The World Turned Upside Down: The Second Low-Carbohydrate Revolution (39 page)

Be suspicious of grand
principles:

"Random controlled trials are the
gold standard." "Metabolic
Ward Studies are the gold standard." "Observational studies are only
good for
generating hypotheses." Such grand principles are unknown in the
physical
sciences where the method that we choose depends on the question that
we want
to answer. You do not need to carry out a long-term trial to see if a
treatment
is appropriate for an acute condition. You do not need a
random-controlled
study to find out whether penicillin is effective for treating
gram-positive
infections. Penicillin is a drug and you may have to do a
random-controlled
trial to determine safety but, at the efficacy end, if the results are
clear-cut, only a small number of tests is necessary. How many? It
depends on
how many people recover spontaneously. A statistician can do that for
you if
you ask the question appropriately.

The random-controlled trial as a gold
standard has really
never recovered from Smith and Pell's landmark paper "Parachute use to
prevent
death and major trauma related to gravitational challenge: systematic
review of
randomised controlled trials"
[110]
.
They concluded
that: "the effectiveness of parachutes has not been subjected to
rigorous
evaluation by using randomised controlled trials..."

Described as both funny and profound,
the paper included all
the relevant information (making fun of the excessive statistical
detail in the
literature):

"We chose the Mantel-Haenszel test
to assess
heterogeneity, and sensitivity and subgroup analyses and fixed effects
weighted
regression techniques to explore causes of heterogeneity. We selected a
funnel
plot to assess publication bias visually and Egger's and Begg's tests
to test
it quantitatively."

Smith and Pell pointed out that there
were only two
solutions to the problem of a lack of random controlled trials:

"The first is that we accept that,
under
exceptional
circumstances,
common sense
might be applied when considering the potential risks and benefits of
interventions (
my emphasis
).

The second is that we continue our
quest for the holy
grail of exclusively evidence based interventions and preclude
parachute use
outside the context of a properly conducted trial."

In the end, the authors suggested that

 "those who advocate
evidence based medicine and criticise
use of interventions that lack an evidence base .. demonstrate their
commitment
by volunteering for a double blind, randomised, placebo controlled,
crossover
trial."

Figure 24-2
.
The
original figure from Smith and Pell
[110]
.

Summary

The multiple faults that are commonly
found in the medical
literature have made it tough going and, more often than not, readers
will not
be happy with the latest study showing that processed food or one or
another of
the usual suspects will kill you. Armed with a few principles you can
understand
what is explicitly wrong with these studies that go so strongly against
common
sense.

Failure to show individual data, the
use of questionable
practices like intention-to-treat and meta-analyses and most of all,
failure to
actually apply common sense, are the things to look for. There is the
barrier
of accepting that the medical literature could be so pervasively bad.
It will
be hard to accept that the Harvard School of Health, that the Best and
the
Brightest could be making elementary mistakes. There are, however, many
precedents.

Easy to forget, though, is that it's
about food. Beyond
therapy, we like food. Don't forget taste. And even if you insist on
food as
medicine, it is likely that there was real biologic benefit in the
tastes that
we have evolved. Easy to forget that it's about taste. That's next.

–

–

PART
III - FOOD AND EATING

Chapter
24

Chemistry
and Food.
The recipes

"nothing to eat on a
low-carb diet."

Two practical objections to
low-carbohydrate diets that are
frequently put forward are that there are limited choices and that the
foods
that are allowed are inherently expensive. In fact, if you stick a pin
in the
Larousse
Gastronomique
,
the classic French encyclopedic guide to food, you will probably be 3
recipes
away from a low-carb dish. There is not much to the idea that
everything has to
be between two slices of bread or accompanied by a side of fries. If
you want
to replace the carbs with something you may have to learn how to cook.
If you
are trying to lose weight, you might want to see how far you can get by
simply
removing the carbohydrate without replacement. This will reduce cost
and not
require learning to cook new dishes.

There are now numerous excellent
low-carbohydrate cookbooks,
e.g. Judy Barnes Baker's
Nourished
and Dana Carpender's
500
Low Carb Recipes
and a very large number of
websites. I will
describe a few principles and give you some basics to get you started
but there
are thousands on the internet and many traditional recipes are
inherently
low-carb. It is low-fat that is the new idea, increasingly recognized
as a fad,
commonly by those who forget that they were once the strongest
supporters.

Chemistry is easy

What is accomplished by fire
is alchemy – whether in
the furnace [chemistry] or in the kitchen stove. And he who governs
fire is
Vulcan, even if he be a cook or a man who tends the stove [chemist].

 – Paracelsus

Chemistry is about change, that is,
it is
about cooking, about
fire, just as Paracelsus described it. He was a sixteenth century
doctor and an
alchemist. He had one foot in the medieval world and one foot in modern
science
and he was something of a madman. He recognized that cooking and
chemistry were
the same thing and he saw that it was all about fire and
transformation.

