choosing the best water filterWater, water everywhere… and so many ways to mess with it!

You’ve got your bottled water, alkaline water, structured water, deuterium-depleted water. It turns out the water can be pretty darn complicated—and contentious. People have strong opinions about what makes the healthiest, most hydrating water. I’m glad to see folks care so much about what they put in their body, but it can be overwhelming.

Today I’m starting with the basics: filtering your water, why you might want to, and how to choose the best water filter for your household. Let me know in the comments if there are other water-related topics you’d like me to cover in the future.


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Why Should You Filter Your Water?

The most basic reason to get a filter is that you don’t enjoy the taste or odor of your tap water. You don’t have to live with whatever funky water comes out of the tap. An inexpensive filter can completely change how your water tastes and smells.

Second, of course, is if you believe your tap water is contaminated. In the U.S., all municipal water is tested annually. Testing doesn’t necessarily guarantee safe water, though. Municipal testing won’t catch all impurities, nor contamination that occurs within your own home (leaching from lead pipes, for example).

The Environmental Protection Agency is responsible for setting water safety standards. Currently the EPA has legal limits on more than 90 potential water contaminants.1 Some areas of the country log more violations than others. 2 3

In an interview last year, Environmental Protection Agency Administrator Andrew Wheeler bragged that 92 percent of Americans drink have access to drinking water that meets all EPA standards.4 What about those other 8 percent?

Good Enough Isn’t Good Enough

Even if you’re in that lucky 92 percent, a bigger point for some folks—and for many of my readers, I know—is that they aren’t content with “acceptable” levels of certain chemicals in their water.

“Safe” drinking water can still contain compounds that you don’t want to voluntarily put in your body. These include chemical contaminants like lead and arsenic, and microbes that can cause water-borne illness.

Many people are also concerned about the chemicals added to water in the name of public health. Your tap water almost certainly contains chlorine or chloramine—a chlorine-ammonia compound—which is added in order to sanitize drinking water.5 6 Don’t get me wrong, I’m not complaining. Chemical disinfectants are the reason so many of us now enjoy tap water that doesn’t make us acutely ill. I get why you’d want to remove them before drinking, though, especially folks who are sensitive to chlorine.

Another source of contention is the fluoride that some water districts add to drinking water, purportedly to increase dental health. This is a huge hornet nest I’m not going to step in today. Suffice it to say that lots of people don’t want to ingest fluoridated water.

FYI, the Environmental Working Group offers more stringent drinking water standards you can reference if EPA standards are laxer than you’d like.7

How to Choose a Water Filter: Test Before You Invest

Different water filters offer different benefits. Before handing over your money, do a little bit of research into the water coming out of your tap. This will help you decide which filter technology you need.

First, go online and search for “[my water district] water quality report,” or contact your water provider and ask for a copy of recent consumer confidence reports.8 This will tell you what type of disinfectant your water district adds, as well as if they are in violation of any EPA regulations. You might want to email your local water quality division to ask if they rotate disinfectants throughout the year. The CDC also keeps a database of which water systems add fluoride.9

If you have a private well or cistern, you already know (hopefully!) that the onus is on you to have your water tested annually by a state-certified lab. The CDC recommends testing for pH levels, total coliform bacteria, nitrates, total dissolved solids, as well as any known contaminants in your area.10 11 Your local health department can help determine what tests are advisable. If you collect rainwater, check out the CDC’s safety recommendations.12

Whether or not you have a well, it is wise to have your water tested if you are concerned about the pipes in your home, or if the taste or smell of your water noticeably changes. Make sure you use a certified lab.13

Once you have determined what, specifically, you want to remove from your water, you can select the proper filtration system.

The Differences Between Water Filtration Systems

As I said, all water filters are not created equal. Each technology has pros and cons. I’m going to cover the three most common.

Activated Carbon Filters

Activated carbon filters work by attracting and absorbing particles from water. There are two types of activated carbon filters: activated carbon blocks and granular activated carbon (GAC). They have similar pros and cons, but carbon blocks are generally more effective at removing impurities.

The most important thing to know about carbon filters is that they can vary considerably in terms of what they do and do not filter out of your water. When selecting a specific product, you must verify that it removes the specific contaminants you want.

Pros

  • Good for removing large particles like silt and for improving the taste and odor of water
  • Probably effective for removing chlorine and lead (check product claims)
  • Tend to be affordable
  • Don’t require power or heat
  • Does not filter out essential minerals

Cons

  • Does not filter viruses, minerals, or inorganic pollutants like arsenic and fluoride
  • Filters may need frequent replacing

Reverse Osmosis

Water is forced through a semi-permeable membrane, which traps contaminants. In home reverse osmosis units, water is generally passed through a carbon filter first to remove large particulate that could clog the membrane.

Pros

  • Generally considered the best all-around system for removing the greatest number/amount of contaminants
  • Can remove fluoride, arsenic, and other compounds that activated carbon cannot
  • Effective for certain pathogens14
  • Membranes do not require frequent replacement

Cons

  • Cannot remove chlorine, chloramine, or most volatile organic compounds
  • Removes most minerals from water
  • Water storage tanks can grow bacteria if not properly maintained
  • Produces a lot of wastewater
  • More expensive up front than carbon filtration systems

That looks like a lot of cons, but the superior filtration ability of reverse osmosis systems will outweigh all those cons for many people. Proponents of reverse osmosis will point out that you can collect wastewater, which is sanitary, and feed it into a graywater system or use it to wash your car. Most reverse osmosis systems simply drain it, though.

