A Recipe For a Best Selling Health Book. Review of Grain Brain

My dream is to write a book on health that will sell millions of copies. I’ll introduce a great new dietary solution. I already have a strategic plan. Firstly, I am going to select a target group. Obviously, it has to be a large group of people.

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I’m going to write exactly what my target audience wants to hear. I’m pretty sure what it is. I am going to refer to the scientific literature (when it suits me). This will be expected of a doctor. However, I’ll only cite papers that support my dietary solution. Otherwise, I might confuse my readers.

I’ll definitively challenge mainstream medicine and public health guidelines because I know my readers will love that.

My target will probably be Paleo and low carb enthusiasts, mainly because this is a huge and rapidly growing group. Furthermore, these people are often very interested in nutrition and how to improve health. I know that for a fact because I often consider myself to be among them.

There are certain issues I know my readers will love to hear. I’ll tell them that many of the things government and official guidelines say about nutrition is wrong. I’ll tell them that eating lots of fat is good and will protect them from getting dreadful diseases like heart disease, depression, Parkinson’s disease and Alzheimer’s. I’ll tell them that if they eat carbs, grains in particular and even fruit, their brains will get sick. I’ll tell them that gluten is dreadful. I’ll tell them that cholesterol is good and that statins (cholesterol-lowering pills) are bad.

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Carbs and Brain Disease

Carbohydrate restriction has now been accepted as an effective method to lose weight among obese individuals. A year ago I wrote a blog article pointing out several health benefits of such a diet. In my dream book, I will take this a step further. I will suggest that eating lots of fats and very few carbs will protect your brain. Although there are no studies available to confirm this, I will be able to create an angle to prove my point.

It’s a scientific fact that diabetes is a risk factor for getting Alzheimer’s disease. More interestingly, a recent publication in the highly respected New England Journal of Medicine suggests that higher blood sugar levels may be a risk factor for dementia, even among persons without diabetes. Furthermore, a study published last year suggested that a dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of mild cognitive impairment or dementia in elderly persons.

In one study, subjects with Alzheimer’s and vascular dementia had a high predilection for sugar and sweet foods. In the National Health and Nutrition Examination Survey, a dietary pattern with a high percent fat was associated with better processing speed, learning, and memory; in contrast high percent carbohydrate was associated with poor processing speed .

This is all highly interesting. Having diabetes and high blood sugar is a risk factor for dementia. So possibly, eating less sugar and more healthy fats might cut the risk of dementia. It’s certainly a hypothesis that deserves to be tested. However, I will need some real stuff for my book. Something more provoking. Nobody wants to read about an unproven hypothesis. If I could claim that all carbs are bad for the brain I might get noticed.

So, I will claim that avoiding all grains and eating lots of fat will protect your brain. I will provide citations to support my case. I’ll not make any distinction between refined grains and whole grains. My readers will accept that. It’s all sugar molecules anyway. I’ll tell my readers that sugar and carbs cause inflammation. Inflammation is an essential part of dementia and many other neurological disorders.

I know whole grains are rich in fiber, B-vitamins, Vitamin E, and often omega-3 fatty acids. They are important sources of minerals. Whole grains are one of our most important source of magnesium. Magnesium consumption has been associated with less inflammation in post-menopausal women. However, I will not confuse the readers of my book with this information.

Diets with a relatively high glycemic index (GI)were found to be associated with inflammation in a large group of women participating in the Harvard Women’s Health Study.

Fiber consumption was associated with less inflammation in seven different studies. Although the mechanisms underlying the associations between GI and inflammation are not fully clear, some data shows that  rapid changes in blood sugar levels may increase free radicals and pro-inflammatory cytokines, leading to inflammation.

In general, whole grains are associated with less inflammation than refined grains. This may be due to one or many of  the active constituents of whole grain which may include dietary fiber, minerals, vitamins and phytochemicals. Again, I will not include this information in my book because I want my message crystal clear.