Chemistry and food.

Chemistry is easy. At least compared
to
physics. There is only
one force, the electromagnetic force – that means two kinds of electric
charge,
plus and minus, and opposite charges attract while like charges repel.
(No
gravitation because atoms are too small and the two strange nuclear
forces
don't enter into it). In the world of chemistry, almost everything
follows from
that basic idea. As applied to cooking, it means there are roughly two
kinds of
things in the world: hydrophilic (water-like) and hydrophobic
(water-fearing,
that is, fat-like). The first is like water or salt which dissolves
freely in
water, has separation of charge, that is, is polar. Cooking is
frequently
challenged with the problem of "oil and water don't mix," that is, how
to keep
the sauce from separating. Physical agitation, as in homogenized milk,
or
chemical emulsifying agents like, egg yolk in mayonnaise, are some of
the
answers.

Learning low-carbohydrate cooking is
largely learning how to
cook vegetables. Most of us know how to cook a steak. In cooking
vegetables,
the major problem is dealing with water. If you look at dried
vegetables, you
see that some are very small and you can appreciate that they
originally
contained a huge amount of water. If you want to fry vegetables, you
usually
need very high heat for a short period of time or the internal water
will not
be driven off fast enough and you will wind up boiling the vegetables
and they
will be soggy. This is why serious amateur cooks buy restaurant stoves
or
restaurant stoves retrofitted for consumers, like
^®
Wolf
or
^®
Viking.
They are capable of much higher heat than standard consumer stoves and
are
really worth it if you can afford them.

If you don't salt and extract the
water from cabbage before
making coleslaw, when you do add mayonnaise, the oil-water interface
may cause
the water to come out of the cabbage and the product will, again, be
soggy.
Also, many vegetables, like cauliflower or spaghetti squash, have a
subtle
taste which will be diluted by the water after steaming or boiling
them. It is
good to squeeze the water out of these before serving or further
processing
them.

Vegetables and leafy greens are the
main thing that people
add back to low-carb diets, at least according to our survey of the
Active
Lower Carber Forums, an online support group
[18]
.
Cooking vegetables can seem like a big task and, like all such tasks,
will give
rise to substantial procrastination. Although it only takes 10 minutes
to core
and steam cauliflower, it can take days to getting around to setting
knife to
food. For procrastination in general, I recommend timing the steps. The
actual
time is always less than you think. Most of the recipes below are for
vegetables and most start from scratch.

How to boil water.

It is always better not to take too
much for granted. It
frequently seems that you have to learn everything. After you teach a
dog to
fetch a stick, you have teach them to let go. So, on boiling water, it
may be
helpful to know that people do ask questions. If you are going to
ingest the
water directly as in coffee or soup, you generally want to start with
cold
water since it has fewer dissolved minerals from pipes. If you are just
boiling
eggs, it doesn't matter. Cover the pot until it boils. To keep it
boiling at
lowest heat remove the cover.

How to boil eggs.

There are some very elaborate ways to
boil eggs in order to
make them easy to peel but the simplest is to just put the cold or room
temperature eggs into boiling water. One or two may crack. Eat those
first. You
can use water that is just below boiling (add cold water after it
boils) but the
idea is that the sudden change in temperature allows the shell and the
attached
membrane to separate from the white of the egg. Hard-boiled eggs are
one of the
staples of low-carbohydrate life style. For traveling, it is the
easiest thing
to carry along. (The little packets of mayonnaise that are in your
workplace
cafeteria also help).

World's most regal
recipe.

Low-carb diets may or may not be
expensive. It's usually
meat that's on sale and even Brussels sprouts can be expensive if you
buy them
fresh. (In New York, just before St. Patrick's Day, corn beef
and
cabbage are very
cheap). But let's get this one out of the way. You can make an
expensive dish.
Here's a regal recipe from the court of Louis XVIII:

Take three veal chops. Tie them
together and broil them. Eat
the middle one.

Le steak hachÉ.

It is worth the trouble to chop your
own hamburger. I find
the best cut is chuck although you can obviously experiment to find
personal
taste. Chuck is also called blade steak or seven-bone steak in some
places; if
you know what a shoulder blade looks like, you will recognize the cross
section.

Analogous to James Bond, you want it
chopped, not ground.
Easiest is the knife blade of a food processor rather than meat grinder
which
tends to give you the smooth paste-like texture – one reason you don't
want to
buy ground beef at the supermarket. (We don't even want to think about
the
others). The meat should really be like chopped steak. Julia Child
recommended
two perfectly balanced chef's knives. (Don't you love recipes like
that?)

1. Unless
   it's a very lean cut, remove all visible fat (the marbling will provide
   sufficient fat for taste).
   
2. Chop
   roughly by hand into small pieces and then chop in the food processor
   until
   uniformly chopped but not smooth. The key is to have some texture. If
   you
   overdo it, you can use it for meat loaf.
   