Distillers

Work by boiling water, then collecting and condensing the steam. When the water vaporizes, impurities are left behind. The condensed water is largely free from contaminants.

Pros

  • Effective at removing most impurities and killing bacteria and viruses
  • Does not require replacement filters

Cons

  • Cannot remove all pesticides or organic compounds
  • Very slow compared to other systems (One popular model I looked at took 5.5 hours to make 1 gallon of distilled water!)
  • Requires electricity (usually)
  • Removes essential minerals
  • Many people dislike the taste of distilled water

“Add-Ons”

Depending on your needs, you might include additional steps that aren’t filtration per se, but they do purify your water:

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With the last few weeks’ definitive guide and follow-up on fish, a reader asked me about trimethylamine N-oxide, or TMAO. What is it?

TMAO is the latest justification given for why eating meat just has to be bad for you. Saturated fat didn’t take. Animal protein didn’t work. Iron was a dud. IGF-1 hasn’t panned out. Methionine isn’t enough. So now they’re using TMAO to convince you not to eat that steak.

How’s it supposed to work?

How TMAO Happens

When certain gut bacteria encounter choline (found in eggs and liver) or carnitine (found in meat, especially red meat), some of it is converted to trimethylamine, or TMA. TMA is the compound that gives fish its “fishy odor.” Fish is actually extremely high in TMA, which I’ll discuss later on. Then, the liver converts a portion of the TMA to TMAO. Studies have shown that elevated serum levels of TMAO are linked to heart disease, type 2 diabetes, kidney disease, and even all-cause mortality. There’s definitely some heterogeneity among the studies, but enough have found a strong connection between TMAO and all manner of poor health conditions that researchers have focused on this compound.

Okay, so anything that contains choline or carnitine will increase TMAO, which should in theory increase your risk of heart disease. Right? Let’s go down the list.

Dietary TMAO Precursors and Their Effects On Health

Eggs. The best source of TMAO-precursor choline in our diet—eggs—should absolutely skyrocket TMAO levels. Except it doesn’t happen.

Three eggs a day has no effect on TMAO levels, even as it increases choline levels and HDL cholesterol.

Okay, so maybe the choline slipped past the TMA-producing gut bacteria in that study, but what about if you quickly switch people from eating oatmeal for breakfast to eating eggs. Surely bad things will happen, right?

No. Eating eggs instead of oatmeal has no effect on TMAO levels. It increases carotenoid and choline levels, though.

Liver. Okay, liver has to do the trick. It has high levels of both carnitine and choline. But no: feeding liver (among other foods) to men fails to increase TMAO levels above control.

Carnitine. Forget meat. What if you go straight to the offensive precursor itself and give actual human women a big daily dose of carnitine for, I don’t know, 24 weeks? Surely it will do something bad.

Nope. TMAO skyrockets, an indication that these ladies’ gut bacteria are converting carnitine to TMA and TMAO, but serum C-reactive protein, interleukin-6, L-selectin, P-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and lipid profile markers are completely unaffected. If gut bacterial conversion of carnitine to TMAO is the preeminent risk factor for heart disease, you’d think some of these ladies’ cardiovascular risk factors would have responded. They had half a year to respond. They did not.

Okay, but maybe there’s lag time between TMAO increases and deleterious changes to health. Nope. They followed those same ladies after cessation of carnitine supplementation. Their TMAO levels dropped, but their health markers stayed the same. No change.

And here’s a study where they used carnitine to increase TMAO levels in patients on dialysis. Not only did nothing bad happen, but the carnitine even reduced markers of vascular injuries. Higher TMAO, better health.

Seafood. As I mentioned earlier, fish and shellfish come pre-contaminated with the TMAO precursor TMA. It’s what gives the characteristic fishy odor, and it definitely gets converted to TMAO. In fact, a human study from a few years ago found that feeding people fish spiked TMAO levels by 60 times. A more recent study even concluded that elevated TMAO levels are a reliable marker for cod intake. The more fish you eat, the more TMAO your body will process.

If you’re going to claim that TMAO is dangerous and causes heart disease, you’ll have to make the case that fish is dangerous and causes heart disease. All the evidence we have points in the opposite direction—that fish and shellfish are protective against heart disease.

So, Why Is TMAO Linked To Poor Health Then?

How do we explain the connection between increased TMAO and poor heart health?

Here it is linked to atrial fibrillation.

Here it is linked to stroke.

Here it is predicting heart events.

The connection is there. And in animal models, TMAO even appears to mechanistically increase atherosclerosis. The mice they dosed with TMAO to increase atherosclerosis were genetically engineered to be ApoE knockouts, a strain of lab mouse that gets heart disease from almost everything, but still.

The connection isn’t causal. It’s an observation. There are no controlled studies giving people foods (or even supplements) that raise TMAO and increase disease or death. There aren’t even prospective observational studies where they track a group’s food intake, TMAO levels, and death/disease over time.

You know what I think (and have always thought)?

High TMAO can be a marker for metabolic disease. It could indicate inhibited kidney function, as the kidneys are response for disposing of excess TMAO. It could indicate poor health in general.

The latest evidence is confirming what I’ve long suspected: the reason high TMAO levels are linked to cardiovascular disease and overall mortality is that both type 2 diabetes and chronic kidney disease cause elevated TMAO levels. The causality is reversed.