The health effects of the Mediterranean diet have been intensively studied. This diet contains fruit and whole grains. A recently published systematic review of eleven published papers addressing cognitive function and dementia found that greater adherence to Mediterranean diet is associated with slower cognitive decline and lower risk of developing Alzheimer’s disease.

However, I will probably not mention this in my book. If I decide to do it I will tell my readers that my diet solution is indeed quite similar to the Mediterranean diet. Of course this will be a bit misleading, but I guess the end justifies the means.

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Diet, Cholesterol and Health

I am going to put a lot of weight on the cholesterol issue. I have to convince my readers that cholesterol does not cause disease. In fact, I want to tell them that cholesterol is good. My arguments will be based on the important role cholesterol plays in our bodies. My main conclusion will be that eating fats, including cholesterol, will prevent brain disease.

We recently learned that statins increase the risk of diabetes by approximately 9 percent. Here, I can cite recent studies and more importantly, I can have an attack on the pharmaceutical industry which my readers will love.

I’ll explain how diet affects our cholesterol levels. When we measure blood cholesterol it is important to understand that 75-80 percent of the cholesterol measured is manufactured by our body, primarily by the liver. In fact, foods that are high in cholesterol tend to decrease the body’s own production of cholesterol. However, despite the body’s great capacity to produce cholesterol, I am going to convince my readers that our body prefers that we “spoon feed” our cholesterol from the foods we eat. Then we don’t have to unnecessary strain our liver. Of course I don’t have to provide any scientific citations here. My readers will know I know what I’m talking about.

I am going to explain what happens if you restrict your cholesterol intake. Then the body sends out an alarm to indicate crisis. The liver starts to use carbohydrates from our diet to produce an excess supply of cholesterol. In a recently published book (Perlmutter D, Grain Brain, p.99) this was called a Molotov cocktail in the works. When you consume high amounts of carbs, and avoid eating cholesterol, you force the liver to over-produce cholesterol, which is really bad. Okay, I’m suggesting that cholesterol is bad for the body if you don’t eat it, but good for your body when you consume lots of it.  So cholesterol is good and bad….. ough…

Of course this does not make sense, but the only solution to stop this terrible and uncontrolled overproduction of cholesterol is to back of the carbs and eat more cholesterol (Perlmutter D, Grain brain, p.99). Obviously, I am not going to cite any scientific studies in relation to these magical explanations.

Depression

Studies have indicated that there is an inverse relationship between blood levels of total cholesterol and depression. This implies that people with depression generally have lower cholesterol levels than those without depression. I will use this to convince my readers that low cholesterol causes depression. Of course they will know that correlation does not imply causation, but I believe they will accept my claims because it fits into our general concept.

Of course, I will not confuse my readers by telling them that there are several non-mutually exclusive explanations for the negative association between depression and total cholesterol. Depression is known to impair appetite in some individuals. In addition, depression is associated with cytokine activation, which can impair cholesterol synthesis.

A review of randomized clinical trials concluded that we do not have sufficient evidence that cholesterol-lowering therapies increase the risk of depression and suicide. Clinical trials with cholesterol-lowering drugs have not found any mood decrements. However, I will stick with the explanation that fits my picture and my claim that low cholesterol causes depression

Impotence

One of the most effective ways to apply to male readers is to touch on the problem of impotence, how to avoid it and how to improve sexual performance.

I will devote a chapter to the issue. I’ll write that one of the most common reasons for impotence is “abysmally low cholesterol levels” (Perlmutter D, Grain Brain, p. 101). Low testosterone levels may prevent both women and men from having a hot sex life. Testosterone is made from cholesterol, so obviously higher cholesterol is better than lower when it comes to sexual performance. This is a logical assumption and easy to understand so I don’t have to refer to any scientific studies. I’ll point out that decreased libido is common among individuals taking statins. I am not going to mention that this might in many cases be due to underlying vascular disease. I will assume the problem is due to low cholesterol. I might actually provide a couple of references to support my view.

