The Mediterranean Zone (17 page)

Fructose is not the problem because you consume at least an equal amount of glucose with it. In fact, the glucose-to-fructose ratio in the American diet is about five to one (and has remained so for the past ninety years). The most likely suspect in our obesity epidemic may be increased glucose, not fructose, consumption. The real problem is when you consume too much glucose in the presence of excess omega-6 fatty acids. That’s how you develop cellular inflammation.

The third source of carbohydrates for most people is galactose, found primarily in milk and dairy products. The gut breaks down the lactose found in both mother’s milk and cow’s milk to the simple carbohydrate fragments glucose and galactose. Unlike glucose, the body has little need for galactose, but it can metabolize it through a separate pathway so it doesn’t build up in the body. The problem comes when the body loses the ability to break down lactose in the gut. Since lactose can’t be absorbed, it moves on to the colon. The 100 trillion bacteria living there love lactose, and ferment it, resulting in bloating (caused by gases released during fermentation),
flatulence, diarrhea, nausea, and vomiting. About 70 percent of adult Europeans (and nearly 100 percent in northern European countries, such as Germany, Denmark, and other Scandinavian countries) still retain the ability to make the enzyme that breaks down lactose into glucose and galactose, so these genetically lucky people don’t have any problems consuming milk or dairy products. However, it is estimated that about 50 percent of the adult Mediterranean population (and 65 percent of the global population) is not so lucky. Their inability to digest lactose led to some of the first uses of biotechnology about eight thousand years ago.

One way to reduce lactose is to make cheese from the milk. The cheesemaking process separates the primary milk protein (casein) from other milk proteins (such as whey) by adding acid to the milk. As the pH of the milk is lowered, the casein forms clumps (curds), and the whey and lactose stay in the solution. Remember the nursery rhyme of Little Miss Muffett eating her curds and whey? That was biotechnology in action. The harder the cheese (such as Parmesan), the less lactose it contains. Another way to reduce lactose is to add bacteria to milk. The added bacteria ferment the lactose into lactic acid. This is how you make yogurt. For the 50 percent of adult Europeans in the Mediterranean regions who still can’t digest lactose, the development of cheese (especially Parmesan) and yogurt provided a way out of their genetic dilemma. This is why cheese and yogurt are protein mainstays of the Mediterranean diet. Today, there is another high-tech alternative: the separation of lactose from milk to generate lactose-free milk.

One of the surprising facts about per capita milk consumption in the United States is that it has decreased by nearly 75 percent in the last forty years. Much of this was a consequence of the removal of milk subsidies by the Reagan administration. Farmers were producing too much milk, forcing the government to buy the excess and convert it into cheese for long-term storage. When the Department of Agriculture decided it was going stop buying milk, it also decided to increase its advertising budget to sell the oversupply of cheese. The Department of Agriculture’s campaign to sell off its cheese overstock led to the rapid growth of cheese pizza as an integral part of the American diet (pizza does exist as a part of the Mediterranean diet, but in Italy pizza is primarily composed of vegetables over a very thin crust), followed by the multi-cheese pizza, followed by the multi-cheese pizza with extra cheese stuffed into the crust. In this continuing
transformation, a food that used to be considered an appetizer or dessert to be eaten in small portions as part of the Mediterranean diet quickly became a major source of calories in the American diet. The American intake of cheese has increased by 300 percent in the past forty years, and I guarantee most of that increase was not coming from artisanal cheeses.

There remains the issue of a possible allergic reaction to milk protein. However, if you eat too much of any one type of protein (even tofu), there is the potential to develop an allergy to it. The usual sources of allergies are proteins in various food ingredients. The primary offenders are milk, eggs, peanuts (actually a legume), nuts, fish, shellfish, soy, and wheat. Of these “big eight,” four of these foods (eggs, nuts, fish, and shellfish) were also around in Paleolithic times, so protein-based food allergies are not totally a consequence of the advent of agriculture.