What’s one of the kidney’s primary jobs? Excreting waste materials and toxins. What’s going to happen if the kidney begins to fail or lose its functioning? The stuff that used to be excreted starts backing up. TMAO is supposed to be excreted in the urine via the kidneys. If the kidneys aren’t working, TMAO levels skyrocket.

But even then, high TMAO isn’t even necessarily a bad thing. Check out that study I linked to earlier where women were given carnitine every day. Their TMAO levels skyrocketed but nothing bad happened. No health markers worsened. In one study, they even improved.

The Takeaways…

That’s the thing with biology. There are dozens of reasons TMAO could be elevated, some of them bad, some of them harmless, some of them good.

There simply exists no credible evidence that increased TMAO because you’re eating fish, or eggs, or liver, or meat, does anything untoward to your health. I’m not ruling it out. But the evidence just isn’t there. There’s far more evidence that eating fish, eggs, liver, and meat improve your health.

That’s it for today, folks. If you have any further questions about TMAO, leave them down below. Until then, enjoy your choline and carnitine!

Thanks for reading.

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References: 

Schiattarella GG, Sannino A, Toscano E, et al. Gut microbe-generated metabolite trimethylamine-N-oxide as cardiovascular risk biomarker: a systematic review and dose-response meta-analysis. Eur Heart J. 2017;38(39):2948-2956.

Dimarco DM, Missimer A, Murillo AG, et al. Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population. Lipids. 2017;52(3):255-263.

Missimer A, Fernandez ML, Dimarco DM, et al. Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations. J Am Coll Nutr. 2018;37(2):140-148.

Zhang AQ, Mitchell SC, Smith RL. Dietary precursors of trimethylamine in man: a pilot study. Food Chem Toxicol. 1999;37(5):515-20.

Samulak JJ, Sawicka AK, Hartmane D, et al. L-Carnitine Supplementation Increases Trimethylamine-N-Oxide but not Markers of Atherosclerosis in Healthy Aged Women. Ann Nutr Metab. 2019;74(1):11-17.

Samulak JJ, Sawicka AK, Samborowska E, Olek RA. Plasma Trimethylamine-N-oxide following Cessation of L-carnitine Supplementation in Healthy Aged Women. Nutrients. 2019;11(6)

Fukami K, Yamagishi S, Sakai K, et al. Oral L-carnitine supplementation increases trimethylamine-N-oxide but reduces markers of vascular injury in hemodialysis patients. J Cardiovasc Pharmacol. 2015;65(3):289-95.

Svingen GFT, Zuo H, Ueland PM, et al. Increased plasma trimethylamine-N-oxide is associated with incident atrial fibrillation. Int J Cardiol. 2018;267:100-106.

Liang Z, Dong Z, Guo M, et al. Trimethylamine N-oxide as a risk marker for ischemic stroke in patients with atrial fibrillation. J Biochem Mol Toxicol. 2019;33(2):e22246.

Haghikia A, Li XS, Liman TG, et al. Gut Microbiota-Dependent Trimethylamine N-Oxide Predicts Risk of Cardiovascular Events in Patients With Stroke and Is Related to Proinflammatory Monocytes. Arterioscler Thromb Vasc Biol. 2018;38(9):2225-2235.

Jia J, Dou P, Gao M, et al. Assessment of Causal Direction Between Gut Microbiota-Dependent Metabolites and Cardiometabolic Health: A Bidirectional Mendelian Randomization Analysis. Diabetes. 2019;68(9):1747-1755.

The post What’s TMAO, and What Does It Have to Do With My Health? appeared first on Mark’s Daily Apple.

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In nutrition, there are very few universal consensuses. Conventional wisdom says that fat makes you fat and whole grains are essential, and millions of people agree, but the ancestral health and keto communities (and reality) disagree. Primal and keto folks don’t worry much about saturated fat and limit polyunsaturated fat; conventional health advocates do the opposite. The opinion on meat intake varies wildly, with some people suggesting we eat nothing but red meat, others recommending “palm-sized” pieces of strictly white meat, and still others cautioning against any meat at all. Pick a food and you can find a sizable group that hates it and a sizable one that loves it. You can find researchers who spend their lives making the case against it and researchers who spend their lives making the case for it.

But not fish. Fish is about as close to a universal as any food. Barring the vegans and vegetarians (some of whom, however, are sneaking wild salmon when their followers aren’t watching), everyone appreciates and extols the virtues of eating seafood. Including me.

Sea Food = Sea Change: The Evolutionary Story

Remember: I always view things through an evolutionary prism. It’s where I begin. If something doesn’t make sense in the light of evolution, it probably doesn’t make sense at all. And seafood has been one of the most important dietary factors in human brain development. Without the selenium, iodine, zinc, iron, copper, and DHA found abundantly in fish and shellfish, human brain encephalization—the massive increase in relative size and complexity of the brain representing a shift toward higher order thought—wouldn’t have been easy to pull off. Maybe impossible.

If the human brain came to rely on the nutrients found in seafood for its evolution, it stands to reason that they remain important. The studies bear this out. Fish offers unique and important benefits to humans living today.

Not to mention the imbalanced, inflammatory omega-3:omega-6 ratios most of us have, or had. Even if you’ve been Primal for ten years, you spent a good portion of your life eating the standard Western diet full of industrial seed oils high in omega-6 fatty acids. Omega-3s from seafood help correct that balance.