I will definitively not refer to a paper from 2012 which is a critical summary of current evidence on cholesterol, statins and impotence.  The authors of this paper point out that epidemiological studies have shown that elevated cholesterol and reduced high-density lipoprotein cholesterol levels are associated with an increased risk of erectile dysfunction (ED). They highlight that although it appears that statins may sometimes cause ED, other studies have demonstrated that statins can lead to an improvement of erectile function.

Statins improve the function of the endothelium (the innermost layer of the artery) and restore endothelium-dependent relaxation which may improve blood flow and ED. Furthermore, the authors also point out that studies on the relationship between statins and testosterone production in males show contrasting results.

A randomized study of men with ED published earlier this year showed no clinically significant change in erectile function as a result of statin treatment compared with placebo. However, simvastatin significantly improved the sexual health related quality of life.

So, the association between cholesterol, statins, and impotence is complicated and not entirely clear. However, I will make it easy for my readers: low cholesterol causes low testosterone which causes impotence. Simple and very easily sold and bought.

 My Dream Book

At the end of the day, I realize that my dream book will not be published. I have two unsolved problems. Firstly, somebody came up with the idea before I did. And secondly, I didn’t really enjoy that particular product, mainly because it is plagued with information bias. So I’ll have to live with the fact that my best seller will never hit the shelves.

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Randall Beck
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Randall Beck

A great way to illustrate a point. But, it leads me to a bit of despair. It’s a wonder any of us can find the truth about statins and heart disease if there are people out there willing to distort it to this magnitude just to make a buck. This leads me to the next logical, inevitable question (please don’t read undue emotion into this): Are you distorting the truth for personal gain?

Axel F Sigurdsson
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Axel F Sigurdsson

Thanks Randall. That’s an honest and important question. If you believe I’m distorting the truth anywhere on my blog, please let me know where. My blog is mainly a hobby. I enjoy it a lot. I guess that’s a personal gain in itself. I’m not selling or promoting anything in particular. So far my blog hasn’t brought me any financial gain. There are a few google advertisements on the site that partly help me cover the costs. My main purpose is to provide up-to date information and opinion on different health issues, mainly in relation to heart disease which is… Read more »

KV
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KV

Bravo, Doctor Axel; very entertaining 🙂

Yes, it’s very important to get more and more extreme in order to stand out from the herd of authors appealing to trendies. Maybe next, one will head north and live for a year in an igloo made of pure cholesterol. That would be really “cool”.

One new internet trend to hook into: getting furious over the phrase “everything in moderation”. Tantrums are attention-getting. That’s showbiz.

Axel F Sigurdsson
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Axel F Sigurdsson

Thanks KV. You’re right about the “moderation” thing. Don´t dare mention “everything in moderation” on the internet.

Jerry White
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Jerry White

So between now and when all the double blind tests are complete and analyzed what do we do about diet and statins? I am 63 trying to take care of myself despite known obstacles. You did not touch on Giladin or the change of chromosome in wheat, any any opinion?

Axel F Sigurdsson
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Axel F Sigurdsson

Jerry. Some great books on health have been written by doctors. Many of those have not become best sellers. If you are wondering about diet and statins, have a look at “The Truth About Statins – Risks and Alternatives to Cholesterol Lowering Drugs”, written by Dr. Barbara H. Roberts. That is a good example of a book written by a doctor who has a point to make but never allows information bias to take charge.

Jerry White
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Jerry White

I will get her book. However, the question remains for an admitted non scientist how you manage information, your cardiologist desire to drive cholesterol and blood pressure as low as possible, your desire to be proactive on your health and all news. Do I have CHD or not?
I have read Grain Brain and Wheat Belly. I find Wheat Belly to be far superior and found Grain Brain a me too for the brain vs the heart.
I enjoy your work and appreciate your replies. Thanks.

gleslie
Guest
gleslie

I think….this was a great way to provide a lot of information in a way any “Joe Blow” could understand the many complexities of the subject. I really enjoyed reading this. Thanks.