Milk allergies are more common in young children (about 3 to 5 percent of children), but about 90 percent of children outgrow their allergy by age 3. If you are a part of the 0.5 percent of the adult population with an allergy to milk protein, the usual indications are increased mucus formation in the nasal passages and the throat, sneezing, a runny nose, hives, or swelling of the lips, mouth, or throat when you consume milk. However, this also means that 99.5 percent of the population has no problems with milk protein, assuming most of the lactose has been removed. The number of people with an allergy to milk proteins are surprisingly similar to those with an allergy to another common protein in the diet: gluten. Bottom line, if you don’t have any apparent allergies to dairy protein, then feel free to add a little Parmesan cheese or yogurt to your Mediterranean Zone meals.

Before I let dairy products off the hook completely, I need to discuss the effect of dairy protein on insulin secretion. Protein, such as carbohydrate, can also stimulate insulin release. Dairy products are powerful stimulators of insulin secretion. On the other hand, eggs have the least insulin-stimulating ability, followed by beef and fish. If you are consuming excess omega-6 fatty acids, then combining that with dairy products can possibly stimulate arachidonic acid formation and increased cellular inflammation. The increased cellular inflammation may be a major contributor to potential allergies coming from dairy products.

Proteins, such as bacteria, normally don’t enter into the bloodstream, thanks to the second skin that lines the digestive system. The lining of the gut is normally a tight barrier that allows only highly digested dietary components (single sugars, fatty acids, and very small protein peptides) that will not trigger allergenic reactions to enter the body. Of course, all bets are off if you have a leaky gut. A leaky gut is just that: Your second skin no longer acts as an effective barrier to prevent larger molecules such as intact proteins or large protein fragments from entering the blood. If they enter the bloodstream, they will be recognized as alien and will start a powerful immune reaction to this protein just as if bacteria or toxins were starting to breach the same barrier and entering the bloodstream.

There are two types of people with gluten problems. The first group has celiac disease, which represents true gluten intolerance. Those with celiac disease represent less than 1 percent of the population. These people simply cannot tolerate any gluten in the diet. My wife has severe celiac disease, so I know the consequences. The second group consists of those individuals who are gluten sensitive. They have few distinct clinical markers to gluten but seem to feel better when they don’t eat gluten-containing products.

It is possible that the current epidemic of gluten sensitivity (not celiac disease) may be an indication that we really have a leaky gut epidemic. The most likely suspect in generating leaky gut syndrome is cellular inflammation, not gluten. In other words, gluten doesn’t cause inflammation; however, existing inflammation in the lining of the gut can cause sensitivity to gluten. In particular, leaky gut syndrome is mediated by a subgroup of inflammatory eicosanoids known as leukotrienes, which are derived from arachidonic acid (AA). As AA levels increase (and EPA levels decrease) in the cells that line the gut, the stage is set for a growing percentage of these people to develop leaky gut syndrome. They become far more susceptible to a wide variety of immunological insults from any antigen-producing chemical (foods or chemicals) entering the bloodstream that would be otherwise prevented from doing so by a healthy gut lining.

Recent books have put forward a number of hypotheses about the connections between wheat, obesity, and chronic disease. The question is: Are these hypotheses justified? One of these assertions is that the increase in wheat consumption correlates well with the obesity epidemic. As I have
pointed out, simply consuming carbohydrates doesn’t make you fat per se, but the constantly elevated insulin levels caused by insulin resistance generated by cellular inflammation will do a very effective job of packing on the pounds. To increase cellular inflammation, you need the combination of excess refined carbohydrates coupled with excess omega-6 fatty acids. And omega-6 fatty acid consumption has grown at an even faster rate than wheat consumption.

The second proposed reason for gluten sensitivity is that the starch in wheat is thought to break down differently than other carbohydrates and enter the bloodstream more rapidly as glucose. This isn’t true. The starches in white potatoes and white rice enter the bloodstream as glucose even faster than those from wheat, but it’s not carbohydrates per se that cause insulin resistance, but cellular inflammation that can be driven by the initial insulin surge when coupled with excess omega-6 fatty acids.