The Modern Picture: Calm the Alarm

But there’s a problem, isn’t there? If you listen to the alarmists, our seas are overfished and full of toxins, and the fish that remain are dripping with mercury, cadmium, and other heavy metals. Farmed fish are even worse, some say; they swim in tepid baths of antibiotics, soybean oil, and glyphosate. Besides, oceanic acidification is killing all the delicious fish and shellfish and crustaceans. Pretty soon the only thing served at Red Lobster will be fried jellyfish.

Though there are glimmers of truth to all those claims, they’re certainly exaggerated:

  • There are still plenty of excellent and sustainable seafood choices to make, according to Seafood Watch, which takes environmental impacts, overfishing, and other ecological and safety concerns into account.
  • While some species are indeed overburdened with heavy metal contamination, plenty aren’t. Eat salmon, sardines, mackerel, younger, smaller tuna. Besides, most seafood—in one study, this included shrimp, crabs, squid, and tropical fish in the Atlantic Ocean—is high enough in selenium that it binds to and prevents absorption of mercury.
  • Jellies may be taking over, or they may be following the natural 20-year boom and bust cycle observed throughout history.
  • Even farmed salmon isn’t as bad as we might assume. And farmed mollusks—oysters, clams, mussels—are as good as wild, since they live no differently from their wild cousins.

Even if all those claims were totally on the level, we’re faced with a grand overarching truth: You have to eat something. What, are you gonna eat vegan meat patties instead of cod, salmon, sardines, and oysters? Drink Soylent? Go vegan? Go Breatharian?

Of course not. You need to eat seafood. You know you should.

But isn’t it too expensive?

For one thing, I already mentioned that safe farmed fish exists. Farmed salmon probably isn’t as bad as we’ve been led to believe (or assume), as long as you watch out for the egregious ones. U.S.-farmed trout, barramundi, and catfish show up with very low toxin levels and good nutrient profiles. And farmed bivalves like oysters, clams, and mussels are raised like they’re wild. There’s basically no difference between a farmed oyster and a wild oyster. They both live out in the ocean attached to rocks, munching on what the sea provides.

Two, wild seafood isn’t always expensive.

Restaurant supply shops, Walmart, and other large stores often have frozen wild salmon, cod, and other wild fish for cheap, about $5-6 per pound.

At Costco, you can get wild caught salmon (at least on the West coast) in season for $5-6 pound. You might have to buy it whole, though (recipe down below). They also have other types of wild fish for good prices.

Canned seafood is a viable option.

Fish and Seafood: How To Optimize the Benefits

Why We Need Seafood

First, evolutionary precedent, which I already discussed. It’s folly to ignore the long history of humans eating seafood. It’s higher folly to ignore the importance of seafood in human brain evolution. Wherever they have access, people eat seafood.

Second, the benefits are well-established. Even if the links to better health are purely correlational (and they’re not, since we have controlled trials listed above), seafood looks great on paper: bioavailable protein, high levels of essential nutrients, the best source of long chained omega-3 fatty acids.

Third, seafood is a reliable source of important micronutrients that may be lacking on a terrestrial Primal, keto, or carnivore diet. Selenium, magnesium, folate, astaxanthin, and vitamin E can be tough to get if you’re just eating steaks and ground beef.

A recent study on the ketogenic Mediterranean diet had great results feeding its participants over two pounds of fish per day. Two. Pounds. Mostly salmon, sardines, and mackerel, which are fatty omega-3 rich fish very low in contaminants.

But what about those who say they’re meat eaters, turf people who claim grass-fed beef and pastured pork is enough for them? Fish is meat. Fish are animals. You’re seriously limiting your options—and selling your ancestors short—by willfully avoiding seafood. And you’re probably missing out on some important nutrients. Like iodine, for example, which doesn’t show up in the standard nutritional databases but is incredibly important for brain and thyroid health and almost certainly appears most abundantly in seafood.

What Exactly Should I Eat?

Okay,  so should I just throw in some salmon and be on my way?

Salmon is a great start, but there’s way more fish (and bivalves, crustaceans, and cephalopods) in the sea.

Can’t I just take fish oil? As a fish oil purveyor, I wish I could say that fish oil is enough. It offers incredible benefits not to be dismissed, but it’s not equivalent to food either. The fact is, I do both. Seafood contains a ton more than just the omega-3s. Just check it out….

  • Salmon: Vitamin D3, B-vitamins, magnesium, iron, selenium.
  • Cod: B-vitamins, magnesium, selenium, potassium
  • Halibut: B-vitamins, vitamin D3, magnesium, selenium, potassium
  • Sardines (canned): B-vitamins, vitamin D3, selenium, calcium (if bone-in), iron, copper
  • Scallops: Vitamin B12, magnesium, folate, selenium, zinc.
  • Oysters: B-vitamins, magnesium, selenium, zinc, copper, iron, omega-3s, manganese
  • Mussels: B-vitamins, selenium, zinc, manganese, folate, omega-3s
  • Clams: Vitamin B12, iron, magnesium, vitamin A
  • Shrimp: B-vitamins, magnesium, selenium, zinc, astaxanthin (a potent carotenoid, great for ocular and mental health)
  • Crab: B-vitamins, vitamin E, magnesium, folate, selenium, zinc, copper
  • Lobster: B-vitamins, vitamin E, selenium
  • Squid: B-vitamins, magnesium, iron, copper, zinc, selenium, vitamin E
  • Octopus: B-vitamins, magnesium, iron, copper, zinc, selenium

Although I didn’t mention it, every single sea creature you can eat is a very good source of highly bioavailable protein and, usually, creatine.