Making it this way will show you why
they invented
hamburger.

La Fleur de
Bas-Carbs
.

Cauliflower is a staple of
low-carbohydrate diets. It is not
carbohydrate-free but the total amount of carbohydrate is relatively
low. It
can be used as a substitute for potato. Jay Wortman's captivating
documentary
"Big, Fat Diet
[111]
,"
about a First Nations (Canadian
analog of Native Americans) community whose life style was turned
around by
low-carb eating, describes how local stores could not keep cauliflower
adequately stocked.

Recipe
1. Steamed cauliflower.

It takes about 1 minute to core a
cauliflower. Make a
cone-shaped hole. Put the cauliflower, core side down, in a pot with 1
inch of
boiling water. You do have to remember to turn the stove off after 7 or
8
minutes but you can do something else while it's cooking. (It's done
when you
can stick a fork in it easily). You now have something you can use
immediately
– top with cheese, make into mashed, or refrigerate for later
preparation.

Recipe
2. Faux mashed
.

Cauliflower "mashed potatoes" is as
good as most real
mashed. It is different than the best. If you have to have that, you
may have
to count carbs or calories. I personally don't think of faux mashed as
a
substitute for potatoes but rather as a vegetable puré.

Steam or boil the cauliflower for
slightly longer than you
might for other recipes. Puré the cauliflower (easiest in a food
processor). I
prefer to add butter and salt and eat as cauliflower puree but you can
use it
as mashed potatoes adding more butter, sour cream or whatever you would
do to
mashed potatoes. The taste is best if you squeeze the water out of the
cauliflower with your hands or using that low-tech cooking device that
most of
us never have or can't find, the cheesecloth.

Beyond eating it as simple puré,
because it is less heavy
than potatoes, you can use it to stuff peppers.

Recipe
3. Home-fries
.

Home-fries pretty much by definition
doesn't have a recipe
beyond frying the cauliflower and breaking it up in the pan or wok as
you go.
Like home-fried potatoes, cooking time will be reduced if you steam or
boil or
steam first, slightly less than you would do for straight cauliflower.
Use any
of the usual additions that you would for regular home-fries, onion,
pepper and
left-overs.

Recipe
4. Deep-fried flowerets
.

A staple of Arabic cooking, it is the
single easiest recipe
in the world. Heat the oil (350-375
^o
C) and
drop in the separated
flowerets. Cook until slightly browned, about 5 minutes, salt and, if
possible
eat immediately. If you have the kind of set-up where guests are close
to the
cooking area, this is the best fried food for a party. As with any
deep-fried
food, the secret is to keep constant high temperature, which keeps the
food
from becoming greasy. This means start with the food at room temp and
cook in
small batches – you can serve each batch while you wait for the oil to
re-equilibrate.

A Selection of Easy
Vegetable Recipes.

Recipe
1. Spaghetti squash

Easiest method: cut the squash in
half the long way. Place
cut side down in a baking dish (both sides if smaller squash and they
fit). Add
about ½ inch of water. Cover with plastic wrap. Microwave for 20-23
minutes for
half large squash or 23-26 minutes for both halves of a smaller squash.
When
done, scrape out the seeds leaving as much of the interior as you can
and
scrape out the remainder into a bowl and season with butter and salt.
Depending
on the age of the squash, you may need to squeeze out the water for
better taste.

While some people use the squash as a
substitute for pasta,
I find that it has a very delicate nutty taste that does not stand up
to tomato
or other strong flavors. One good variation is cooked shrimp with dried
seaweed.

Recipe
2. Sautéd cucumbers.

I'm not a big fan of cucumbers but
this is an elegant side
dish. Cut the cucumber the long way. Scoop out the seeds and cut on the
diagonal to make crescent shape slices about ⅛ inch think. Sauté in
butter until the slices are translucent.

Recipe
3. Microwave Italian Style Broccoli

Americans tend to under-cook
vegetables because our parents
or grand-parents over-cooked them. For straight broccoli, the Italians
are
best. There is a mixture of water, garlic and oil which is cooked for
the right
time in a frying pan. The method keeps structure of the broccoli while
bringing
out the taste. If you go to a good Italian restaurant or order broccoli
when
traveling in Italy, you will see. An approximation is to slice the
whole
vegetable the long way, arrange in a baking dish with the flowerets
pointing
into the center (microwaves cook from the perimeter). Add a small
amount of
water (half-cup for whole broccoli). Add chopped garlic and olive oil.
Microwave on high for 5-8 minutes depending on amount and freshness.

Recipe
4. Hearts of Palm

Easy dish for variety using bottled
hearts of palm. Drain
the stalks and slice the long way. Fry in butter to drive off residual
liquid.
They are slightly sour and while they are cooking, sprinkle with
sucralose or
other sweetener. It doesn't take much so you can use sugar if you want.
Also,
black pepper helps.

Recipe
5. Stuffed Peppers.