davebrown9
Guest

Seriously, if you want to understand what causes the inflammatory response, I suggest you read “The Modern Nutritional Diseases” by Fred and Alice Ottoboni. Besides being incredible thorough, these two retired, PhD public health scientists are masters of explanation. In Chapter 9 the authors explain how both high insulin and high omega-6 intake affect the cascade of chemical events that result in the release of inflammatory eicosanoids. In other words, excessive glucose and excessive omega-6 produce the same effect in this particular chemical cascade having to do with the metabolism of essential fatty acids. They also explain why it is… Read more »

Mie
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Mie

Too bad for you Dave that the abovementioned is (yet again) cherry-picking, true to your style. A diet relatively higher in safa does indeed result in somewhat increased conversion of ALA from vegetable sources to EPA and DHA compared to a diet containing n-6 fatty acids in abundance. However, 1) no one’s arguing for a diet containing n-6 fatty acids in excession 2) diets richer in safa haven’t been shown to be healthy 3) the conversion of ALA to EPA and DHA isn’t the only thing relevant to fat intake / PUFA intake / inflammation And safa has indeed been… Read more »

Z.M.
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Z.M.

Mie you criticize Dave for “cherry-picking” but then you cite a review which cherry-picked studies claiming saturated fat is pro-inflammatory. Only 1 study they cited is relevant and it found that there was no significant difference between the safa meals and carbohydrate meal with respect to all inflammatory markers. The only meal which was significantly lower than the safa meals was the oleic for IL-6 and E-selectin but not CRP.

I did my own non-cherry picked review and put everything in context – https://diettrialclaims.blogspot.com/2013/08/saturated-fat-and-inflammation.html

Go down to “Saturated Fat and Inflammation”.

Mie
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Mie

My dear Z.M. Before you accuse anyone of cherry-picking, you’d better understand the meaning of the term. First of all, if you accuse the review of cherry-picking, this implies that the authors didn’t consider ALL the relevant studies in the field. If this is the case, please do show which studies were left out of discussion and why they should be included. The burden of proof is yours. Second of all, if the end results are indeed that IL-6 values increased in some of the studies mentioned whereas others found no significant results in either direction (that is, safa DID… Read more »

Z.M.
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Z.M.

Mie: “First of all, if you accuse the review of cherry-picking, this implies that the authors didn’t consider ALL the relevant studies in the field. If this is the case, please do show which studies were left out of discussion and why they should be included. The burden of proof is yours.” Nice try. The burden is on you and the authors to show that saturated fat is inflammatory. Both of you fall far short. Going down to the “SFA” section they only cited one relevant study i.e. a controlled study where the subjects actually consumed safa and measured markers… Read more »

Mie
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Mie

“Going down to the “SFA” section they only cited one relevant study i.e. a controlled study where the subjects actually consumed safa and measured markers of inflammation.” If you choose to limit the observation to trials, yes. Apart from that: once again, go read a Wikipedia entry on “cherry-picking”. Then come back and show WHICH STUDIES the authors left out but which should have been included. Because that is what is required if you indeed wish to prove that the review cherry-picked studies. And since the majority of observational studies (listed in table 13) didn’t observe any benefits nor meaningful… Read more »

Z.M.
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Z.M.

Mie: “Then come back and show WHICH STUDIES the authors left out but which should have been included.”

Funny Mie. I’m not going to cite them here when I’ve already done the work and cited them on my blog.

I’m not going to fall into your trap of trying to shift the burden. It is you who made the blanket statement that “safa has indeed been shown to be pro-inflammatory”. To support such a statement you absolutely have to cherry-pick.

Mie
Guest
Mie

You don’t get it, do you? You need to show that the list of studies you mention in your blog SHOULD have been included in the review.

davebrown9
Guest

Thanks for the link to the article entitled “Dietary factors and low-grade inflammation in relation to overweight and obesity.” I wasn’t aware that trans-MUFAs are inflammatory. I wonder how that works. I’ll have to ask the Ottobonis about that. As for the inflammatory effects of saturated fats, I’ve looked at the research. Inflammatory effects only occur when serum palmitic acid reaches inordinately high levels. Other chain lengths of saturated fatty acid have no effect. In truth, high intake of saturated fat (either percentage-wise or in absolute terms) does not translate into high serum levels of palmitic acid. However, eating saturated… Read more »

Z.M.
Guest
Z.M.