And some studies even suggest that fish proteins themselves offer unique benefits.

Most of the research is in animals, but it’s compelling and another good—if speculative—reason to include fish in your diet.

I’m Sold. How Much Should I Eat?

Keeping in mind the contamination in certain varieties, eat much as you can afford/tolerate. It’s hard to eat too much seafood. In my experience, there seems to be a built-in regulatory mechanism that reduces the palatability of seafood at a certain level of consumption. A big slab of wild sockeye salmon is fantastic, but I can’t eat pounds of it like I can with a grass-fed ribeye.

You can also use omega-3:omega-6 ratio as an indicator. Run the numbers on the seafood you’re eating and aim for a 1:1 or 1:2 ratio and you should be golden.

In my opinion, leaner fish has no upper limit. Eat as you desire.

Keep in mind that the keto Mediterranean diet study I recently discussed gave over 2 pounds of fish to participants every day, and they had great results. Two. Pounds. Mostly salmon, sardines, and mackerel, which are fatty omega-3 rich fish very low in contaminants. After 12 weeks of that:

  • They lost 30+ pounds.
  • Their BMIs dropped from almost 37 to 31.5, from the middle of class 2 obesity to the bottom of class 1 obesity.
  • They lost 16 centimeters, or 6 inches, from their waist.
  • Fasting blood sugar dropped from 118 (pre-diabetic) to 91 (ideal).
  • Triglycerides dropped from 224 to 109.
  • HDL increased from 44 to 58.
  • They went from prehypertensive to normotensive.
  • Their liver enzymes and liver fat reduced and in some cases completely resolved.
  • All 22 subjects started the study with metabolic syndrome and ended it without metabolic syndrome.

As always, pay attention to how you feel. Eat and observe. Make it an official N=1 experiment and look for the feedback it provides.

How I Do Seafood

Okay, but how do you eat it? How do you prepare it?

Admittedly, there’s a lot less room for error with seafood.  It goes bad more quickly, cooks faster, and simply isn’t as forgiving. We’ve all had the experience of buying some salmon fresh from the butcher, keeping it in your fridge a half day too long because we weren’t sure how to prepare it, and having to throw it out. That’s the worst.

I’m not a big “recipe” guy (I have people who help me parse out my creations into legible formats for blog posts and cookbooks). I like to improvise. A dish here, a dash there. So, I’m just going to give a freeform account of how I eat fish, shellfish, and other seafood. If you need clarification on something, feel free to ask in the comment board.

I like doing a kind of pseudo-ceviche using any high quality lean fish—halibut’s great—marinated in Primal Kitchen® Greek Dressing & Marinade with a few splashes of tamari or soy sauce and some diced fresno chile. Let it sit for 5-10 minutes, then plow into it. Really good, even though if you tried to serve this in Peru they’d probably arrest you.

I always have canned sardines from Wild Planet in my pantry. A favorite quick (and keto-friendly) meal is to do a can or two of sardines mashed up with an avocado and a tablespoon or two of Greek Goddess dressing.

If I’m doing salmon, I’ll sometimes marinate the fish in the Primal Kitchen No-Soy Teriyaki.

Another great way to cook fish is in a curry. Sear the fish, making sure to get crispy skin if it’s on. Set aside. In the same pan without washing or draining, heat up some garlic, ginger, chili peppers (if you like it hot), and onions (or shallots), adding more fat if you need it. Salt. When they’ve softened, add the curry powder or paste. Cook for a minute or so. Then add some bone broth and coconut milk. Reduce until you’ve reached the texture you desire. I’ll keep gelatin powder on hand to whisk in if it doesn’t have enough body. At the last moment, add the fish back in and toss to coat.

Scallops? Either raw at a good sushi joint, preferably separated by thinly sliced lemon, or seared in butter followed by a pan reduction with white wine and butter. By the way, for those who are interested, Butcher Box has some killer scallops now (it’s literally the last day to grab the deal—apologies to anyone reading this tomorrow.) And full disclosure—I’ve always been a proud affiliate. They do things right there.

Clam chowder is still the best way to eat clams, roasted on an open fire on the beach with a little sand still in there. Maybe it’s just the New England in me.

Anytime I’m out at a decent restaurant I trust with oysters on the menu, I order them. At least a half dozen, raw. I also like the canned smoked oysters from Crown Prince.

Mussels I like the classic way: cooked in butter, white wine, and garlic. Only modification I make is after the mussels have cooked, I remove them from the pan, sprinkle in some gelatin powder, and reduce down to make a viscous sauce.

Cod or other similar lean white fishes are best in lots of butter and garlic, followed by a squeeze of lemon.

Whole salmon? Clean, gut, and scale. If you can, keep the liver. It’s delicious. Salt and pepper the interior and exterior of the salmon. Cut some deep vertical slashes in the outside, on both sides. Stuff shallots, garlic, and lemon slices into the interior and inside the slashes. Coat with avocado oil, then grill over indirect heat with the cover on until skin is crispy and flesh is lightly pink and flaky, or bake at 375 for 30-40 minutes.

If I’m ever cooking a cephalopod, it’s all about the Instant Pot. Throw some bone broth, lemon juice, and olive oil in the pot with the squid or octopus and cook on manual for 15-20 minutes. If you like, you can take it out, allow it to cool, then grill it over coals or open flame. Save the broth.

