability to increase their skeletal muscle mass by a factor of 2.25 over the sarcopenia level (115 pounds of skeletal muscle mass vs 51 pounds) and women have the ability to increase it by a factor of 2.4 (77 pounds vs 32 pounds).

Unlike your liver, you can deplete your muscle's store of glycogen by exercising before tucking into the potato salad and watermelon at the church picnic. Then those muscle cells will be the quicker-picker-upper with regard to any blood-sugar spikes (Note: I am not talking about people who are diabetic, here).

Data from Rats but it gives you a picture of what blood-sugar does over time. The dotted line on top is pure glucose at a rate of 1 gram per kg of body weight.

Which brings up another point. The current research is currently focusing on Area-under-the Curve for blood-sugar levels. They measure blood-sugar at 15 minutes, 30 minutes, 60 minutes and then at two and three hours. The damage done to your cells by high blood-sugar is at least partially influenced by how long the cells were marinating in the high blood sugar.

Looking at the curve, some of the mysteries of G-I start to unravel. How can 150 grams of white-potato with 30 grams of starch (a carb) have a higher glycemic-index than 50 grams of glucose (pure sugar)? It is likely due to the different shapes of the "post prandial time-mmole/L curve. The glucose spikes much more quickly and the body has longer to pull it out of the blood-stream.

Where now?

Considering my genetic endowment, it is clear that I can probably fend off most inflammation-triggered health issues if I move every day. If I stop moving it will be very difficult to start moving again. It is as if I were a shark. Sharks die if they stop swimming forward.

Inflammation and auto-immune issues are not just quality-of-life issues. There is an inflammation component to "clotting" issues like pulmonary embolisms, ischemic strokes and myocardial infarctions. You can live with narrowed arteries for decades and not know it. The problem arises when clots form and grow, perhaps in response to chemical signals that the vessel wall is inflamed, and they break off and are carried downstream, only to lodge somewhere unhealthy.

*Low-Inflammation diets are very big on fiber. The reason they give is that "whole wheat bread has a lower GI than white bread because the fiber slows down the absorption of the sugar from the digestive track". When looked at from a GI Loading standpoint the rise in GI is identical when divided by the amount of digestible carbohydrates.

That is not to say fiber is bad, just that it does not work by the mechanism usually touted.

**It would be fascinating to see the raw data for the GI studies. Just how much variation is there from subject-to-subject? Presumably the subjects are fairly close together in age (like college kids) and sorted for "health" meaning the ones who are unfit are rejected. I think G-I numbers would be less respected if we actually knew how homogeneous the test subjects were and the range of values that were measured (including the high-and-low that some statisticians throw out when it makes the results inconvenient)