The third argument driving the wheat-is-evil movement is that the glycemic index of wheat is higher than table sugar. That’s true because table sugar is half fructose, which has little effect on insulin secretion. However, it is not the glycemic index of a carbohydrate but the glycemic load of the total meal that is important in determining the amount of insulin that will be secreted. When you balance the glycemic load of a meal by adding adequate amounts of low-fat protein (as you do following the Mediterranean Zone), you don’t get a massive rise in blood glucose levels that leads to elevated insulin levels.

Finally, it has been hypothesized that the metabolism of gluten proteins produce powerful narcotic-like protein fragments that make you addicted to wheat. It is true that when a seven-peptide fragment of wheat is incubated with nerve cells, it can induce opioid-like effects. However, protein fragments of that size do not pass into the blood, let alone enter the brain, if you have a healthy gut (and a healthy blood-brain barrier). Only peptides containing two or three amino acids can pass across a healthy gut lining. Peptides of that limited size are too small to cause any type of immunological reaction, much less act as addictive agents. Of course, all bets are off if you have a leaky gut in which much larger things (such as whole bacteria, microbial fragments, intact protein such as gluten, and so on) can enter the bloodstream and play havoc with our immune system.

What causes a leaky gut? It comes from increased cellular inflammation
in the cells that make up the lining of the gut membrane. Following the Mediterranean Zone is an excellent way to start to heal a leaky gut if you are gluten sensitive. As your gut inflammation decreases, you might consider adding some grains back into your diet to see how the healing process is going. The only two grains I would suggest are slow-cooked oatmeal and barley because they are both rich in soluble fiber that slows down carbohydrate entry into the blood, lowering the glycemic response. However, I wouldn’t go beyond those two sources of grains.

So why do people feel better when they go on a gluten-free diet? For the same reason that they feel better on the Zone Diet. You are removing high-glycemic load carbohydrates from your diet, making it more difficult to maintain arachidonic acid levels that ultimately cause a leaky gut. This improvement can be accelerated if you are reducing your intake of omega-6 fatty acids at the same time. For most Americans, the primary sources of gluten are bread, pasta, and pastries. Take these food items out of the diet, and you significantly lower the glycemic load and when that happens, you lose weight and feel better.

I firmly believe that cutting out all grains from the diet is an excellent idea. In fact, I was quoted in
Time
magazine in 1997 stating, “If all the bread left the face of the earth, we would have a much healthier planet.” My quote was based on the importance of reducing the glycemic load of the diet, not the removal of gluten. I haven’t changed my opinion. You won’t starve to death if you replace those high-glycemic carbohydrates with lots of vegetables and limited amounts of fruits, which provides more anti-inflammatory polyphenols with far fewer carbohydrates.

There is a grain of nutritional truth in all of these new dietary villains. However, they don’t cause inflammation; they are secondary consequences of an inflamed gut caused by pre-existing cellular inflammation. That’s why they are not a panacea for addressing chronic disease. Your primary “drug” to reduce diet-induced inflammation is following the Mediterranean Zone. Only once you have mastered that dietary intervention as indicated by reaching the clinical markers that define the Zone, then think about reducing (not totally eliminating) these new dietary “villains.” If you are already in the Zone, then you probably won’t see much difference as you reduce their levels because they are already minor food ingredients in the Mediterranean Zone.

Although there is no epidemiological link between saturated fat and heart disease, that doesn’t mean saturated fat is good for you. While saturated fat is not nearly as inflammatory as omega-6 fatty acids, it can induce cellular inflammation by interacting with one of the toll-like receptors on the surface of every cell in the body. Saturated fats can fool this receptor into thinking the cell is under microbial attack. Intervention studies have continuously demonstrated that saturated fats are more inflammatory than monounsaturated fats. If you want to add fat to your diet, then add extra-virgin olive oil instead of vegetable oils such as safflower, corn, or soybean.

The real villain we should be seeking to control in our battle against obesity and its associated diseases is diet-induced inflammation. The trouble with pointing the finger at a single dietary food ingredient as a “villain” is that you are overlooking the complex relationships in nutrition, which makes it more likely that you will continue to suffer the health consequences of increased cellular inflammation.