Whenever I cook fish, I use either monounsaturated fats (as found in avocado oil and olive oil) or saturated fats (as found in butter and coconut oil). Both types of fats enhance absorption of omega-3 fatty acids, whereas omega-6 fats inhibit it. Both omega-3 and omega-6 compete for the same absorption pathway.

When applicable (as in curry), I also use turmeric to cook my fish. Turmeric and its curcumin enhances absorption of omega-3s, specifically increasing DHA levels in the brain.

I know seafood is intimidating for some people. They don’t like the “fishiness.” They don’t know how to cook it. It’s “too expensive.” It goes bad too quickly. Hopefully, after today you feel a bit better about cooking and eating seafood. Hopefully, you feel equipped and empowered to incorporate some salmon, cod, trout, oysters, and other marine animals into your diet.

Take care, everyone, and please leave your favorite ways to eat seafood down below. How much seafood do you eat? What’s your go-to recipe? What underrated sea animal do you covet but others do not?

Thanks for reading!

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The post The Definitive Guide To Fish: Why and How To Eat It appeared first on Mark’s Daily Apple.

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For today’s edition of Dear Mark, I’m answering a few questions from recent comment boards. First, with all the scary tick-related news coming out lately, are there any non-toxic tick repellents that actually work? Are there essential oils that repel and/or kill ticks? Is there a safer way to use insecticides? Next, were the people in the Mediterranean keto study actually eating a kilo of fish on their fish days? And is the wine an important part of the Mediterranean diet? Is the wine therapeutic or just for pleasure?

Let’s find out:

Non toxic effective tick repellents safe for children? Any suggestions? I live in NC so the tick thing scares the hell out of me. Found at parks in short grasses, like how am I supposed to avoid this???

If you want to avoid DEET and other pesticides, there are many essential oils that repel ticks. Let’s go through the various tick species.

The castor bean tick:

Repelled by miswak essential oil and killed by Libyan rosemary essential oil.

Repelled by rosemary and mint essential oils.

Repelled by Dorado azul, also known as pignut or bushmint and traditionally used as mosquito repellent. The terpene known as alpha-humulene was the most repellent terpene found in the oil; you can buy both the oil and the humelene.

Repelled by turmeric oil, even beating out DEET.

The cattle tick:

Repelled by French marigold essential oil.

Repelled by mastrante essential oil.

The deer tick:

Repelled by nootkatone (a grapefruit aromatic compound) and to a lesser degree ECOSMART organic insect repellent. Here’s a cool video showing ticks trying to climb a person’s finger that’s been dipped in nootkatone.

Nothing is 100% guaranteed to repel all ticks. In fact, many of these oils show 50-60% effectiveness in the field. But if you use a combination of relevant essential oils, frequent tick checking, smart clothing choices (long socks, shoes/boots, pants), and avoidance of tick-heavy landscapes (tall grass, oak leaves, etc, notwithstanding these new breeds that apparently love short grass), you’ll be in good hands—or at least better hands than the naked guy rolling around in piles of oak leaves.

And if you’re really worried, you could always tuck pants into your shoes, then spray the shoes and lower section of your pants with peremethrin, an insecticide that kills the ticks as they climb before they can reach your flesh. Use a dedicated pair of pants and shoes that you don’t use for anything else and reapply each time you go out. A light spray on the outside of reasonably-thick pants should provide tick protection without actually putting the pesticide into contact with your skin.

2.2 pounds of fish each day?!

I know, I was surprised to read that myself. But right there, according to the researchers:

We estimated during the first 4 weeks of this study that the average edible fish consumption per subject during the ‘‘fish block’’ day was approximately 1.12 0.41 kg=day.

So it wasn’t just an allowance of fish. They actually tracked their consumption and found they were eating over 2 pounds of fish on average on the days they ate fish.

The study said that they had “fish block” and “no fish block” days. With no mix of fish and other meats on the same day. What is the reason for this?

They offered no justification in the study write-up.

Maybe it was to increase variety.

Maybe it was to reduce their intake of omega-3s. I mean, a kilo of fish per day adds up to a lot of omega-3s, especially if you’re doing sardines and salmon. There is such a thing as too much a good thing, and excessive omega-3 can lead to blood thinning, excessive bleeding, and imbalanced omega-3:omega-6 ratios in the opposite direction.

Maybe it was to help people stick to the diet, to break up all that fish with some meat and chicken.

Great, but why the wine? Is it not a contradictory with ketosis? But is it for pleasure or is it for a therapeutic reason?

Wine is emphasized in Mediterranean diet studies (both keto and regular) because wine is considered an important part of the cuisines of most Mediterranean countries, at least on the European side. Italy, France, Spain, Portugal, and Greece all have an extensive history of wine production and consumption. Since researchers are casting a wide net to capture everything that might be contributing to the health effects, they’re including everything that appears in the “Mediterranean diet.”

It’s good to keep in mind that ketosis and alcohol detoxification do utilize some of the same physiological pathways. If you’re drinking an excessive amount, you’ll run the risk of inhibiting ketone production.

Still, wine does appear to have therapeutic effects, especially in people with metabolic syndrome—the subjects of this study.

Red wine is very high in polyphenols, due to both the polyphenols in grapes themselves and the unique polyphenols that form during fermentation. One study compared grape extract to red wine made with the same types of grapes, finding that red wine provided benefits the grape extract did not.