Mie: “You don’t get it, do you? You need to show that the list of studies you mention in your blog SHOULD have been included in the review.”

It should be obvious that they should have been included in the review — they are controlled trials measuring inflammatory markers in response to saturated fat meals.

thehomeschoolingdoctor
Guest

Nice tongue in cheek.

Kevin O'Connell
Guest
Kevin O'Connell

Isn’t the main problem with “whole grains” the lectin WGA (wheat germ agglutinin) and its unpleasant effects?
See, for example Pusztai et al. (1993), Antinutritive effects of whear-germ agglutinin and other N-acetylglucosamine-specific lectins (PMID: 8399111).
+ Dalla Pellegrina et al. (2209) Effects of wheat germ agglutinin on human gastrointestinal epithelium… (PMID: 19332085)
+ a useful WGA overview and compendium of links at https://www.greenmedinfo.com/toxic-ingredient/wheat-germ-agglutinin-wga

Mie
Guest
Mie

Once again, the existence of mechanism doesn’t mean its relevant in real life.

Graeme Nattress
Guest

You say: “A recent meta-analysis of randomized clinical trials found that treatment with statins and other cholesterol-lowering medications was not associated with subsequent increases in rate of suicide. ” but the linked study said “whereas a trend toward increased deaths from suicide and violence was observed in trials of dietary interventions and non-statin drugs”.

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Graeme. Thanks for reading so thoroughly. I mixed two citations. I’ve put in the correct ones now. I refer to the above study in the next sentence. You may recall that the first studies on cholesterol lowering drugs (non-statins) indicated that they might be associated with an increased risk of violent death including suicide. However, similar findings have not been reported in the statin trials. There may very well be a relationship between cholesterol and depression. I’m not saying there isn’t. But the association is complex and we don’t have any proof that lowering cholesterol will increase someone’s risk of… Read more »

Mie
Guest
Mie

Great stuff, Axel!

Of course, the best possible parody of the nonsensical crap that the so-called “diet gurus” come up with is unintentional: I’m talking about their own writings, of course. You just can’t top that baloney, no matter how hard you try. 🙂

Richard Lowfat4ever
Guest
Richard Lowfat4ever

Thanks Doc, my favourite article of yours, and the first one I am going to definitely share to a neo-libertarian climate-change skeptic of mine to demonstrate the futility of blog science. There are several strong scientific leads that speak against the alleged dangers of low cholesterol concentrations in the serum. I cover briefly few of them. First, the average of LDL of 19 different free-ranging mammalian specimen is just 42mg/dl. These animals do just fine, some of them are aggressive but many of them are not. Second, de Langen. An army of cholesterol bloggers pretend that the Dutch MD who… Read more »

wendy
Guest
wendy

This letter is exactly what has been going on in my own brain! I can’t decipher exactly how to help my husband (CAD, recent heart attack, high LDL & blood pressure, and family history of heart disease) because I can find arguments for both sides of everything!!! I feel paralyzed.

tannngl
Guest

Dr. Sigurdsson, I read your post on ‘Grain Brain’ last week. Neat way to critique a book by another MD! -Entertaining and informative. (As much of your blog is). You are correct of course, on most of these counts. If I may provide an alternate view, let me tell you what I think of ‘Grain Brain’. I am a retired RN after working full time for 35 years in many areas; I spent the most years in psychiatry and cardiology. My last hospital primarily provided cardiac interventions in the cath lab and the operating suites. Loved that job. That was… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

@ tannngl Thanks for the comment. I appreciate your interest and your kind words about my blog. Exactly like your husband, many people feel better and improve their health by cutting carbs and sugar and increasing fat intake. However, that doesn’t imply there is less risk for Alzheimer’s disease, depression etc. There are certainly studies showing a correlation between blood sugar and the risk of dementia. But it has never been proved that switching to low carb/high fat will prevent these diseases like Dr Perlmutter claims. Grain Brain illustrates a problem that is very common among many health books written… Read more »

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