Drinking wine with a fast food meal can reduce postprandial oxidative stress and inflammatory gene expression; it can actually make an otherwise unhealthy meal full of refined, rancid fats less damaging (though still not advisable).

Blood pressure: In people with (but not without) a genetic propensity toward efficient or “fast” alcohol metabolism, drinking red wine at dinner seems to lower blood pressure.

Type 2 diabetics: Type 2 diabetics who initiate red wine drinking at dinner see reduced signs of metabolic syndrome, including moderately improved glycemic control and blood lipids.

Inflammation: A study found that non-drinkers who begin regularly drinking moderate amounts of Sicilian red wine enjoy reduced inflammatory markers and improved blood lipids.

I’d say the wine is a therapeutic addition to the Mediterranean keto diet. Don’t let that override your own experience, however. Wine might have therapeutic effects for many people, but not everyone feels better including it. It’s an option, but it’s hardly a necessary one for a healthy diet.

If you have any more questions, feel free to ask away down below. Thanks for reading, everyone.

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References:

El-seedi HR, Khalil NS, Azeem M, et al. Chemical composition and repellency of essential oils from four medicinal plants against Ixodes ricinus nymphs (Acari: Ixodidae). J Med Entomol. 2012;49(5):1067-75.

Ashitani T, Garboui SS, Schubert F, et al. Activity studies of sesquiterpene oxides and sulfides from the plant Hyptis suaveolens (Lamiaceae) and its repellency on Ixodes ricinus (Acari: Ixodidae). Exp Appl Acarol. 2015;67(4):595-606.

Goode P, Ellse L, Wall R. Preventing tick attachment to dogs using essential oils. Ticks Tick Borne Dis. 2018;9(4):921-926.

Politi FAS, Fantatto RR, Da silva AA, et al. Evaluation of Tagetes patula (Asteraceae) as an ecological alternative in the search for natural control of the cattle tick Rhipicephalus (Boophilus) microplus (Acari: Ixodidae). Exp Appl Acarol. 2019;77(4):601-618.

Lima Ada S, Carvalho JF, Peixoto MG, Blank AF, Borges LM, Costa junior LM. Assessment of the repellent effect of Lippia alba essential oil and major monoterpenes on the cattle tick Rhipicephalus microplus. Med Vet Entomol. 2016;30(1):73-7.

Schulze TL, Jordan RA, Dolan MC. Experimental use of two standard tick collection methods to evaluate the relative effectiveness of several plant-derived and synthetic repellents against Ixodes scapularis and Amblyomma americanum (Acari: Ixodidae). J Econ Entomol. 2011;104(6):2062-7.

Hansen AS, Marckmann P, Dragsted LO, Finné nielsen IL, Nielsen SE, Grønbaek M. Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease. Eur J Clin Nutr. 2005;59(3):449-55.

Di renzo L, Carraro A, Valente R, Iacopino L, Colica C, De lorenzo A. Intake of red wine in different meals modulates oxidized LDL level, oxidative and inflammatory gene expression in healthy people: a randomized crossover trial. Oxid Med Cell Longev. 2014;2014:681318.

Gepner Y, Henkin Y, Schwarzfuchs D, et al. Differential Effect of Initiating Moderate Red Wine Consumption on 24-h Blood Pressure by Alcohol Dehydrogenase Genotypes: Randomized Trial in Type 2 Diabetes. Am J Hypertens. 2016;29(4):476-83.

Gepner Y, Golan R, Harman-boehm I, et al. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes: A 2-Year Randomized, Controlled Trial. Ann Intern Med. 2015;163(8):569-79.

Avellone G, Di garbo V, Campisi D, et al. Effects of moderate Sicilian red wine consumption on inflammatory biomarkers of atherosclerosis. Eur J Clin Nutr. 2006;60(1):41-7.

The post Dear Mark: Safe Tick Repellent, Fish Intake on Mediterranean Diet, and Therapeutic Value of Wine appeared first on Mark’s Daily Apple.

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Though she is at the forefront of functional medicine, what sets Dr. Wahls apart is her experience using nutrition and lifestyle interventions to treat progressive health problems and heal her own MS, and later that of others.

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For today’s edition of Dear Mark, I’m answering three questions. First, can LDL actually infiltrate the arteries, or is there more to the story? Malcolm Kendrick says there’s more to the story, so I dig into some literature to see if they corroborate his position. Second, is New Zealand farmed salmon good to eat? And finally, what should you do about elevated ferritin levels—and why else might they be elevated if not because of your iron?

Let’s go:

My reading of this post by Malcolm Kendrick MD is that LDL particles cannot infiltrate the endothelial lining of our arteries:
https://drmalcolmkendrick.org/2018/08/16/what-causes-heart-disease-part-52/

Great read. Malcolm Kendrick is consistently fascinating, insightful, and enlightening.

He’s basically suggesting that LDL particles can’t manhandle their way into the artery wall, which are equipped with tight junctions—the same kind that regulate passage through our gut lining. Something has to “allow” them in. The something he finds most plausible is injury, trauma, or insult to the endothelial lining (artery wall, for lack of a better phrase).

A free public textbook available on PubMed since last month called The Role of Lipids and Lipoproteins in Atherosclerosis tackles the topic head on. In the abstract, they say:

Population studies have demonstrated that elevated levels of LDL cholesterol and apolipoprotein B (apoB) 100 [note: ApoB is a stand-in for LDL particle number, as each LDL-P has an ApoB attached to it], the main structural protein of LDL, are directly associated with risk for atherosclerotic cardiovascular events (ASCVE). Indeed, infiltration and retention of apoB containing lipoproteins in the artery wall is a critical initiating event that sparks an inflammatory response and promotes the development of atherosclerosis.

This seems to posit that infiltration of the LDL particle into the artery wall is a critical initiating event. But is it the critical initiating event? Does something come before it? How does the infiltration happen, exactly? Moving on:

Arterial injury causes endothelial dysfunction promoting modification of apoB containing lipoproteins and infiltration of monocytes into the subendothelial space. Internalization of the apoB containing lipoproteins by macrophages promotes foam cell formation, which is the hallmark of the fatty streak phase of atherosclerosis. Macrophage inflammation results in enhanced oxidative stress and cytokine/chemokine secretion, causing more LDL/remnant oxidation, endothelial cell activation, monocyte recruitment, and foam cell formation.

If I’m reading this correctly, they’re saying that “arterial injury” is another critical initiating event—perhaps the critical initiating event, since the injury causes “endothelial dysfunction,” which in turn modifies (or oxidizes) the LDL particles. But wait: so they’re saying the LDL particles are already there when the arterial injury occurs. They’ve already made it into the endothelial walls, and they’re just…waiting around until the arteries get injured. Okay, okay, but, just like Malcolm Kendrick points out, nowhere in the abstract have the authors actually identified how the LDL particles enter the endothelial lining. Maybe it’s “common knowledge,” but I’d like to see it explained in full.

Moving on:

In atherosclerosis susceptible regions, reduced expression of eNOS and SOD leads to compromised endothelial barrier integrity (Figure 1), leading to increased accumulation and retention of subendothelial atherogenic apolipoprotein B (apoB)-containing lipoproteins (low-density lipoproteins (LDL)) and remnants of very low-density lipoproteins (VLDL) and chylomicrons)

Ah ha! So, in regions of the arteries that are prone to atherosclerosis, low levels of nitric oxide synthase (eNOS)—the method our bodies use to make nitric oxide, a compound that improves endothelial function and makes our blood flow better—and superoxide dismutase—an important antioxidant our bodies make—compromise the integrity of the arterial lining. The compromised arterial lining allows more LDL particles to gain entry and stick around. So, are low levels of nitric oxide and impaired antioxidant activity the critical initiators? That’s pretty much what Malcolm Kendrick said in his blog post.

Still—high LDL particle numbers are a strong predictor of heart disease risk, at least in the studies we have. They clearly have something to do with the whole process. They’re necessary, but are they sufficient? And how necessary are they? And how might that necessariness (yes, a word) be modified by diet?

I’ll explore this more in the future.

In regards to the oily fish article (and more indirectly given the omega 6 concern- the Israeli Paradox) What do you think of NZ farmed salmon? I’m in Australia, & occasionally like a fresh piece of salmon- there are no wild caught available here sadly, but I am wondering how it measures up as an alternative?

Last year, I explored the health effects of eating farmed salmon and found that it’s actually a pretty decent alternative to wild-caught salmon, at least from a personal health standpoint—the environmental impact may be a different story.

I wasn’t able to pull up any nutrition data for New Zealand farmed salmon, called King or Chinook salmon. Next time you’re at the store, check out the nutritional facts on a NZ farmed salmon product, like smoked salmon. The producer will have actually had to run tests on their products to determine the omega-3 content, so it should be pretty accurate. Fresh is great but won’t have the nutritional facts available. I don’t see why NZ salmon would be any worse than the farmed salmon I discussed last year.

According to the NZ salmon folks, they don’t use any pesticides or antibiotics. That’s fantastic if true.

I used to eat a lot of King salmon over in California, and it’s fantastic stuff. Very fatty, full of omega-3s. If your farmed King salmon comes from similar stock, go for it.

ok can someone tell me how to reduce ferritin? Is is just by giving blood?

Giving blood is a reliable method for reducing ferritin. It’s quick, effective, simple, and you’re helping out another person in need. Multiple wins.

Someone in the comment board recommended avoiding cast iron pans in addition to giving blood. While using cast iron pans can increase iron intake and even change iron status in severe deficiency, most don’t have to go that far. Giving blood will cover you.

Ferritin is also an acute phase reactant, a marker of inflammation—it goes up in response to infections (bacterial or viral) and intense exercise (an Ironman will increase ferritin). In fact, in obese and overweight Pakistani adults, elevated ferritin seems to be a reliable indicator of inflammatory status rather than iron status.

Thanks for reading, everyone. Take care and be well!

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References:

Birgegård G, Hällgren R, Killander A, Strömberg A, Venge P, Wide L. Serum ferritin during infection. A longitudinal study. Scand J Haematol. 1978;21(4):333-40.

Comassi M, Vitolo E, Pratali L, et al. Acute effects of different degrees of ultra-endurance exercise on systemic inflammatory responses. Intern Med J. 2015;45(1):74-9.

The post Dear Mark: How Does LDL Even Penetrate the Arteries, New Zealand Farmed Salmon, Elevated Ferritin appeared first on Mark’s Daily Apple.

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If you’re one of the many Americans who has had one-too-many sugar cookies, here is a seven-step detox to cure your post-holiday weight gain, legendary bloat, and molasses-like blood.

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